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Acute coronary syndrome with ST-segment elevation during exercise testing in a master athlete

Daniel Neunhaeuserer, Sports Cardiology Quiz Section Co-Editor

Preventive Cardiology
Rehabilitation and Sports Cardiology

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


Test your knowledge

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 on the site are only examples and do not guarantee outcomes from formal examinations.



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Notes to editor

Author information:

Stefano Palermi 
Public Health Department, University of Naples Federico II, Naples, Italy
Sports and Exercise Clinical Network of Veneto Region, Padova, Italy

Franco Giada 
Unit of Sports Medicine, P.F. Calvi Noale Hospital, Noale, Venice, Italy
Sports and Exercise Clinical Network of Veneto Region, Padova, Italy