A growing body of evidence reporting altered cardiac function and myocardial damage following arduous exercise together with the increased prevalence of arrhythmias observed in highly trained athletes suggests that repetitive bouts of prolonged, arduous exercise may be deleterious to long-term cardiac health. Here we report the case of an experienced, highly trained Marathon runner who died suddenly whilst running. Autopsy findings demonstrated LV hypertrophy and idiopathic interstitial myocardial fibrosis. We postulate that life-long, repetitive bouts of arduous physical activity would have resulted in fibrous replacement of the myocardium causing a pathologic substrate for the propagation of fatal arrhythmias.
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