Pulmonary embolism as a cause of a reduced performance capacity of endurance trained men - report of 2 cases

摘要

HISTORY AND ADMISSION FINDINGS: Two trained long-distance runners, aged 53 and 58 years, respectively, presented (independently) at our outpatient department because of an acute reduction in physical performance after considerable exertion. Neither had specific clinical symptoms, particularly no dyspnea. INVESTIGATIONS: Neither patient had abnormal findings on physical examination, such as signs for deep venous thrombosis. The electrocardiogram and echocardiography were normal. Exercise tests revealed a significant limitation in physical performance and, in one patient, a reduction in arterial blood oxygen and elevated d-dimers as the only abnormal laboratory test result. DIAGNOSIS, TREATMENT AND COURSE: The diagnosis of pulmonary embolism was made by computed tomography, which showed the typical changes. In both patients venous phlebography revealed deep vein thrombosis and signs of post-thrombotic changes. Laboratory tests were unremarkable, with normal blood coagulation and no factor II mutations. Anticoagulants were administered to each patient and they slowly resumed their training program. At a subsequent examination physical performance had improved, but there was still a reduction in arterial oxygen during exercise. CONCLUSION: Even endurance-trained sportspersons without thrombophilic risk factors may develop deep vein thrombosis. Even when there are no symptoms, pulmonary embolism should always be included in the differential diagnosis of a sudden and significant reduction in physical performance.