Specific Populations: Female Athletes

Females participating in athletic activities have gained an enormous popularity in recent years. Female athletes are a different species and cannot be compared with their male counterparts. Female athletes differ from their male counterparts in several aspects, such as in anthropometry, in the hormonal system, in basic physiology and in psychology. Female athletes have a smaller heart muscle mass, skeletal muscle mass and a lower endurance capacity. Moreover, the peak oxygen uptake in females is lower too. In addition, female athletes have a lower number of circulating androgens, and the female hormonal cycle influences the athletic performance. While electrical and morphological cardiac adaptation to exercise in male athletes is often associated with increasing vagotonia, dilatation of the four cardiac cavities and hypertrophy of the ventricular walls, the cardiac adaptation in female athletes is far less pronounced. Furthermore, sudden cardiac death (SCD) among female athletes is less frequently observed: the SCD-male-to-female ratio is approximately 9:1. In contrast to these clinically relevant gender differences, a surprisingly low number of studies in sports cardiology have been performed in female athletes. Thus, this chapter describes the sports cardiology issues relevant to female athletes, e.g. physiologic cardiac adaptation, screening for eligibility to participate in exercise, and exercise during pregnancy are discussed.