Elective plastic surgery done for cosmetic gain always take a careful look at the patient’s general health beforehand. With some notable exceptions (morbid obesity, diabetes, smokers) it is fair to say that any person under the age 50 is unlikely to have medical problems that would exclude them from having almost any type of plastic surgery safely. Most certainly, the most athletic and fit individuals would seem to be ideal candidates to undergo a surgical experience without incident. Recent reports have pointed out, however, that there is one unique athletic patient that is at risk of the heart stopping (asystole) during surgery. Several cases have now emerged in young women who were endurance trained (marathon runners) with presurgical slow heart rates below 60 (bradycardia) that are at risk for cardiac arrest during surgery. The exact mechanism is not fully understood why this can potentially happen. Ironically the most very fit, perhaps unnaturally fit, patient has an increased cardiac risk for surgery in general if they have a low heart rate. While no deaths have been reported from these events happening in surgery, plastic surgeon and anesthesiologist need to be on guard in the athletic patient with a slow heart rate.