MEDICAL AREA   

Medicina dello Sport 2019 September;72(3):366-73

DOI: 10.23736/S0025-7826.19.03510-5

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English, Italian

Asymptomatic myocardial bridge in adolescent athlete without hypertrophic cardiomyopathy, revealed by medical examination for non-competitive sports suitability

Tommaso BALLATORE ✉, Claudio DANIELI, Mario D. SIRTORI

Service of Sports Medicine, Unit of Hygiene and Public Health, Department of Prevention, ATS Milano Città Metropolitana, Pioltello, Milan, Italy

The article describes the case of a young 15 years old athlete, adopted, who, at the medical examination for non-competitive sports fitness, presented at the basal ECG negative T waves in D2, D3, AVF, V4, V5, V6. Initiated at a second level cardiological screening, including echocardiogram, ECG Holter and exercise test on the cycloergometer, she resulted negative for cardiopathy, but, although asymptomatic, the anomalies of the repolarization, characterized by a pseudo normalization of the T wave during the effort test, persisted. The young woman was then sent to perform cardiac CT, with calculation of FFR and MRI, and was diagnosed with an intramyocardial bridge on the anterior descending coronary artery, with normal coronaric perfusion, without signs of heart disease. Bisoprolol-based therapy (1.25 mg/day) was undertaken, and, accounted for the asymptomatic nature and the absence of further coronary anomalies, the athlete was considered suitable for non-competitive swimming, with heart rate limitation and half-yearly medical checks. Electrocardiographic similarity with Wellens Syndrome and the pseudo normalization of negative T waves, usually associated with ischemic disorders, sometimes structural, of the coronary arteries, raised doubts and reflections on the probable association between the above-mentioned nosologies. The objective of this work was to contribute to the casuistry of coronary anomalies, intercepted at a young age (specifically the myocardial bridge), highlighting the particular similarity with Wellens Syndrome and the pseudo-normalization of the T wave, in order to clarify the relationships between these diseases and sporting activity, underlining the practical implications that derive from them.

KEY WORDS: Myocardial bridging; Adolescent; Athletes