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Cardiac adaptation in athletes of black ethnicity: differentiating pathology from physiology
  1. Navin Chandra1,2,
  2. Michael Papadakis1,2,
  3. Sanjay Sharma1,2
  1. 1St George's University of London, Division of Cardiac &Vascular Sciences, London, UK
  2. 2Cardiology Department, University Hospital Lewisham, London, UK
  1. Correspondence to Professor Sanjay Sharma, Professor of Cardiology & Consultant Cardiologist, St George's University of London, Cranmer Terrace, London SW17 0RE, UK; ssharma21{at}


Cardiac adaptation to intense physical exercise is determined by factors including age, gender, body size, sporting discipline and ethnicity. Differentiating physiology from pathological conditions such as hypertrophic cardiomyopathy (HCM) is challenging, but relevant, as HCM remains the commonest cause of sudden death in young athletes. Marked electrocardiographic repolarisation changes and echocardiographic left ventricular hypertrophy have been demonstrated in athletes of black ethnicity. Such changes highlight the overlap between ‘athlete's heart’ and morphologically mild HCM with potential for false-positive diagnoses and disqualification from competitive sport. The focus of this article is to provide practical considerations in differentiating physiological adaptation to exercise from cardiac pathology in athletes of black ethnicity.

  • Athlete's heart
  • black athletes
  • ethnicity
  • sudden cardiac death
  • hypertrophic cardiomyopathy
  • pre-participation screening
  • myocardial disease
  • cardiomyopathy hypertrophic
  • arrhythmias
  • arrhythmogenic right ventricular dyplasia

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  • Funding Authors NC and MP are funded by research grants from the charitable organisations ‘Cardiac Risk in the Young’ (CRY). Author SS is Consultant Cardiologist to CRY and a CRY trustee.

  • Competing interests None to declare.

  • Provenance and peer review Not commissioned; internally peer reviewed.