Glück gehabt! Kasuistik eines 55-jährigen marathonläufers mit koronarer hauptstamm- und RIVA-stenose

History and admission findings: In a 55-year-old jogger, who finished a city marathon without any problems and took part in a study, elevated cardiac troponin I and T levels of 0.93 and 0.13 ng/ml, respectively, were detected after the run. Before the marathon-run, examination by the general practitioner (ECG and echocardiography at rest, ultrasound of the abdomen) revealed no signs of illness except hypertrophy of the intimamedia thickness of the carotid artery. Investigations: Physical examination, ECG and echocardiography at rest were without abnormalities. During and after treadmill-exercise, ST-segment depressions of 0.25 mV and 0.4 mV were shown in the precordial leads V4 through V6. During exercise-echocardiography, at 200 W, wall-motion-abnormalities were seen at the septum. Therefore, sports activities were forbidden and a coronary angiography was recommended. Diagnosis, treatment and course: Coronary angiography showed 50% stenosis of the left main stem and 80% stenosis of the proximal left anterior descending artery, indicating surgery for CABG, which could be performed without problems. Conclusion: Not only in competitive athletes, but also in recreational athletes, exercise examinations play an important role in sports medicine. History, physical examination, ECG at rest and exercise are the main tools in sports medicine, which can be supplemented by echocardiography to answer further questions. With these tools, it is possible to detect most of the causes of sudden cardiac death in sports, and therefore to minimize the cardiovascular risk during sports activities.