Acute coronary syndrome with ST-segment elevation during exercise testing in a master athlete

9 January 2023

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The case

A 58-year-old male professional marathon runner comes to our sports medicine center for annual pre-participation screening (PPS). He is known for a sensorineural disorder from birth (deaf-mutism) but presented no cardiovascular risk factors other than a mild “white coat” hypertension. He has a sedentary job and a normal diet. All previous PPS visits have been unremarkable.

He is 177 cm x 77 kg (BMI of 24.58 kg/m²) with a waist circumference of 85 cm.
Resting blood pressure is 135/85 mmHg.
Physical examination, urine examination and spirometry show unremarkable findings.

The 12-lead resting ECG is within normal limits (Figure 1).

Figure 1: ECG at rest

The exercise stress test is performed on the cycle ergometer (following 30 watts x 2 min protocol), with a surgical mask, as recommended by the Italian Sports Medicine Federation (FMSI) recommendations for performing sports medicine examinations during the SARS-CoV-2 pandemic.

At 200 W, 110 bpm (67% of predicted maximum heart rate), a large convex ST-segment elevation suddenly appears between V1 and V6 leads (Figure 2), together with a simultaneous angina sensation of the patient.

Figure 2: ECG at 200 W, 110 bpm: elevation of the ST segment

References

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Notes to editor

Author information:

Stefano Palermi
Public Health Department, University of Naples Federico II, Naples, Italy
Sports and Exercise Clinical Network of Veneto Region, Padova, Italy

Franco Giada
Unit of Sports Medicine, P.F. Calvi Noale Hospital, Noale, Venice, Italy
Sports and Exercise Clinical Network of Veneto Region, Padova, Italy