A 50-year old female asymptomatic athlete with mitral valve prolapse

13 October 2019

Organised by:

The case

A 50-year old female with no personal or family history of sudden cardiac death presented to our institution for a routine cardiovascular check-up. The athlete competed in air races nationally and internationally for the last 25 years. She reported no symptoms and no impairment of her physical performance. She does not take any medication and denied the use of illicit drugs.

Clinical examination:

Body surface area (BSA) was 1.69
Blood pressure and HR were within normal limits
Cardiac auscultation revealed a mid to late systolic murmur.
No peripheral oedema

Figure 1: 12-lead ECG

The resting ECG is normal, with training related changes including mild sinus bradycardia of 56 b.p.m and an incomplete bundle branch block:

References

1. Bonow RO, Nishimura RA, Thompson PD, Udelson JE. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities : Task Force 5 : Valvular Heart Disease American College of Cardiology. Circulation. 2015;292–7.

2. Pelliccia A, Fagard R, Bjørnstad HH, Anastassakis A, Arbustini E, Corrado D, et al. Recommendations for competitive sports participation in athletes with cardiovascular disease A consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;1422–45.

3. Basso C, Marra MP, Rizzo S, De Lazarri M, Giorgi B, Cipriani A, et al. Arrhythmic Mitral Valve Prolapse and Sudden Cardiac Death. Circulation.2015; 132(7):556-66

4. Marra MP, Basso C, Lazzari M De, Rizzo S, Cipriani A, Giorgi B, et al. Valvular Heart Disease Morphofunctional Abnormalities of Mitral Annulus and. Cir Cardiovasc Imaging.2016; 9(8): e005030

5. Pradella S, Grazzini G, Brandani M, Calistri L, Nardi C, Mori F, et al. Cardiac magnetic resonance in patients with mitral valve prolapse : Focus on late gadolinium enhancement and T1 mapping. Eur Radiol. 2019; 29(3):1546-1554

6. Gati S, Malhotra A, Sharma S. Exercise recommendations in patients with valvular heart disease. Heart. 2019; 105(2):106-110.

7. Arcy JLD, Syburra T, Guettler N, Davenport ED, Manen O, Gray G, et al. Contemporaneous management of valvular heart disease and aortopathy in aircrew. 2019; Heart. 2019 ;105(Suppl 1):s57-s63

Notes to editor

Author information:

María Sanz-de la Garza MD, PhD, Laura Sanchis, MD, PhD , Marc Abuli, Marta Sitges, MD, PhD. For all authors: Cardiovascular Institute, Hospital Clinic, Barcelona