Acute coronary syndrome with ST-segment elevation during ergometric testing in a master athlete

The occurrence of ischemic ST-segment elevation during an ergometric test is rare. Here we present the case of a 58-year-old male master athlete, deaf-mute since birth, without cardiovascular risk factors and asymptomatic, undergoing a medical examination for competitive athletics. During the maximal ergometric test (MET), performed with a surgical mask as required by the COVID-19 protocol of the Italian Sports Medicine Federation (FMSI), the athlete presented the onset of an ischemic type of ST-segment elevation in the V1-V6 leads, associated with angina symptoms, which resolved within a few minutes. The presence of critical but not occlusive coronary stenosis on urgent coronarography, the fact that the ST elevation and angor were of short duration, and the lack of raised troponin levels, suggest coronary spasm on a non-critical stenosis as a pathophysiological hypothesis, related to emotivity and use of a mask. In conclusion, ST-segment elevation during ergometric testing is rare, but it still must be taken into account during the sports medicine examination of a master athlete. The sports physician must be prepared to recognize such emergencies and act accordingly.