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Management of young athletes with T-wave inversions

Sports Cardiology Quiz

The authors:

Dr. Silvia Castelletti, Cardiomyopathy Fellow, The Heart Hospital, London, UK
Dr. Giovanni Quarta, PhD, Consultant Cardiologist, AO Papa Giovanni XXIII, Bergamo, Italy
Dr. Michael Papadakis, Lecturer in cardiology, St George’s University of London, UK

on behalf of the EACPR Sports Cardiology Section.

Sports Cardiology

The case:

A 17-year-old Caucasian swimmer was referred for specialist investigation after an abnormal ECG on routine pre-participation cardiovascular screening. He had been participating in competitive exercise since the age of 11 years. His current regime consisted of swimming for 4 hours 5-6 days per week. He did not report any sinister cardiac symptoms. He denied recreational or performance enhancing drug use. There was no family history of premature sudden cardiac death or cardiomyopathy. Clinical examination was unremarkable. His 12-lead ECG is presented below.



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For further reading:

Outcomes in athletes with marked ECG repolarization abnormalities.
Pelliccia A, Di Paolo FM, Quattrini FM, Basso C, Culasso F, Popoli G, De Luca R, Spataro A, Biffi A, Thiene G, Maron BJ.
N Engl J Med. 2008;358:152–161.
[*2] The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African/Afro-Caribbean origin.
Papadakis M, Carrè F, Kervio G, Rawlins J, Panoulas VF, Chandra N, Basavarajaiah S, Carby L, Fonseca T, Sharma S.
Eur Heart J. 2011;32:2304–2313.
[*3] Prevalence and significance of T-wave inversions in predominantly Caucasian adolescent athletes.
Papadakis M, Basavarajaiah S, Rawlins J, Edwards C, Makan J, Firoozi S, Carby L, Sharma S.
Eur Heart J. 2009;30:1728–1735.
[*4] Cardiac adaptation to exercise in adolescent athletes of African ethnicity: an emergent elite athletic population.
Sheikh N, Papadakis M, Carrè F, Kervio G, Panoulas VF, Ghani S, Zaidi A, Gati S, Rawlins J, Wilson MG, Sharma S.
Br J Sports Med. 2013.
[*5]  Recommendations for competitive sports participation in athletes with cardiovascular disease: A consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology.
Pelliccia A, Fagard R, Bjørnstad HH, Anastassakis A, Arbustini E, Assanelli D, Biffi A, Borjesson M, Carrè F, Corrado D, Delise P, Dorwarth U, Hirth A, Heidbuchel H, Hoffmann E, Mellwig KP, Panhuyzen-Goedkoop N, Pisani A, Solberg EE, van-Buuren F, Vanhees L, Blomstrom-Lundqvist C, Deligiannis A, Dugmore D, Glikson M, Hoff PI, Hoffmann A, Hoffmann E, Horstkotte D, Nordrehaug JE, Oudhof J, McKenna WJ, Penco M, Priori S, Reybrouck T, Senden J, Spataro A, Thiene G, Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology, Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology.
Eur Heart J. 2005;26:1422–1445.