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A retrospective study of 40 non-lethal myocardial infarctions occurring during physical exercise (average age 38 years) compared with 100 controls (average age 41 years) showed that the coronary artery disease which was identical after 40 years of age, differed in the youngest age subgroups. Juvenile exercise-induced infarction (N = 20) was characterised by a high incidence of normal coronary vessels (N = 8 compared with 6 in 39 controls of comparable age). The cardiovascular risk factors were qualitatively and quantitatively the same with a high incidence of smoking (85 to 95 p. 100) in the juvenile groups, especially with normal coronary arteries. Premonitory chest pain was sporadic and atypical before the age of 40 but was typical and recurrent in half of the older men, though generally unrecognised. Analysis of the circumstances surrounding infarction showed that in 90 p. 100 of cases (and in all juvenile cases) there were several factors in common related to the conditions under which the exercise was performed: external conditions (particularly the weather) or individual conditions (fatigue, dietary error, etc.) which probably played a contributory role. These observations suggest that a preventive strategy may be possible based on an anti-smoking campaign, on the identification of high risk subjects and on the adoption of adequate conditions of surveillance and performance of physical training.

38 observations of myocardial infarction (M.I.) (group A), remarkable by their occurrence immediately (31 cases) or with a delay (less than 12 hours, 7 cases) after the onset of chest pain and/or lipothymia during (30 cases) or a the end (7 cases) of a non unusual physical effort, have been documented with a 60 items questionnaire for the analysis of exercise, mesologic and personal data. Group A comprised men averaging 37 +/- 8 years, with extreme at 24-54 (less than 40 years: n = 21, m = 30, 5 +/- 3.5 years), divided into high-level athletes (n = 15), very well (n = 12) or moderately (n = 7) trained, and sedentary (n = 4). This group was compared to a historical population of 105 men suffering from a M.I. non preceded by exertion (group B), average age 41 +/- 9, extreme at 19-54 years, with a comparable social status (sports adepts: 26 per cent). The analysis of the responses in group A discloses in order: time of onset of the M.I. (69 per cent before 9 hours), the need for physical performance (45%), heat discomfort (31%). It is endurance work 19 times (50%). Groups A and B are undifferentiated (0.8 less than chi 2 less than 2, p = N,5) concerning the number of risk factors (2.18 +/- 0.98 and 2.42 +/- 1.18), the preceding angor on exertion (24 or 63% and 59 or 56%), the topography of the M.I. (lower 58 and 59),the incidence of complications (extension, left ventricular failure, arrhythmias) in the acute phase (24 and 30%).(ABSTRACT TRUNCATED AT 250 WORDS)