An athlete with repolarisation anomalies on exercise testing

Dr Michael Papadakis, Sports Cardiology Quiz Section Editor

02 Feb 2014

Prof. Sanjay Sharma , FESC

Prof. Michael Papadakis , FESC

Dr. Harshil Dhutia

The case

Description

A 54-year-old master triathlete attends an inherited cardiac diseases clinic as part of familial evaluation after the sudden death of his 44-year-old brother.
His brother died in his sleep and a subsequent post-mortem did not identify any cardiac or extra-cardiac pathology.
The athlete has been competing for more than 30 years and has never experienced any significant cardiovascular symptoms and there was no past medical history of note.
Clinical examination was unremarkable.

This is 12 Lead ECG undertaken as part of the evaluation:

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Note: The views and opinions expressed on this page are those of the author and may not be accepted by others. While every attempt is made to keep the information up to date, there is always going to be a lag in updating information. The reader is encouraged to read this in conjunction with appropriate ESC Guidelines. The material on this page is for educational purposes and is not for use as a definitive management strategy in the care of patients. Quiz material in the site are only examples and do not guarantee outcomes from formal examinations.

References

Recommendations for interpretation of 12-lead electrocardiogram in the athlete.
Corrado D, Pelliccia A, Heidbuchel H, et al. Eur Heart J 2010;31:243–59.
Unexplained sudden death, focusing on genetics and family phenotyping.
Raju H, Behr ER. Curr Opin Cardiol 2013;28:19-25.
Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes.
Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, Blom N, Brugada J, Chiang CE, Huikuri H, Kannankeril P, Krahn A, Leenhardt A, Moss A, Schwartz PJ, Shimizu W, Tomaselli G, Tracy C. Europace (2013) 15, 1389–1406.
Recommendations for competitive sports participation in athletes with cardiovascular disease.
Pelliccia A, Fagard R, Bjornstad HH, et al. Eur Heart J 2005;26:1422– 45.
Eligibility recommendations for competitive athletes with cardiovascular abnormalities.
Maron BJ, Zipes DP. J Am Coll Cardiol 2005; 45:1312–75.
Augmented ST-Segment Elevation During Recovery From Exercise Predicts Cardiac Events in Patients With Brugada Syndrome.
Makimoto H, Nakagawa E, Takaki H, Yamada Y, Okamura H, Noda T, Satomi K, Suyama K, Aihara N, Kurita T, Kamakura S, Shimizu W. J Am Coll Cardiol. 2010; 56:1576–1584.
Unmasking the Brugada phenotype during exercise testing and its association with ventricular arrhythmia on the recovery phase. Papadakis M, Petzer E, Sharma S. Heart 2009;95:2022.

Notes to editor

Dr Harshil Dhutia, Cardiology research fellow
Dr Michael Papadakis, Lecturer in Cardiology, St George’s University of London
Prof Sanjay Sharma, Professor of Clinical Cardiology, St George’s University of London

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