Pollice Paolo, Robles Antonio Gianluca, Chieppa Domenico Riccardo Rosario, Pollice Saverio, Bartolomucci Francesco
Unit of Cardiology, Cardiovascular Department, Civil Hospital "Lorenzo Bonomo", Andria, BT, Italy.
Unit of Radiology, Diagnostic Imaging Department, Territorial Assistance Unit "San Nicola Pellegrino", Trani, BT, Italy.
J Cardiol Cases. 2025 Apr 2;31(6):178-181. doi: 10.1016/j.jccase.2025.03.005. eCollection 2025 Jun.
Arrhythmogenic cardiomyopathy is a rare and insidious disease that can be misdiagnosed with the common first-line diagnostic techniques. It can also primarily debut with sustained ventricular arrhythmias that can lead to cardiac arrest. We report the case of a 49-year-old triathlon athlete who during strenuous physical exercise experimented cardiac arrest. After successful resuscitation he was admitted to our unit: electrocardiogram, emergency echocardiogram, and coronary angiography did not show anything abnormal. Holter monitoring showed premature ventricular complexes with two different morphologies and cardiac magnetic resonance allowed us to make diagnosis of biventricular arrhythmogenic cardiomyopathy previously unrecognized. A subcutaneous implantable cardiac defibrillator was positioned for secondary prevention. Our case shows that in athletes a deep process of diagnostic screening is mandatory and this must include also cardiac magnetic resonance in case of element of clinical suspicion such as premature ventricular complexes at Holter monitoring and/or low voltages on limb leads in baseline 12‑lead electrocardiogram. A network of basic life emergency support measures is fundamental in every setting in which sport at competitive and non-competitive levels is performed.
A deep diagnostic cardiologic screening for young athletes is important especially in case of premature ventricular complexes at electrocardiographic Holter monitoring and/or in clinical suspicion of an underlying cardiomyopathy. In selected cases the execution of cardiac magnetic resonance imaging is essential to permit the correct diagnostic assessment of a previously undiagnosed cardiomyopathy as the arrhythmogenic cardiomyopathy preventing dangerous (also lethal) clinical presentation.
致心律失常性心肌病是一种罕见且隐匿的疾病，采用常见的一线诊断技术可能会误诊。它也可能最初表现为持续性室性心律失常，进而导致心脏骤停。我们报告一例49岁的铁人三项运动员病例，该运动员在剧烈体育锻炼时发生心脏骤停。成功复苏后，他被收入我们科室：心电图、急诊超声心动图和冠状动脉造影均未显示任何异常。动态心电图监测显示有两种不同形态的室性早搏，心脏磁共振成像使我们得以诊断出此前未被识别的双心室致心律失常性心肌病。植入了皮下植入式心脏除颤器用于二级预防。我们的病例表明，对于运动员，必须进行深入的诊断性筛查，若有临床可疑因素，如动态心电图监测发现室性早搏和/或基线12导联心电图肢体导联低电压等情况，筛查还必须包括心脏磁共振成像。在进行竞技和非竞技水平运动的每一个场所，基本生命急救支持措施网络至关重要。
对年轻运动员进行深入的心脏诊断性筛查很重要，尤其是在心电图动态监测发现室性早搏和/或临床怀疑存在潜在心肌病的情况下。在某些特定病例中，进行心脏磁共振成像对于正确诊断先前未被诊断的心肌病（如致心律失常性心肌病）以预防危险（甚至致命）的临床表现至关重要。
