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Silent Myocardial Ischemia in a Healthy 45-Year-Old Marathon Runner with Proximal LAD Stenosis

This case study presents a healthy 45-year-old male marathon runner who exhibited silent myocardial ischemia due to over 70% stenosis in the proximal left anterior descending (LAD) artery. Despite being asymptomatic and having no cardiovascular risk factors, routine exercise ECG stress testing revealed features indicative of subendocardial ischemia. Comprehensive coronary computed tomography angiography confirmed significant narrowing of the proximal LAD. Subsequently, the patient underwent successful balloon angioplasty and stenting, achieving complete revascularization.

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Silent Myocardial Ischemia in a Healthy 45-Year-Old Marathon Runner with Proximal LAD Stenosis

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  1. Asymptomaticmarathonrunner with silentmyocardial ischemia due coronaryarterydisease for proximal LAD stenosis > 70% A healthy 45-years-old man runnerunderwent to exercise ECG treadmill stress testing for sports pre-participation screening Massimo Bolognesi Via Lambruschini 307 47023 Cesena, Italy, 7 Greenhill Prince Arthur Road Hampstead , London NW3 5U Email: massbolo1@tin.it

  2. Case History • 45 - years – old man • Family History positive for CAD • No cardiovascularriskfactors • Healthyasymptomaticmaratonrunner • Physicalexaminationunremarkable • Goodphysical fitness with 60/ml/kg of VO2max • Regular Training (80-90 Km/week) • Previous sport medicalevaluationnormal

  3. ElettrocardiographycFindings NormalResting ECG Positive ECG exercise stress testing

  4. ECG features of Subendocardial ischemia induced by exercise stress testing

  5. Coronary computed tomography angiography showed narrowing of proximal LAD

  6. Coronary computed tomography angiography

  7. Proximal LAD arterystenosis > 70%

  8. CoronaryAngiogrambefor PCI

  9. Coronary Angiogram before PCI

  10. Balloon Angioplasty – PCI with Stent on LAD shows complete revascularization

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