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      The response of the pulmonary circulation and right ventricle to exercise: exercise-induced right ventricular dysfunction and structural remodeling in endurance athletes (2013 Grover Conference series)

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          Abstract

          Abstract

          There is unequivocal evidence that exercise results in considerable health benefits. These are the result of positive hormonal, metabolic, neuronal, and structural changes brought about by the intermittent physiological challenge of exercise. However, there is evolving evidence that intense exercise may place disproportionate physiological stress on the right ventricle (RV) and the pulmonary circulation. Both echocardiographic and invasive studies are consistent in demonstrating that pulmonary arterial pressures increase progressively with exercise intensity, such that the harder one exercises, the greater the load on the RV. This disproportionate load can result in fatigue or damage of the RV if the intensity and duration of exercise is sufficiently prolonged. This is distinctly different from the load imposed by exercise on the left ventricle (LV), which is moderated by a greater capacity for reductions in systemic afterload. Finally, given the increasing RV demand during exercise, it may be hypothesized that chronic exercise–induced cardiac remodeling (the so-called athlete’s heart) may also disproportionately affect the RV. Indeed, there is evidence, although somewhat inconsistent, that RV volume increases may be relatively greater than those for the LV. Perhaps more importantly, there is a suggestion that chronic endurance exercise may cause electrical remodeling, predisposing some athletes to serious arrhythmias originating from the RV. Thus, a relatively consistent picture is emerging of acute stress, prolonged fatigue, and long-term remodeling, which all disproportionately affect the RV. Thus, we contend that the RV should be considered a potential Achilles’ heel of the exercising heart.

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          Author and article information

          Journal
          Pulm Circ
          Pulm Circ
          PC
          Pulmonary Circulation
          University of Chicago Press (Chicago, IL )
          2045-8932
          2045-8940
          September 2014
          September 2014
          : 4
          : 3
          : 407-416
          Affiliations
          [1 ]Department of Medicine, St Vincent’s Hospital, University of Melbourne, Fitzroy, Australia
          [2 ]Department of Cardiovascular Medicine, University of Leuven, Leuven, Belgium
          Author notes
          Address correspondence to Dr. André La Gerche, Department of Cardiology, St Vincent’s Hospital, PO Box 2900, Fitzroy 3065, Australia. E-mail: andre.lagerche@ 123456svhm.org.au .
          Article
          PC2013097
          10.1086/677355
          4278600
          © 2014 by the Pulmonary Vascular Research Institute. All rights reserved.

          For permission to reuse, contact journalpermissions@press.uchicago.edu.

          Categories
          Review Article

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