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Unusual cause of exercise-induced ventricular fibrillation in a well-trained adult endurance athlete: a case report.

Vogt S, Koenig D, Prettin S, Pottgiesser T, Allgeier J, Dickhuth HH, Hirschmueller A - J Med Case Rep (2008)

Bottom Line: In contrast, in older athletes who die suddenly, atherosclerotic disease of the coronary arteries is mostly found.Multislice computed tomography of the coronary arteries confirmed these findings.The athlete was subsequently treated by acetylsalicylic acid 100 mg (0-1-0), bisoprolol 2.5 mg (1-0-0) and atorvastatin 10 mg (0-0-1) and was instructed to keep his training intensity under the 'individual anaerobic threshold'.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Freiburg, Department of Preventive and Rehabilitative Sports Medicine, Germany. stefan.vogt@uniklinik-freiburg.de

ABSTRACT

Introduction: The diseases responsible for sudden deaths in athletes differ considerably with regard to age. In young athletes, congenital malformations of the heart and/or vascular system cause the majority of deaths and can only be detected noninvasively by complex diagnostics. In contrast, in older athletes who die suddenly, atherosclerotic disease of the coronary arteries is mostly found. Reports of congenital coronary anomalies as a cause of sudden death in older athletes are rare.

Case presentation: A 48-year-old man who was a well-trained, long-distance runner collapsed at the finish of a half marathon because of a myocardial infarction with ventricular fibrillation. Coronary angiography showed an anomalous origin of the right coronary artery from the left sinus of Valsalva with minimal wall alterations. Multislice computed tomography of the coronary arteries confirmed these findings. Cardiomagnetic resonance imaging demonstrated a mild hypokinesia of the basal right- and left-ventricular posterior wall. An electrophysiological study showed an inducible temporary polymorphic ventricular tachycardia and an inducible ventricular fibrillation. The athlete was subsequently treated by acetylsalicylic acid 100 mg (0-1-0), bisoprolol 2.5 mg (1-0-0) and atorvastatin 10 mg (0-0-1) and was instructed to keep his training intensity under the 'individual anaerobic threshold'. Intense and long-lasting exercise under extreme environmental conditions, particularly heat, should also be avoided.

Conclusion: This case report presents a coronary anomaly as the most likely reason for an exercise-induced myocardial infarction with ventricular fibrillation in a well-trained 48-year-old endurance athlete. Therefore, coronary anomalies have also to be considered as a possible cause of cardiac problems in older athletes.

No MeSH data available.


Related in: MedlinePlus

Multislice computed tomography of the heart demonstrates the coronary artery anomaly with a left-side origin of the right coronary artery. CX, circumflex coronary; LAD, left anterior descending artery; RCA, right coronary artery. The right ventricle has been digitally removed.
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Figure 1: Multislice computed tomography of the heart demonstrates the coronary artery anomaly with a left-side origin of the right coronary artery. CX, circumflex coronary; LAD, left anterior descending artery; RCA, right coronary artery. The right ventricle has been digitally removed.

Mentions: A coronary angiography was conducted because of the unknown etiology of the ventricular fibrillation. A coronary artery anomaly with a left-side origin of the right coronary artery (RCA) with minimal wall alterations was revealed. Multislice computed tomography of the coronary arteries confirmed these findings (Figures 1 and 2). Cardio-magnetic resonance imaging demonstrated a non-transmural late-enhancement of gadolinium in the basal ventricular posterior wall, on both right and left sides, with corresponding hypokinesia of the right ventricular wall and an ejection factor of 48%. Two days after the incident, an electrophysiology study showed inducible temporary polymorphic ventricular tachycardia and inducible ventricular fibrillation (Figure 3). The electrophysiology study was performed at the apex of the right ventricle (base-stimulation: 600 ms, extra-stimulations beginning with 250 ms). The myocardial scar could have been responsible for the induction of ventricular fibrillation. However, this finding was unspecific and did not completely clarify the etiology of the symptoms. No cardiac arrhythmia was detected in a 24-hour ECG.


