Case Reports of the Athletic Heart

In this educational section for CA ACC Sports and Exercise Health Committee, test your knowledge with clinical case reports and multiple choice questions. Further information and references provided in the discussion sections.  

Athletes with Coronary Artery Calcifications: A Case Report

Authors: Deepak Ravi, MD; Timothy Canan, MD, Division of Cardiology, Department of Medicine, University of California, Los Angeles

A 58-year-old male with history of prostate adenocarcinoma, treated with robotic prostatectomy without the need for androgen deprivation therapy, was referred to cardiology for evaluation of coronary artery calcifications that were noted incidentally during staging computed tomography (CT) imaging. He has otherwise been healthy and takes only vitamins regularly. His parents both smoked and died of lung cancer and has no family history of early coronary artery disease. He stopped eating fast food as a teenager, gave up red meat, and has now been following a plant-based diet for many years. He has exercised his entire adult life, including weightlifting, running, high-intensity circuit training, and has now switched mainly to cycling due to knee arthritis. His current exercise routine includes 60-minute rides on a stationary bike with high-intensity power intervals six days per week. He denies any chest pain, pressure, dyspnea, or drops in exercise capacity or power output recently. He does endorse some palpitations during early recovery that last less than 10 seconds without lightheadedness or syncope. His blood pressure in clinic is 121/60 mmHg, BMI 25.7 kg/m2, with no abnormalities on physical exam. Labs show a total cholesterol of 244 mg/dL, HDL 91 mg/dL, LDL 137 mg/dL, and triglycerides 80 mg/dL. Resting electrocardiogram shows sinus bradycardia at 50 bpm without ectopy, ST or T wave abnormalities.

Question 1 of 2
What would you do next?

  • A. Lifestyle modifications of diet and exercise
  • B. Medical management with aspirin, low dose statin, and beta blocker
  • C. Further risk stratification needed
  • D. Invasive coronary angiography

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    Question 2 of 2
    What is the next appropriate step?

  • A. Medical management with aspirin, low dose statin, and beta blocker
  • B. Exercise stress testing
  • C. CT coronary angiogram
  • D. Invasive coronary angiography

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    Athletes with COVID-19: A Case Report

    Authors: Christine P. Shen, MD; Sandeep R. Mehta, MD, Division of Cardiology, Scripps Clinic

    A 29-year-old female tested positive for coronavirus disease 2019 (COVID-19) after presenting to outpatient COVID testing with cough, chills, and body aches. Her course was complicated by left-sided numbness, and MRI brain showed left frontal and parietal lobe abnormal hyperintense signals. She was treated with a course of prednisone for presumed viral leukoencephalopathy. Prior to her infection, she was a competitive athlete in weightlifting and performed high-intensity workouts 2-3 hours per day, 5-6 days per week. She had no prior medical history. Family history was significant for myocardial infarction in two first-degree relatives.

    Within 3 weeks of being diagnosed with COVID-19, she developed severe exertional intolerance. Upon standing or walking for a few minutes, she experienced lightheadedness, shortness of breath, and tachycardia with heart rates of 120s-150s as measured on a consumer-grade wearable device. Her heart rate decreased to the 70s, her usual resting heart rate, upon lying down. She reported generalized fatigue and difficulty concentrating. She presented for cardiologist consultation three months after her initial COVID-19 diagnosis. At that time her blood pressure was 122/78 and her heart rate was 90 while sitting. She did not have orthostatic hypotension. On physical exam, she did not have any abnormalities. Her most recent lipid panel showed LDL 57 mg/dL, HDL 62 mg/dL, triglycerides 53 mg/dL, and total cholesterol 130 mg/dL. BMP, CBC, and TSH were normal. EKG showed sinus rhythm with sinus arrhythmia. Resting echocardiogram showed normal ejection fraction of 65%, normal wall thickness, normal diastolic function, and normal valvular function. CT angiography of the chest showed no evidence of pulmonary embolus.


    Question 1 of 2
    Which of the following tests will most likely show the cause of her symptoms?

  • A. Exercise treadmill stress test
  • B. CT coronary cardiac
  • C. Tilt table testing
  • D. Cardiac MRI

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    Question 2 of 2
    What is the next appropriate step for this patient?

  • A. Lifestyle management with salt and fluid loading, compression stockings, and graded exercise.
  • B. Beta-blocker
  • C. Fludrocortisone
  • D. Midodrine

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    Read Discussion, Take Home Message & References for this Case Report