Chest pain in an elite master ultra-marathon runner: a case report with a follow-up on his subsequent athletic activity
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Jerzy Kukuczka Academy of Physical Education, Katowice, Poland (Institute of Sport Sciences)
Jerzy Kukuczka Academy of Physical Education, Katowice, Poland (Department of Sports Training)
Sechenov University, Moscow, Russia (Department of Sports Medicine and Medical Rehabilitation)
Medical University of Silesia, Katowice, Poland (Department of Cardiology, School of Health Science)
University of Zurich, Zurich, Switzerland (Institute of Primary Care)
Exercise Physiology Laboratory, Nikaia, Greece
Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
Online publication date: 2020-05-11
Corresponding author
Beat Knechtle   

Medbase St. Gallen Am Vadianplatz, Vadianstrasse 26, 9001 St. Gallen, Switzerland
Int J Occup Med Environ Health. 2020;33(4):523-34
Ultra-marathon running has enjoyed increasing popularity, with the number of master ultra-marathon runners growing annually. This study presents a case of a 51-year-old highly experienced long-distance runner (body mass: 65.1 kg, body height: 168 cm), who took part in a 48-h ultra-marathon race held in 2010, but dropped out of the competition due to acute cardiac problems manifested after 16 h of running and having completed a distance of 129 km. Two weeks following the race, intense cardiac examination was performed to explain the drop-out due to chest pain. A 12‑lead electrocardiogram, a 2D transthoracic echocardiography in 3 apical projections of the left ventricle, a computed tomography of the chest, an invasive coronary angiography and a maximal oxygen uptake (VO2max) test were performed. The 12-lead ECG revealed a negative T wave in III and aVF without morphological abnormalities. The echocardiographic examinations presented a normal size and function of the heart chambers, and a normal valvar structure and function (only trivial mitral and tricuspid regurgitation was observed). The invasive coronary arteriography – due to an increased calcium score in the CT scan – showed only a non-significant systolic dynamic narrowing in the eighth segment of the left anterior descending artery due to a muscle bridge. The physical performance characteristics of the athlete and a follow-up history of his athletic activity showed that the cardiac problems he had experienced during the ultra-marathon race did not prevent him from being active in sport. Int J Occup Med Environ Health. 2020;33(4):523–34
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