We usually think that athletes and sportsmen in general are safe from diseases, including cardiovascular diseases and that great champions are like superheroes, always healthy… but in reality this is not the case. The heart of great sportsmen is often modified by the intense training they are subjected to and the line that divides a so-called "Athlete's heart" from a pathological heart is sometimes thin: in both cases, ventricular hypertrophy and / or dilation can be recorded , Altered ECG, bradycardia or arrhythmias. This apparently fleeting difference is actually crucial. The athlete's life depends on this diagnosis and even in the absence of symptoms, a hidden pathology may be present that can lead to death.

An infamous example is the case of Davide AstoriAstori, the captain of the Fiorentina football team, was found dead in his hotel room on the morning of Sunday, March 4, 2018, where he was scheduled to play a football match. The investigation into Astori's death was lengthy, and there were many theories surrounding his death: initially, the press and newspapers reported that his heart had undergone an episode of bradycardia, meaning that it had begun to beat at a slower rate until it finally stopped, an event that was medically highly unlikely.

Arrhythmogenic cardiomyopathy It occurs following the defective production of structural proteins in heart cells. These cells, called "cardiomyocytes," require efficient contractile proteins (e.g., myosin, actin, troponin, etc.), as well as other proteins (e.g., catenin, desmoplakin, plakophyllin, etc.) essential for keeping the cells "bonded" to one another, thus allowing synchronous contraction of the organ. If these proteins are absent or altered, due to the presence of genetic "variants" identifiable through genetic analysis, the bonds between cardiomyocytes are destroyed, resulting in damage to part of the muscle tissue and its replacement with fibrous tissue, usually in the right ventricle, but sometimes also in the left ventricle.

Unfortunately, this pathology is not easy to diagnose, because it can remain silent and asymptomatic for a long time or give rise to apparently trivial arrhythmias such as extrasystoles. The difficulty of the diagnosis should not discourage but should instead make even a small anomaly considered as potentially important, both in the resting electrocardiogram and especially in the exercise one.

In these cases, the collaboration between sports doctors and cardiologists in the reference centers with extensive experience in the diagnosis of cardiomyopathies is important.