This post is authored by Renee Sullivan, MD, member of the ACC’s Sports and Exercise Cardiology Section.
I recently presented a case study at the ACC’s Sports Cardiology Summit about a 20 year old athlete with syncope and rhythm disturbance. The patient was previously healthy, exercised and ran competitively his entire life, however, over the last six months he had experienced palpitations and syncope immediately after he would end a four mile run. Although this would not happen with every run, he eventually decided to seek care since he was passing out more frequently.
From what I could tell, the cause of the syncope was not clear and could have been related to neurocardiogenic syncope as it happened right after the run was complete and never happened during the run; but it was also possible that an arrhythmia was to blame.
We decided to issue a holter monitor which the patient would wear while running, and we immediately observed ventricular tachycardia. The patient refused admission but came to the office the next day to undergo an exercise treadmill test. At 28 minutes, we again noted the patient had ventricular tachycardia but he did not pass out.
An aggressive EP study was then performed on the patient, but ventricular tachycardia was not inducible. Further, his echocardiogram, cardiac MRI, and CT coronary angiogram were all normal.
The patient was started on a beta blocker to suppress ventricular tachycardia. He chose to continue participating in sports despite the ventricular tachycardia and did not want an implantable cardioverter-defibrillator. Luckily, the patient is healthy, currently participates in extreme sports and rarely has palpitations.
A number of observations can be learned from this case. When evaluating an athlete, or any patient, it is important to reproduce the physical activity that causes the symptoms to the best of our ability. However, often times the symptoms may not happen in a test situation, and the athlete must be playing the exact sport in order for the symptoms to occur. This may be due to stress or catecholamines.
In addition, we are often faced with patients who do not want to be restricted from playing sports and prolong seeking medical advice, which can be detrimental to their health. It’s critical that young athletes understand the warning signs and know when to seek help.
There is a lot to learn from one another within the sports and exercise community, and I hope that by sharing this case, others can learn from our observations. I invite you to leave your own case studies or observations in the comment section below.
For more information about the ACC’s Sports and Exercise Cardiology Council and Section, click here.