Silent Myocardial Ischemia in Master Marathon Runner | Chapter 08 | New Insights into Disease and Pathogen Research Vol. 1

Silent myocardial ischemia is defined as objective documentation of myocardial ischemia in the absence of angina or anginal equivalents. Silent myocardial ischemia is quite different from silent coronary artery disease. The symptomatic angina is the tip of the ischemic iceberg and it is less frequent in athletes  than in non-athletes. Athletes change their perception of ischemic stimulus and increasing pain threshold from increased circulating endorphin levels.  Silent  myocardial  ischemia  is  more  prevalent  than angina in patients with coronary artery disease, and athletes are not immune to it. In  order  to  discover  early  stages  of malignant neoplasia (e.g. breast and colon cancer) in the asymptomatic  stage and  thus  prevent  reaching  final  stages  of the  disease, screening participation has been widely accepted. Vice versa,  although atherosclerotic cardiovascular disease  causes  more  deaths and disabilities  than  all   causes  of  death  correlated  to  cancer, there  are  no  precise  guidelines  concerning  the  screening  of asymptomatic  elements  suffering  from  atherosclerosis. There are a number of reports of exercise-related sudden deaths and myocardial infarctions in aerobically trained athletes suffering from exercise – induced silent myocardial ischemia. The most appropriate and common method to discover silent myocardial ischemia is exercise stress testing. Therefore, in this chapter  the authors describe three emblematic cases of silent myocardial ischemia detected in master marathon runners during systematic pre-participation screening. These marathon runners were asymptomatic but were suffering from a severe coronary artery disease that was detected only thanks to exercise treadmill stress test, and were then properly treated. Silent myocardial ischemia is not such a rare event in athletes, indeed quite the opposite. In fact, even though athletes are asymptomatic this does not exclude the possibility that they are suffering from severe coronary artery disease.

Author(s) Details

Massimo Bolognesi

Sports Cardiology Medicine Center, ASL 112, District of Cesena, Italy.

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