P159 AN INSIDIOUS CASE OF VENTRICULAR STRESS EXTRASYSTOLES IN A YOUNG ATHLETE

Abstract

Abstract VEBs in young people and athletes are generally benign; however, in some cases, they can be a sign of underlying heart disease and predispose to the risk of SCD during sports. Clinical Case A 14–year–old boy arrives for renewal of competitive sports eligibility. He practices competitive football; always eligible according to previous checks; not familiar with heart disease or SCD; asymptomatic; with normal cardiac objectivity. Basic ECG: RS conduction and repolarisation within normal limits. ECG during exercise: 2 monomorphic VEBs, RBB type with superior axis (Fig. 3). For this reason, he performs TT Echocardiogram and ECG sec. Holter. Holter ECG: 1 SVEB 0 VEB. MB Color Doppler Echocardiogram: LV of normal size and wall thickness with a normal pump function; no alterations of the regional dynamics, undamaged valve systems, RV in the standard; suspected image due to anomaly of coronary origin (right coronary artery from the left sinus of Valsalva). Fig. 1 shows a modified PSAX. In particular, the image highlights the origin of the right coronary and left coronary from the left sinus of Valsalva. The course of the right coronary is parallel to the anterior aortic wall. The cardiac CT confirmed the anomalous origin of the right coronary from the left coronary sinus with a course between the aorta and pulmonary artery. In the proximal section, the right coronary would seem to run for about 12 mm within the adventitia of the aortic wall (Fig. 2) Hence, myocardial scintigraphy was performed on stress testing, given a possible corrective strategy. Discussion Anomalies involving the origin of the coronary arteries and among these, the right coronary artery originating from the left represent one of the leading causes of SCD in athletes under 35 years of age. It is a pathology challenging to diagnose. Indeed, the affected subjects, in most cases, are healthy at the sports doctor visit. Early identification is a priority in the diagnostic classification of a young athlete. In this case, the evidence of extra systolic beats on the exercise stress test and the subsequent ultrasound demonstration of the anatomical anomaly proved significant. The importance of echocardiography in recognizing coronary anomalies in young athletes, as highlighted in our report, should also suggest introducing this method as a screening test for their early identification and, consequently, the prevention of MCI.