Getting to Know the Heart of an Athlete

Author: Brian Keeffe, MD, Cardiovascular Center of Marin

As a cardiologist caring for patients in Marin for more than 10 years, I have long since learned the importance of regular exercise for lowering long-term cardiovascular risk. The American Heart Association recommends at least 30 minutes of moderate-intensity aerobic activity at least 5 days a week, or at least 25 minutes of vigorous aerobic activity at least 3 days per week, or a combination of both.

If you are an exercise enthusiast as so many of us who live in Marin County are, you are likely meeting and exceeding those basic requirements with regular trips to the gym, or hiking, or biking on the weekends.

Marin County also has more of its share of endurance and competitive athletes, who participate in sports such as triathlons, long distance running, open water swimming, rowing, or endurance bicycle races or gran fondos. Most of these athletes set ambitious goals for themselves such as increasing the distance run or cycled or coming across the finish line with faster times. Whatever the goal, these athletes must be able to depend that their hearts, lungs, and muscles are working efficiently and at top levels.

Because of my own interest and participation in endurance sports, I have developed a strong interest in a new field called sports cardiology. Sports cardiology focuses on helping athletes of all levels stay healthy and active.  This includes diagnosing and treating cardiac symptoms or conditions in athletes, decreasing the risk of heart disease development in athletes, and improving the cardiovascular health of athletes at all levels.

In a sports cardiology practice, for example, I consult with patients who have existing or suspected heart disease and who want to find out if they can safely return to or participate in sports. I may evaluate recreational athletes who want to increase fitness levels safely and effectively. I may assess high level, endurance athletes, knowing they are fit but who want to be able to perform at the highest levels safely. I also commonly assess patients who have unexplained symptoms or exercise intolerance who want to know if they can continue to exercise or even begin an exercise program after a time of inactivity.

In all these cases, the goal is to be able to understand, diagnose and test the heart's performance in the context as athletic individuals. We perform comprehensive cardiovascular and physiologic testing to assess the athlete, including history, physical exam, electrocardiography, echocardiography, and exercise testing tailored to the patient’s sport of choice and often including cardiopulmonary exercise testing. 

The heart is a miraculous organ, beating 100,000 times a day, 35 million times a year and about two billion times in an average lifetime. Because of the great dependability of the heart, patients at times may take it for granted by not paying attention to the tenets of good cardiovascular health – starting with a heart-healthy diet and regular exercise. For athletes especially, the heart is something that should not be taken for granted.

That's why I am excited to announce a new resource for athletes from beginners to experienced and competitive endurance athletes, the Marin General Hospital Cardiovascular Performance Center, which is opening this fall in Novato. The center will offer a number of services including comprehensive cardiovascular screening, evaluation of cardiovascular symptoms, assessment of unexplained drops in exercise performance, evaluation of cardiovascular risk factors, clearance for returning to sports participation, and advanced exercise testing, including cardiopulmonary exercise testing. 

For more information about sports cardiology or Marin General Hospital’s new Cardiovascular Performance Center, visit

Note: Dr. Keeffe has competed twice in the Leadville 100 mountain bike race at 10,000 feet elevation in Leadville Colorado. He has also completed multiple sport distance off-road triathlons, and is a regular competitor in Marin’s Dipsea Race. 

Dr. Keeffe has been working with members of the San Rafael Fire Department for the past five years, testing their cardiac status through electrocardiogram exercise testing as well as their exercise fitness through cardiopulmonary exercise testing. "It gives me great satisfaction to help the firefighters in the city I live in," he says.