We report a case of a marathon runner who presented with chest
tightness, ST-segment depression, and ventricular fibrillation
following treadmill exercise testing. At cardiac catheterization, the
patient was found to have an isolated lesion in the left anterior
descending (LAD) artery that was hemodynamically insignificant by
accepted angiographic and coronary flow reserve standards. Ventricular
fibrillation was thought to be idiopathic, and an implantable
cardioverter defibrillator was placed. Chest pain and ST-segment
depression followed by ventricular fibrillation was reproduced during
follow-up treadmill testing, prompting reconsideration of the original
diagnostic hypothesis. A coronary stent was deployed in the LAD artery.
The patient has been asymptomatic and arrhythmia free during follow-up
treadmill testing and recreational running.