BMJ Case Reports 2009; doi:10.1136/bcr.12.2008.1345
  • Reminder of important clinical lesson

Myocardial fibrosis in an veteran endurance athlete

  1. Mathew Wilson1,
  2. Rory O'Hanlon2,
  3. Sanjay Prasad2,
  4. Sandeep Basavarajaiah3,
  5. Nigel Stephens4,
  6. Roxy Senior5,
  7. Anthony Shaw6,
  8. Sanjay Sharma3,
  9. Gregory Whyte6,7
  1. 1
    Research Centre for Sport and Exercise Performance, University of Wolverhampton, Gorway Road, Walsall, WS1 3BD, UK
  2. 2
    Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK
  3. 3
    Kings College London, Department of Cardiology, 125 Coldharbour Lane, London, SE5 9NU, UK
  4. 4
    Northwick Park Hospital, Department of Cardiology, Watford Road, London, HA1 3UJ, UK
  5. 5
    Northwick Park Hospital, Watford Road, London, HA1 3UJ, UK
  6. 6
    CRY Centre for Sports Cardiology, Olympic Medical Institute, Northwick Park Hospital, London, HA1 3UJ, UK
  7. 7
    Liverpool John Moores University, Research Institute for Sport and Exercise Science, Henry Cotton Campus, Truman Street, Liverpool, L3 2ET, UK
  1. Mathew Wilson, mat.wilson{at}
  • Published 17 August 2009


This study reports the cardiac structure and function of a lifelong male endurance athlete, who has run over 148 000 miles, who presented with symptoms of chest discomfort, dyspnoea and loss of competitive running performance. Importantly, the athlete documented several periods of regular intensive endurance activity while suffering with flu-like symptoms. Cardiovascular MRI demonstrated a pattern of late gadolinium enhancement, which indicated myocardial scarring as a result of previous myocarditis.

Myocarditis is a non-ischaemic inflammatory disease of the myocardium associated with cardiac dysfunction and arrhythmogenic substrate. The clinical course of viral myocarditis is mostly insidious with limited cardiac inflammation and dysfunction. However, as in the present case, overwhelming inflammation may occur in a subset of patients leading to myocardial fibrosis due to recurrent inflammation.


  • Competing interests: none.

  • Patient consent: Patient/guardian consent was obtained for publication.

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