The case
A 58-year-old male professional marathon runner comes to our sports medicine center for annual pre-participation screening (PPS). He is known for a sensorineural disorder from birth (deaf-mutism) but presented no cardiovascular risk factors other than a mild “white coat” hypertension. He has a sedentary job and a normal diet. All previous PPS visits have been unremarkable.
- He is 177 cm x 77 kg (BMI of 24.58 kg/m2) with a waist circumference of 85 cm.
- Resting blood pressure is 135/85 mmHg.
- Physical examination, urine examination and spirometry show unremarkable findings.
The 12-lead resting ECG is within normal limits (Figure 1).
Figure 1: ECG at rest
The exercise stress test is performed on the cycle ergometer (following 30 watts x 2 min protocol), with a surgical mask, as recommended by the Italian Sports Medicine Federation (FMSI) recommendations for performing sports medicine examinations during the SARS-CoV-2 pandemic.
At 200 W, 110 bpm (67% of predicted maximum heart rate), a large convex ST-segment elevation suddenly appears between V1 and V6 leads (Figure 2), together with a simultaneous angina sensation of the patient.
Figure 2: ECG at 200 W, 110 bpm: elevation of the ST segment
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