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The ‘H2O’ swimming slogan illustrates the life of the competitive swimmer as one that is driven by devotion and passion. For the aquatic team physician, this slogan begs the questions: What exactly do we know about the adaptations of the swimmer's heart to the years of endurance training? How is the elite swimmer's heart different to population norms? What else should we be doing to preserve the swimmer's health (figure 1)?
Swimming is rich with legendary stories of successful athletes: the eight Olympic gold medals of Michael Phelps, the renowned feats of Ian the ‘Thorpedo’ and the television success of Tarzan ‘Johnny Weissmuller’, who won both swimming and water polo Olympic medals. But sadly, not all careers have a fairy-tale ending as swimmers’ careers are often ended prematurely by preventable sport-related injury or illness. Although uncommon, elite swimmers also suffer from sudden cardiac death, as evident in the 2012 death of the 100 m breast stroke world record holder, Alexander Oen.
The Olympic Charter obliges all International Federations to encourage and support measures to protect the health of athletes. The Olympic Movement Medical Code further expands these health protection mandates, which are also reflected in the Fédération …
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Acknowledgements The authors extend their special thanks to the swimmers who participated in the cardiac screening project in Doha. We thank you for bringing your hearts to us for assessment! They are also thankful to the cardiac team at Aspetar, under the research leadership of Nathan Riding, and the clinical expertise of Dr Antonio Pelliccia of Rome for their pioneering vision and proficiency as the authors peered into the ‘unknown’ hearts of elite swimmers. They are appreciative of the international experts of the FINA Injury and Illness Methodology Expert Working Group under the scientific leadership of Astrid Junge and moderator Karim Khan, for sharing their time and expertise in the quest to improve the monitoring of aquatic athlete health. They gratefully acknowledge the FINA Sports Medicine Committee for their collaboration and the medical team of Aspetar that took special care of the FINA Family during the FINA World Championships 2014.
Contributors MM made substantial contributions to conception and design, coordination of the paper, drafting and revising of the manuscript, and gave approval of the final version to be published. HPD made substantial contributions to design, drafting and revising of the manuscript, and gave approval of the final version to be published.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.