r. K* is a 20-year-old national
serviceman with no signi cant
medical history. He was also a
keen athlete and 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 uid around the heart but the
contractility was unaffected and there
was no scarring or damage to the heart
muscle. These changes suggested
which is often self-limit-
ing. Mr. K was discharged with anti-
in ammatory painkillers to relieve his
One month after discharge, the exer-
tional chest pain still plagued Mr. K
although he did not experience any
fainting episodes. His treadmill test
also turned out ne with no evidence
Coronary artery with an abnormal origin.
Inflammation of the lining of the heart.
Based on the 2015 American College of
Cardiology Eligibility and Disqualification
Recommendations for Athletes with
Not his real name.By Asst. Prof. Yeo Tee Joo Consultant, Department of Cardiology Dr. Yeo completed subspecialty fellowship trainings in Cardiovascular Prevention and Rehabilitation at the Toronto Rehabilitation Institute and Sports Cardiology at St George’s, University of London. He is now focused on improving the NUHCS Cardiac Rehabilitation experience for patients and establishing the Sports Cardiology service in NUHCS.
Mr. K’s case illustrates the
importance of uncovering
underlying illnesses and a
structured approach to
management in a
Cardiology clinic. The
goal, wherever possible,
is to enable athletes to
continue pursuing their
passion in a safe and
The Sports Cardiology service at the NUH Sports Centre offers holistic
management of athletic individuals with heart disease, including
personalised guidance on participation and resumption of physical
activities. Active individuals with cardiovascular disease are advised to
seek medical evaluation.
To nd out more or make an appointment, please email us atOrtho_Sports@nuhs.edu.sg
or call us at
.National University Hospital Sports Centre
such as brisk
Exercise at least ve
days a week, 30
minutes each day.
Eat a Mediterranean
style diet rich in olive oil.
Quit smoking, modify
your diet and take time
Tips to Fight Hear t Di seases
into your daily lives
(e.g. take the stairs
instead of the lift).
of abnormal electrical rhythm or inade-
quate circulation to the heart muscle.
Given his persistent symptoms, how-
ever, a CT coronary angiogram was
performed and it revealed an anoma-
lous right coronary artery arising from
the left coronary sinus with an inter-ar-
This abnormal course puts the right
coronary artery at risk of being com-
pressed between the aorta and pulmo-
nary artery, particularly during strenuous
physical activity. This leads to reduc-
tion or even complete cut-off of blood
supply to the heart muscle. Conse-
quently, 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 sports
This meant that he had to withdraw
from competitive water polo. However,
this extremely dif cult 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 mode-