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An Unexpected Finding in an Adolescent Rowing Athlete With Angina Pectoris. A Case Report.

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Significant intraventricular gradients during exercise, though rare, can cause chest pain. This case highlights an adolescent athlete experiencing severe effort angina due to these gradients during upright exercise.

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Area of Science:

  • Cardiology
  • Exercise Physiology

Background:

  • Significant intraventricular gradient development during exercise is uncommon, typically associated with left ventricular hypertrophy.
  • The underlying mechanisms include increased physiological gradients, ventricular cavitary obliteration leading to end-systolic obstruction, and systolic anterior motion of the mitral valve causing mid-systolic obstruction.

Purpose of the Study:

  • To describe a rare case of significant intraventricular gradient development during exercise in an adolescent athlete.
  • To correlate exercise-induced intraventricular gradients with symptoms of effort angina.

Main Methods:

  • Case report of an adolescent rowing athlete presenting with exertional chest pain.
  • Exercise stress echocardiography was performed to replicate symptoms and assess cardiac function during exertion.

Main Results:

  • The adolescent athlete experienced severe effort angina exclusively during upright exercise.
  • Symptoms were reproducible during the exercise stress echocardiography, indicating a correlation between exercise intensity and gradient development.

Conclusions:

  • Exercise-induced intraventricular gradients can manifest as significant effort angina, even in young athletes without pre-existing obstructive cardiac conditions.
  • This case underscores the importance of considering intraventricular gradients in the evaluation of exertional chest pain in pediatric and adolescent populations.