Acute Myocardial Infarction in a Young Bodybuilder Fighter Pilot

BACKGROUND: Although advanced coronary artery disease in young, healthy fighter pilots is uncommon, an acute cardiac event in flight could be catastrophic.CASE REPORT: After a gym workout, a 31-yr-old F-16 pilot reported severe central chest pain, one vomiting episode, and excessive sweating but no radiation of pain. Electrocardiograph showed ST elevation in V2-V6. Coronary arteriography showed a thrombotic lesion at the proximal left anterior descending (LAD) artery (90%) and one occluded LAD branch with thrombus; the rest of the arteries were normal and ejection fraction was 55%. Primary percutaneous coronary intervention to LAD with one drug-eluting stent was done. The pilot was discharged in stable hemodynamic condition with medication advice. Assessment revealed no significant cardiac risk factors. He did not seek medical care for two central chest pain episodes following a gym workout prior to this event because rest relieved the pain. He gave a history of using commercial protein supplements for bodybuil ding in the past 6 yr.DISCUSSION: In this case report, the impact of aggressive gym workouts and chronic use of commercially available bodybuilding protein supplements on cardiovascular health is discussed, as well as aeromedical dilemmas related to this pilot's career. This case sparks debate about whether a highly motivated young pilot with an unexpected cardiac event should be subjected to regular intensive cardiac evaluation throughout his remaining flying career, with permanent flying limitations, or be motivated to pursue a career shift to facilitate noncomplicated career rehabilitation.