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A 50-year old female asymptomatic athlete with mitral valve prolapse

Sabiha Gati, Sports Cardiology Quiz Section Editor

Rehabilitation and Sports Cardiology

The case

A 50-year old female with no personal or family history of sudden cardiac death presented to our institution for a routine cardiovascular check-up. The athlete competed in air races nationally and internationally for the last 25 years. She reported no symptoms and no impairment of her physical performance. She does not take any medication and denied the use of illicit drugs.

Clinical examination:

  • Body surface area (BSA) was 1.69
  • Blood pressure and HR were within normal limits
  • Cardiac auscultation revealed a mid to late systolic murmur.
  • No peripheral oedema

Figure 1: 12-lead ECG 

The resting ECG is normal, with training related changes including mild sinus bradycardia of 56 b.p.m and an incomplete bundle branch block:


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Note: The views and opinions expressed on this page are those of the author and may not be accepted by others. While every attempt is made to keep the information up to date, there is always going to be a lag in updating information. The reader is encouraged to read this in conjunction with appropriate ESC Guidelines. The material on this page is for educational purposes and is not for use as a definitive management strategy in the care of patients. Quiz material in the site are only examples and do not guarantee outcomes from formal examinations.


1. Bonow RO, Nishimura RA, Thompson PD, Udelson JE. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities : Task Force 5 : Valvular Heart Disease American College of Cardiology. Circulation. 2015;292–7.

2. Pelliccia A, Fagard R, Bjørnstad HH, Anastassakis A, Arbustini E, Corrado D, et al. Recommendations for competitive sports participation in athletes with cardiovascular disease A consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;1422–45.

3. Basso C, Marra MP, Rizzo S, De Lazarri M, Giorgi B, Cipriani A, et al.   Arrhythmic Mitral Valve Prolapse and Sudden Cardiac Death. Circulation.2015; 132(7):556-66

4. Marra MP, Basso C, Lazzari M De, Rizzo S, Cipriani A, Giorgi B, et al. Valvular Heart Disease Morphofunctional Abnormalities of Mitral Annulus and. Cir Cardiovasc Imaging.2016; 9(8): e005030

5. Pradella S, Grazzini G, Brandani M, Calistri L, Nardi C, Mori F, et al. Cardiac magnetic resonance in patients with mitral valve prolapse : Focus on late gadolinium enhancement and T1 mapping. Eur Radiol. 2019; 29(3):1546-1554

6. Gati S, Malhotra A, Sharma S. Exercise recommendations in patients with valvular heart disease. Heart. 2019; 105(2):106-110.

7. Arcy JLD, Syburra T, Guettler N, Davenport ED, Manen O, Gray G, et al. Contemporaneous management of valvular heart disease and aortopathy in aircrew. 2019; Heart. 2019 ;105(Suppl 1):s57-s63

Notes to editor

Author information:

María Sanz-de la Garza MD, PhD, Laura Sanchis, MD, PhD , Marc Abuli, Marta Sitges, MD, PhD. For all authors: Cardiovascular Institute, Hospital Clinic, Barcelona