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Heart breaking finals during a basketball game

Daniel Neunhaeuserer, Sports Cardiology Quiz Section Co-Editor

This clinical case emphasises the importance of an appropriate evaluation of patients’ medical history, particularly when athletes refer possible cardiovascular symptoms associated with physical exercise.

Moreover, the exercise stress test is an important tool to screen athletes, but it should always best reproduce the circumstances, aiming for maximal exercise intensities (if not contraindicated), which may affect also the recovery period. (1)

Preventive Cardiology
Rehabilitation and Sports Cardiology

The case

A 20-year-old male competitive basketball player comes to our attention for several episodes of palpitations, especially during recovery after intensive training sessions or sports competitions. This sensation typically occurred after substitution during the game and was sometimes associated with dizziness, lasting a few minutes and resolving spontaneously. He has a negative family history for sudden cardiac death (SCD) and/or cardiomyopathies (CMPs). No other symptoms were reported. Different previous cardiological assessments including also resting ECG (Figure 1), 24-h Holter ECG and echocardiography showed no pathological findings. This young athlete continued playing basketball for about two years, experiencing frequently these symptoms, which have been attributed to emotional stress, particularly after substitution. Since these symptoms led to anxiety of the athlete who considered stopping sports competitions, he decided to organize a final evaluation at our Sports and Exercise Medicine Division.

At our outpatient clinic, an incremental maximal exercise test was performed on treadmill (Bruce Ramp protocol for 12:29 minutes), reaching the athlete’s exhaustion at 94% of age-related predicted maximum heart rate. Reproducing a rapid recuperation phase after peak exercise intensity, suddenly he starts feeling heart palpitations and dizziness during the first minute of recovery. Figure 2 shows the ECG observed in these moments.

The athlete’s ECGs

Figure 1: Resting ECG


Figure 2: ECG in the first minute of the recovery phase after exercise testing, associated with heart palpitations and dizziness.


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.


  1. Quinto G, Neunhaeuserer D, Gasperetti A, Battista F, Foccardi G, Baioccato V, Gobbo S, Bergamin M, Ermolao A. Can exercise test intensity and modality affect the prevalence of arrhythmic events in young athletes? Res Sports Med. 2021 Jun 3:1-9. doi: 10.1080/15438627.2021.1937162. Epub ahead of print. PMID: 34080931.
  2. Brugada J, Katritsis DG, Arbelo E, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia. Eur Heart J. 2020;41(5):655-720.
  3. Pelliccia A, Sharma S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2020:1-80.

Notes to editor


  • Giulia Quinto, MD (1,2)
  • Daniel Neunhaeuserer, MD, PhD (1,2)
  • Francesco Peruzza, MD (3)
  • Maurizio Del Greco, MD (3)
  • Andrea Ermolao, MD (1,2)

(1) Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Italy
(2) Sports and Exercise Medicine Clinical Network of Veneto Region, Italy
(3) Santa Maria del Carmine Hospital (Rovereto-TN), Italy