At 33, a professional football player was still competing at an elite level when brief chest pains and an irregular heartbeat raised a difficult question: was his heart coping normally with sport, or was something wrong?
His symptoms were easy to underestimate. The pain was sharp and short-lived. During exercise, he sometimes felt lightheaded or noticed palpitations. He had not fainted, had no shortness of breath and reported no recent illness.
Yet an abnormal electrocardiogram prompted further investigation. His experience, documented in JACC: Case Reports, offers a useful look at myocarditis in athletes—and why physical fitness cannot replace a careful cardiac assessment.
Why Extra Heartbeats Needed Attention
The ECG recorded premature ventricular contractions, usually called PVCs. These are early electrical beats arising from the heart’s lower chambers.
PVCs can occur in healthy people. Their presence alone does not establish myocarditis or mean an athlete must permanently stop competing. In this case, however, they appeared alongside symptoms during activity. The ECG also showed fragmented R waves, an electrical finding that encouraged doctors to investigate further.
The question was whether these findings reflected an isolated rhythm disturbance or a problem involving the heart muscle itself.
What Cardiac MRI Revealed
Cardiac magnetic resonance imaging provided additional information. It showed late gadolinium enhancement, or LGE: areas where contrast behaved abnormally within the heart muscle.
LGE can reflect myocardial injury or fibrosis, but it does not independently establish the cause or prove that inflammation is currently active.
The published report also described probable myocardial edema and a mildly reduced left ventricular ejection fraction of 48% on MRI. That number measures the proportion of blood pumped out of the left ventricle with each contraction; it does not mean that only 48% of the heart was working.
Together, the findings raised concern about a previous or ongoing inflammatory process.
A Probable Diagnosis, With Remaining Uncertainty
A PET scan did not detect active myocardial inflammation. The team considered subacute myocarditis following an earlier viral infection the most likely explanation.
Myocarditis is inflammation of the heart muscle. It can affect pumping function and the electrical pathways that coordinate heartbeats. Its presentation varies: some people experience significant illness, while others have mild symptoms. [2]
For this athlete, the diagnosis remained probable rather than definitive. A reassuring PET result did not erase the MRI abnormalities or resolve every question about future risk.
That uncertainty became central to the next decision: how long should he step away from competitive sport?
