Pursing Sports Safely
Anomalous Coronary Artery1 is a rare condition that can cause sudden cardiac death particularly in those with abnormal blood vessels. In the USA, this condition accounts for nearly 17 per cent of sudden cardiac deaths in competitive athletes. Asst. Prof. Yeo Tee Joo shares the case of a local athlete.
Mr K is a 20-year-old national serviceman with no significant medical history. He was also a keen athlete and a competitive water polo player.
One day after a route march, Mr. K suddenly experienced chest pain and was found to have mildly elevated Troponin I, indicating stress to the heart and its surrounding structures. His cardiac MRI scan showed a small layer of fluid around the heart but the contractility was unaffected and there was no scarring or damage to the heart muscle. These changes suggested Pericarditis2 which is often self-limiting. Mr. K was discharged with anti‑inflammatory painkillers to relieve his symptoms. One month after discharge, the exertional chest pain still plagued Mr. K although he did not experience any fainting episodes. His treadmill test also turned out fine with no evidence of abnormal electrical rhythm or inadequate circulation to the heart muscle. Given his persistent symptoms, however, a CT coronary angiogram was performed and it revealed an anomalous right coronary artery arising from the left coronary sinus with an inter-arterial course. This abnormal course puts the right coronary artery at risk of being compressed between the aorta and pulmonary artery, particularly during strenuous physical activity. This leads to a reduction or even a complete cut-off of blood supply to the heart muscle. Consequently, abnormal heart rhythms and even sudden cardiac death may occur.
Treatment and Changes to Lifestyle
Mr. K was updated on the diagnosis, its impact on physical activities and risk of sudden cardiac death. He was also advised to limit physical exertion including ceasing competitive sports3. This meant that he had to withdraw from competitive water polo. However, this extremely difficult decision was made less painful with clear guidance on safe exercise boundaries and strong family support. Mr. K continues to enjoy recreational water polo games at moderate intensity.
National University Hospital Sports Centre
The Sports Cardiology service at the NUH Sports Centre offers holistic management of athletic individuals with heart disease, including personalized guidance on participation and resumption of physical activities. Active individuals with cardiovascular disease are advised to seek medical evaluation.
To find out more or make an appointment, please email us at
Ortho_Sports@nuhs.edu.sg or call us at 6772 2100.
By Asst. Prof Yeo Tee Joo
Coronary artery with an abnormal origin.
2Inflammation of the lining of the heart.
3Based on the 2015 American College of Cardiology Eligibility and Disqualification Recommendations for Athletes with Cardiovascular Abnormalities.
*Not his real name.