Journal of Cardiology and Heart Failure

ABSTRACT

A 50-year-old elite marathon runner with a remarkable family history of sudden cardiac death (SCD) presented with brief episodes of burning chest discomfort occurring during warm-up and resolving with continued exertion. Despite exceptional physical fitness and absence of traditional cardiovascular risk factors, coronary computed tomography angiography (CCTA) revealed significant multivessel coronary artery disease involving the left anterior descending (LAD), left circumflex (LCx), and right coronary artery (RCA). Invasive coronary angiography confirmed severe stenoses. The calculated SYNTAX score was 18 (low anatomical complexity). The patient underwent successful multivessel percutaneous coronary intervention (PCI) using contemporary drug-eluting stents, including a double-kissing crush technique for a LAD–diagonal bifurcation lesion, achieving final TIMI 3 flow in all treated vessels.

This case highlights warm-up angina as a manifestation of ischemic preconditioning and emphasizes that elite endurance performance does not exclude severe atherosclerotic disease. Careful evaluation of exertional symptoms in athletes, particularly those with a significant family history of SCD, remains essential.

Learning Objectives

• To recognize warm-up angina as a manifestation of ischemic preconditioning;
• To understand that severe multivessel coronary artery disease may occur in elite athletes without traditional risk factors;
• To emphasize the importance of maintaining a high index of suspicion for coronary pathology in athletes presenting with exertional symptoms.

Keywords: Warm-Up Angina; Ischemic Threshold; Marathon Athlete; Coronary Artery Disease; Percutaneous Coronary Intervention; Atypical Chest Pain; Endurance Exercise