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

  • View Correct Answer

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