Heart breaking finals during a basketball game

The case

A 20-year-old male competitive basketball player comes to our attention for several episodes of palpitations, especially during recovery after intensive training sessions or sports competitions. This sensation typically occurred after substitution during the game and was sometimes associated with dizziness, lasting a few minutes and resolving spontaneously. He has a negative family history for sudden cardiac death (SCD) and/or cardiomyopathies (CMPs). No other symptoms were reported. Different previous cardiological assessments including also resting ECG (Figure 1), 24-h Holter ECG and echocardiography showed no pathological findings. This young athlete continued playing basketball for about two years, experiencing frequently these symptoms, which have been attributed to emotional stress, particularly after substitution. Since these symptoms led to anxiety of the athlete who considered stopping sports competitions, he decided to organize a final evaluation at our Sports and Exercise Medicine Division.

At our outpatient clinic, an incremental maximal exercise test was performed on treadmill (Bruce Ramp protocol for 12:29 minutes), reaching the athlete’s exhaustion at 94% of age-related predicted maximum heart rate. Reproducing a rapid recuperation phase after peak exercise intensity, suddenly he starts feeling heart palpitations and dizziness during the first minute of recovery. Figure 2 shows the ECG observed in these moments.

The athlete’s ECGs

Figure 1: Resting ECG

Figure 2: ECG in the first minute of the recovery phase after exercise testing, associated with heart palpitations and dizziness.