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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.

Warning Signs

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

Cardiovascular Abnormalities.


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

potentially serious

underlying illnesses and a

structured approach to

management in a

dedicated Sports

Cardiology clinic. The

goal, wherever possible,

is to enable athletes to

continue pursuing their

passion in a safe and

moderated manner.•

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 at

or call us at

6772 2100


National University Hospital Sports Centre

Engage in

aerobic activities

such as brisk

walking and


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

to relax.

Tips to Fight Hear t Di seases



physical activities

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-

terial course.

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-

rate intensity.