Sudden death in young athlets has been thoroughly studied, and there is an agreement that the usual causes are hereditary or congenital. This was not the case in our adolescent, although it has been demonstrated that intraventricular gradients can be caused by maneuvers that change loading conditions in structurally normal hearts, and it is know that participating in sports can bring about elicit such changes. However for SAM to occur, there must be some alteration of the geometry of the ventricular chamber or of the mitral valve apparatus. Three mechanisms have been proposed for them increasing significantly during exercise: 1) increase in non-obstructive physiologycal gradients 2) end-systolic obstruction secondary to ventricular cavitary obliteration and 3) mid-systolic obstruction caused by SAM of the mitral valve restricting ejection. It has long been know that small intraventricular gradients are a commom phenomenon. A possible role of exercise stress echo for intraventricular pressure gradient assessment in symptomatic athletes with structurally normal hearts is suggested. This leads us to advise withdrawal from participation in competitive sport according to the recomendations of the European Society of Cardiology. The authors discuss the significance of this event. These echocardiographic findings were not present at rest and disappeared shortly after termination of exercise.
Late during the investigation, he underwent treadmill stress echocardiography, during which he developed intraventricular gradient of over 130 mmHg with end-systolic peak and systolic anterior movement (SAM) of the mitral valve. The young boy did a treadmill stress test which was positive for myocardial ischemia. The ECG and echocardiogram findings were normal. The authors report the case of a 16-year-old boy who practices karate, who underwent medical evaluation because of atypical chest discomfort, related to strenuous effort.