(1) Internal General Medicine, Department of Sports Cardiology Medicine Center,Via Ungaretti 494, 47521 Cesena
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Sudden cardiac death (SCD) in athletes is a rare event; however, it is still 2-4 times more often when compared to non-athletes. The single most important predictor is exercise fainting or near fainting, which should be a warning requiring explanation and investigation. Early identification of athletes at high risk of sudden death imposes drastic decisions such as restriction of competitive sports activity, but also by prophylactic treatment with drugs and implantable cardioverter defibrillator (ICD).
The author report here the case of a 43-year-old female triathlete who had recurrent syncope from physical effort (running) caused by a life-threatening ventricular arrhythmia and therefore was declared ineligible for competitive sport. This athlete however, died a few years later suddenly during a cycling event.
Sports cardiologists should never underestimate the life-threatening ventricular arrhythmias when these are associated with recurrent syncope. Relying not only on the results of genetic and cardiovascular imaging, but rather considering clinical observations and making accurate diagnoses when the two hallmark signs are present with vulnerable substrate: syncope associated to malignant ventricular arrhythmias.