马拉松运动员是运动诱发心律失常还是孟乔森综合征？

Exercise-Induced Arrhythmia or Munchausen Syndrome in a Marathon Runner?

作者信息

Gajda Robert, Drygas Wojciech, Gajda Jacek, Kiper Pawel, Knechtle Beat, Kwaśniewska Magdalena, Sterliński Maciej, Biernacka Elżbieta Katarzyna

机构信息

Center for Sports Cardiology at the Gajda-Med Medical Center in Pułtusk, ul. Piotra Skargi 23/29, 06-100 Pułtusk, Poland.

Department of Kinesiology and Health Prevention, Jan Dlugosz University, 42-200 Czestochowa, Poland.

出版信息

Diagnostics (Basel). 2023 Sep 12;13(18):2917. doi: 10.3390/diagnostics13182917.

DOI:10.3390/diagnostics13182917

PMID:37761288

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11340689/

Abstract

A 36-year-old professional marathon runner reported sudden irregular palpitations occurring during competitions, with heart rates (HR) up to 230 bpm recorded on a sports HR monitor (HRM) over 4 years. These episodes subsided upon the cessation of exercise. Electrocardiograms, echocardiography, and cardiac magnetic resonance imaging results were borderline for athlete's heart. Because an electrophysiology study and standard exercise tests provoked no arrhythmia, doctors suspected Munchausen syndrome. Ultimately, an exercise test that simulated the physical effort of a competition provoked tachyarrhythmia consistent with the HRM readings. This case demonstrates the diagnostic difficulties related to exercise-induced arrhythmia and the diagnostic usefulness of sports HRMs.

摘要

一名36岁的职业马拉松运动员报告称，在比赛期间突然出现不规则心悸，在4年时间里，运动心率监测仪（HRM）记录到的心率（HR）高达230次/分钟。这些发作在运动停止后消退。心电图、超声心动图和心脏磁共振成像结果接近运动员心脏的临界值。由于电生理研究和标准运动测试未诱发心律失常，医生怀疑是孟乔森综合征。最终，一项模拟比赛体力消耗的运动测试诱发了与HRM读数一致的快速性心律失常。该病例说明了与运动诱发心律失常相关的诊断困难以及运动HRM的诊断效用。