One Size Does Not Fit All: Tailoring Stress Tests for Athletes

A 21-year-old male college track athlete presents with exercise-induced tachycardia, reaching up to 240 beats per minute (bpm), accompanied by palpitations and lightheadedness during high-intensity anaerobic exercises such as sprinting. Initial stress testing with an exercise stress echocardiogram was normal and did not induce any arrhythmias. However, an outpatient Holter monitor detected supraventricular tachycardia (SVT), which was induced during sprinting. In this case, by designing a unique stress test protocol that involved mimicking the specific metabolic demands of our athlete's sport, we were successfully able to elicit symptoms and uncover the arrhythmia. Reliance on standardized exercise stress testing protocols can lead to false reassurance, as they may fail to unmask the patient's underlying symptoms or cardiac pathology. These protocols do not account for the increased physical fitness of athletes or the physiological differences associated with the "athlete's heart." This case highlights the need for stress test protocols for athletes to be tailored, incorporating provocative testing that replicates their sport-specific activities or the circumstances surrounding symptom onset.