Unusual cause of exercise-induced ventricular fibrillation in a well-trained adult endurance athlete: a case report.

Vogt S, Koenig D, Prettin S, Pottgiesser T, Allgeier J, Dickhuth HH, Hirschmueller A - J Med Case Rep (2008)

Multislice computed tomography of the heart demonstrates the coronary artery anomaly with a left-side origin of the right coronary artery. CX, circumflex coronary; LAD, left anterior descending artery; RCA, right coronary artery. The right ventricle has been digitally removed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2365969&req=5

Figure 1: Multislice computed tomography of the heart demonstrates the coronary artery anomaly with a left-side origin of the right coronary artery. CX, circumflex coronary; LAD, left anterior descending artery; RCA, right coronary artery. The right ventricle has been digitally removed.
Mentions: A coronary angiography was conducted because of the unknown etiology of the ventricular fibrillation. A coronary artery anomaly with a left-side origin of the right coronary artery (RCA) with minimal wall alterations was revealed. Multislice computed tomography of the coronary arteries confirmed these findings (Figures 1 and 2). Cardio-magnetic resonance imaging demonstrated a non-transmural late-enhancement of gadolinium in the basal ventricular posterior wall, on both right and left sides, with corresponding hypokinesia of the right ventricular wall and an ejection factor of 48%. Two days after the incident, an electrophysiology study showed inducible temporary polymorphic ventricular tachycardia and inducible ventricular fibrillation (Figure 3). The electrophysiology study was performed at the apex of the right ventricle (base-stimulation: 600 ms, extra-stimulations beginning with 250 ms). The myocardial scar could have been responsible for the induction of ventricular fibrillation. However, this finding was unspecific and did not completely clarify the etiology of the symptoms. No cardiac arrhythmia was detected in a 24-hour ECG.

Bottom Line: In contrast, in older athletes who die suddenly, atherosclerotic disease of the coronary arteries is mostly found.Multislice computed tomography of the coronary arteries confirmed these findings.The athlete was subsequently treated by acetylsalicylic acid 100 mg (0-1-0), bisoprolol 2.5 mg (1-0-0) and atorvastatin 10 mg (0-0-1) and was instructed to keep his training intensity under the 'individual anaerobic threshold'.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Freiburg, Department of Preventive and Rehabilitative Sports Medicine, Germany. stefan.vogt@uniklinik-freiburg.de

ABSTRACT

Introduction: The diseases responsible for sudden deaths in athletes differ considerably with regard to age. In young athletes, congenital malformations of the heart and/or vascular system cause the majority of deaths and can only be detected noninvasively by complex diagnostics. In contrast, in older athletes who die suddenly, atherosclerotic disease of the coronary arteries is mostly found. Reports of congenital coronary anomalies as a cause of sudden death in older athletes are rare.

Case presentation: A 48-year-old man who was a well-trained, long-distance runner collapsed at the finish of a half marathon because of a myocardial infarction with ventricular fibrillation. Coronary angiography showed an anomalous origin of the right coronary artery from the left sinus of Valsalva with minimal wall alterations. Multislice computed tomography of the coronary arteries confirmed these findings. Cardiomagnetic resonance imaging demonstrated a mild hypokinesia of the basal right- and left-ventricular posterior wall. An electrophysiological study showed an inducible temporary polymorphic ventricular tachycardia and an inducible ventricular fibrillation. The athlete was subsequently treated by acetylsalicylic acid 100 mg (0-1-0), bisoprolol 2.5 mg (1-0-0) and atorvastatin 10 mg (0-0-1) and was instructed to keep his training intensity under the 'individual anaerobic threshold'. Intense and long-lasting exercise under extreme environmental conditions, particularly heat, should also be avoided.

Conclusion: This case report presents a coronary anomaly as the most likely reason for an exercise-induced myocardial infarction with ventricular fibrillation in a well-trained 48-year-old endurance athlete. Therefore, coronary anomalies have also to be considered as a possible cause of cardiac problems in older athletes.

No MeSH data available.


Related in: MedlinePlus