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.
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