At present time, the rational search for a protection of cardiovascular system of athletes and the assessment of such protection efficiency are the very important problems in sports pharmacology and sports cardiology. It is worth noting that athletic training pharmacology, aimed at the stimulation of physical workability in the majority of sports events, can become, together with overloads, the principal reason for a deterioration of health and life’s quality as well as for the sudden death of athletes without a proper cardioprotection. The problem of protection is significantly complicated under modern conditions due to the permanent hardening of anti-doping sanctions (e.g., the recent ban on the use of trimetazidine and meldonium) that essentially limit the possibilities for sports cardiologists. Therefore, the most grounded exit, from the current position, is the use of metabolitotropic medications, in particular, those on the basis of L-carnitine (gamma-butyrobetaine). The wide spectrum of physiologic and biochemical influence of this substance on organism gives possibility to moderately affect the physical and mental workability of athletes even under the conditions of long-term intense physical loads. The complex action of pharmacological agents on the basis of L-carnitine on organism allows one to use it on all stages of the preparation with high efficiency of the cardioprotective and ergogenic effects. Despite the bans of WADA, sports cardiologist possesses a sufficient pool of pharmacological agents that can ensure the protection of myocardium under conditions of training process and competition and can preserve athlete’s health as well as his/her physical workability.

Both specific and nonspecific metabolic transformations, occurring in the body of athlete under intensive and prolonged physical loads, have been characterized in the review paper. It has been emphasized that oxidative stress, which belongs to general pathogenic factors of further myocardium pathology formation, and load induced hypoxia, which is later associated with tissue hypoxia of metabolic origin, represent the initial link of subsequent homeostatic balance changes. Changes in the activity of creatine phosphokinase-MB fraction, content of cardiac troponins I and T as well as terminal natriuretic peptides are referred to specific markers of myocardium strain. Wider range of myocardium strain nonspecific markers includes both alterations of lipid metabolism and numerous, oxidative stress mediated, metabolic changes at the level of cellular and subcellular membranes of cardiomyocytes, followed by changes in the activity of membrane-bound enzymes and lysosomal proteinase ejection first into extracellular matrix and then – into circulatory bed as well as erythrocyte membranes and their ATP content that are accompanied by deterioration of blood oxygen transport function. The above mentioned negatively influences myocardial contractility and leads to the development of hypertrophic cardiomyopathy. Identification of the markers of athlete heart strain allows timely to be corrected by pharmacological means, aimed at normalization of metabolic disorders and prevention of myocardial hypertrophy, which is the major cause of sudden coronary death among athletes.