Abstract
Abstract Background: The primary purpose of pre-participation screening is identifying the cohort of athletes affected by unsuspected cardiovascular diseases, such as coronary artery disease (CAD) as well as preventing sudden cardiac death (SCD) during sports competitions or training, through appropriate intervention. Case Report: This case report describes the recent history of a middle-aged marathon runner suffering from asymptomatic ischemic heart disease at high risk for SCD and illustrates the clinical pathway. An exercise ECG stress testing was positive for subendocardial ischemia. Computerized tomography (CT) coronary angiogram subsequently showed critical narrowing of the left anterior descending artery. Invasive coronary angiography was performed following angioplasty procedure. One month later an exercise ECG stress testing was normal, indicative of complete myocardial revascularization. Conclusions: Silent myocardial ischemia (SMI) is not such a rare event in athletes, especially in endurance sports athletes. In fact, even though they are asymptomatic this does not exclude the presence of a severe coronary artery disease. Exercise stress testing is safe and affordable non-invasive screening for detecting asymptomatic coronary artery disease in athletes. Myocardial revascularization procedure is to re-establish the athlete’s state of fitness for competitive sports.
Highlights
Systematic sports pre-participation screening of athletes has the potential to identify those at risk and reduce cardiovascular event mortality [1,2,3], this does not always take place
The importance of early identification in silent cardiovascular diseases at a sub-clinical stage relies on the concrete possibility of preventing sudden cardiac death (SCD) through life- style modification, which includes restriction of competitive sports activity, and prophylactic treatment with drugs and implantable defibrillator
Pre-participation screening in this population is finalized to the identification of cardiovascular diseases such as silent myocardial ischemia (SMI) and coronary artery disease that have low incidence in the general population [10]
Summary
Athletes with ischemic heart disease had known cardiovascular risk factors. Absence of symptoms, such as chest pain, is not a discriminating factor in the presence of severe ischemic heart disease, especially when the exercise ECG stress testing is positive for sign of impaired coronary flow reserve. Our report confirms the absence of symptoms and signs in Master athletes with atherosclerotic coronary disease and the importance of carefully investigating athletes with known cardiovascular risk factors during pre-participation screening, and the need to refer athletes for further clinical and instrumental investigation even though the exercise test is ambiguous
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