Asymptomatic Ischemic Heart Disease in a 45-year-old Male Athlete: A Case Report

Background: The primary purpose of pre-participation screening is identifying the cohort of athletes affected by unsuspected cardiovascular diseases, such as coronary artery disease (CAD) as well as preventing sudden cardiac death (SCD) during sports competitions or training, through appropriate intervention. Case Report: This case report describes the recent history of a middle-aged marathon runner suffering from asymptomatic ischemic heart disease at high risk for SCD and illustrates the clinical pathway. An exercise ECG stress testing was positive for subendocardial ischemia. Computerized tomography (CT) coronary angiogram subsequently showed critical narrowing of the left anterior descending artery. Invasive coronary angiography was performed following angioplasty procedure. One month later an exercise ECG stress testing was normal, indicative of complete myocardial revascularization. Conclusions: Silent myocardial ischemia (SMI) is not such a rare event in athletes, especially in endurance sports athletes. In fact, even though they are asymptomatic this does not exclude the presence of a severe coronary artery disease. Exercise stress testing is safe and affordable non-invasive screening for detecting asymptomatic coronary artery disease in athletes. Myocardial revascularization procedure is to re-establish the athlete’s state of fitness for competitive sports.