Acute and subacute myocarditis represents the cause of sudden cardiac death in 5-25% of athletes. Making a diagnosis of myocarditis is always challenging due to its heterogeneous clinical presentation, especially in athletes with minimal and equivocal symptoms. The clinical onset of myocarditis can occur in many ways because patients may complain of different symptoms such as chest pain, or dyspnea from exercise, fatigue, heart failure or even imitate the signs of myocardial infarction. Athletes are different from sedentary individuals with respect to their perception of clinical symptoms which are often underestimated. Herewith the author describes a case of subacute myocarditis that was diagnosed in an asymptomatic athlete who underwent sports pre-participation screening.
Myocarditis is a typical inflammatory disease of the myocardium that can cause some cardiac dysfunctions and in particular uncommon arrhythmias . Myocarditis represents a high percentage of sudden cardiac death events in predominantly young athletes, ranging between 5 and 22% according to some research [2,3]. Much of such evidence is from autopsy data which have determined the cause. For example, research by Swedish authors revealed that myocarditis was the most frequent autopsy diagnosis and occurred in relation to exercise . The same thing was highlighted in another observational study in which myocarditis was discovered on histopathological examination in 22% of cases of athletic people . This evidence should be taken into careful consideration by athletes for who exercise and competitive sport is a major component of their lifestyle . In the case here described, subacute myocarditis was diagnosed in an asymptomatic athlete after considerable thought and interpretation of all the noninvasive cardiovascular imaging, i.e. sequentially ECG, then Echocardiography and finally CRM which led to the certainty of the diagnosis.