Mitral Valve Prolapse

9 May 2023

Organised by:

The case

Pre-participation screening in a 57-year-old cyclist

A 57-year-old Caucasian man underwent pre-participation cardiac screening with ECG-monitored exercise stress testing for competitive sports eligibility, as required by the Italian legislation:

He was a non-smoker and physically active person who reported cycling about 10,000 km per year.
He was asymptomatic and denied heart palpitations, syncope, and any further cardiac-related symptoms.
His past medical history was unremarkable, except for a mild mitral valve prolapse (MVP) with preserved ejection fraction (EF) and mild left atrium dilatation.
His family history was negative for sudden death and ischaemic heart disease.

Auscultation revealed a regular heart rhythm with a mid-systolic click. Examination of lungs and abdomen were normal. Height was 183 cm, weight 69 kg (BMI= 20,6 kg/m²), blood pressure 120/75 mmHg.

Figure 1:

Resting 12-lead ECG – sinus rhythm, V1-V3 with poor R wave progression, left ventricular hypertrophy, left axis deviation.

Figure 2:

Peak stress ECG: the subject underwent incremental cycle ergometer testing. He reached the maximum load at 285 watts and presented this peak ECG.

References

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4. Corrado D, Drezner JA, D'Ascenzi F, Zorzi A. How to evaluate premature ventricular beats in the athlete: critical review and proposal of a diagnostic algorithm British Journal of Sports Medicine 2020;54:1142-1148.

5. Perazzolo Marra M, Basso C, De Lazzari M, Rizzo S, Cipriani A, Giorgi B, Lacognata C, Rigato I, Migliore F, Pilichou K, Cacciavillani L, Bertaglia E, Frigo AC, Bauce B, Corrado D, Thiene G, Iliceto S. Morphofunctional Abnormalities of Mitral Annulus and Arrhythmic Mitral Valve Prolapse. Circ Cardiovasc Imaging. 2016 Aug;9(8):e005030. doi: 10.1161/CIRCIMAGING.116.005030. PMID: 27516479; PMCID: PMC4991345.

Notes to editor

Author information:

Prof. Dalle Carbonare, Luca G. University Hospital of Verona, Director of the Graduate School of Sport Medicine and Exercise, Dpt. Of Medicine - Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
Dr. Martini, Davide University Hospital of Verona, School of Sport Medicine and Exercise, Dpt. Of Medicine - Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
Dr. Braggio, Michele University Hospital of Verona, School of Sport Medicine and Exercise, Dpt. Of Medicine - Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy