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Medicina dello Sport 2011 September;64(3):329-34


language: English, Italian

ST-segment elevation during the treadmill exercise test in an amateur athlete: diagnosis and extemporaneous treatment in a Sports Medicine Centre

Marzullo M. 1, Manganiello M. 1, Martello R. 1, Palumbo G. 2

1 Service of Sports Medicine “Federico II” University of Naples, Naples, Italy; 2 Department of Sports Medicine “G. D’Annunzio” University, Chieti, Italy


Sudden cardiac death (SCD) is the result of two factors: physical effort and a diseased heart. The treadmill exercise test is an ideal instrumental method for revealing insidious, unknown diseases in a safe environment and studying and treating them as quickly as possible. A fifty-year-old amateur runner, without evident risk factors or clinical and basic instrumental abnormalities, asked to be certified fit for competitive sport. Five minutes into the treadmill exercise test an ST-segment elevation appeared in the inferior leads, subsequently accompanied by precordial pain and cold sweats. The test was stopped and the athlete was given sublingual isosorbide dinitrate. The symptoms decreased and the ECG-alterations normalised. We immediately decided to carry out a coronarography that showed a significant stenosis of the right coronary artery. In the same hospital we performed a resolutive angioplasty (PTCA) with stenting. After six months the athlete was given complete, non-invasive cardiac screening that resulted in him being certified fit (for the next six months) for competitive running. SCD is a dramatic event in sports because it affects apparently healthy people. In our case, after the II-level exams (maximal treadmill exercise test), we performed a coronarography that showed a coronary anomaly which could have caused the death of the athlete if he had not been treated with PTCA and stenting. The treadmill exercise test and the presence of III-level facilities in the same hospital allow for a safer and quicker restitutio ad integrum for the athlete suffering from insidious, unrecognized diseases.

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