A 34-year-old amateur triathlete presenting with dyspnoea

12 August 2019

Organised by:

The case

A 34-year old triathlete was admitted under the cardiology team after self-presenting with one month of progressive shortness of breath now occurring at rest.

He participated in several international sporting competitions.
Blood tests showed an equivocal CRP and troponin level.
Electrocardiogram (ECG) demonstrated sinus rhythm at 99bpm with inferolateral T-wave inversion.
An echo demonstrated a non-dilated left ventricle (LV) with normal LV wall thickness and mildly reduced systolic function.
An echogenic, thickened pericardium, a 12mm pericardial effusion and a large right sided pleural effusion were also seen.

The athlete was advised to stop all forms of exercise and further investigations were expedited.

References

1. Aquaro GD, Barison A, Cagnolo A, Todiere G, Lombardi M, Emdin M. Role of tissue characterization by Cardiac Magnetic Resonance in the diagnosis of constrictive pericarditis. Int J Cardiovasc Imaging. 2015 Jun;31(5):1021–31.

2. Garcia MJ. Constrictive Pericarditis Versus Restrictive Cardiomyopathy? J Am Coll Cardiol. 2016 May 3;67(17):2061–76.

3. Pelliccia A, Solberg EE, Papadakis M, Adami PE, Biffi A, Caselli S, et al. Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC). European Heart Journal. 2019 Jan 1;40(1):19–33.

4. Maron BJ, Udelson JE, Bonow RO, Nishimura RA, Ackerman MJ, Estes NAM, et al. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 3: Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Other Cardiomyopathies, and Myocarditis: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation. Lippincott Williams & Wilkins Hagerstown, MD; 2015 Dec 1;132(22):e273–80.

Notes to editor

Author information:

Nikhil Ahluwalia, Cardiology Registrar, Bart’s Heart Centre, London, UK, Sports Cardiology MSc student, Cardiology Clinical Academic Group, St George’s University of London.

James C. Moon, Consultant Cardiologist, Bart’s Health Centre, London, UK. Professor of Cardiology, NIHR University College London Hospitals Biomedical Research Centre, London, UK.