Ischaemic electrocardiographic changes in an athlete with normal coronary arteries

During a maximal exercise test transient ischaemic electrocardiographic (ECG) changes developed in a young athlete who had entirely normal coronary arteries on angiography. Myocardial scintigraphy revealed a perfusion defect in the anterior wall of the left ventricle with a reduced washout of 133Xenon. A localized hypokinetic area coterminuos with the perfusion defect was disclosed by echoventriculography. This athlete, the first studied by selective coronary angiography and determination of regional myocardial perfusion, demonstrates that athletes are not protected from the recently highlighted syndrome of ischaemic heart disease with normal coronary arteries.