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Veteran athlete presenting with palpitations and pre-syncope

Sabiha Gati, Sports Cardiology Quiz Section Editor

Rehabilitation and Sports Cardiology

The case

60 year-old male endurance athlete presented to the emergency department with a 7-day history of palpitations associated with presyncope:

  • The palpitations occurred mainly at rest and were not related to exercise.
  • The athlete had been exercising intensively for almost 25 years and participated in at least one annual marathon, in cross-country skiing and running.
  • His exercise tolerance remained normal.
  • He did not report any symptoms of chest pain, dyspnoea or syncope.
  • There was no previous history of acute febrile illness.
  • No significant cardiovascular risk factors of note.
  • There is no family history of premature sudden cardiac death or cardiovascular disease.
  • He is currently not taking any medications.
  • His physical examination was completely normal.

A 12-lead ECG was performed and is shown below.






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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.


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Notes to editor

Author information:

Dr. Christine Kissel, Cardiology Consultant, University Heart Centre, Zurich, Switzerland/ MSc Sports Cardiology, Cardiology Clinical Academic Group, St George’s, University of London

Dr. Ardan Saguner, Electrophysiology Consultant, University Heart Centre, Zurich, Switzerland