Phidippides cardiomyopathy: a review and case illustration

Area of Science:

• Cardiology
• Sports Medicine
• Exercise Physiology

Background:

• Endurance sports like marathons are increasingly popular, raising concerns about exercise-induced sudden cardiac death.
• Traditional causes of sudden cardiac death in athletes, such as hypertrophic cardiomyopathy, are often excluded.
• Phidippides cardiomyopathy is an emerging consideration in unexplained sudden cardiac events following extreme exertion.

Observation:

• Sustained high cardiac output during endurance events causes significant cardiac volume overload.
• Approximately one-third of marathon runners exhibit right atrial and ventricular dilation.
• Elevated cardiac troponin and natriuretic peptides are observed in affected athletes.

Findings:

• A subset of endurance athletes develop cardiac fibrosis, a potential substrate for arrhythmias.
• Phidippides cardiomyopathy presents a newly recognized risk for ventricular tachyarrhythmias and sudden death.
• Cardiac magnetic resonance imaging is the preferred diagnostic tool for this condition.

Implications:

• Recognizing Phidippides cardiomyopathy is crucial for evaluating sudden death in endurance athletes.
• Further research is needed to understand the pathophysiology and long-term prognosis.
• Screening and preventative strategies may be warranted for high-risk endurance athletes.