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Dr. Flavio D'Ascenzi ,
Background: This case demonstrates the challenges of interpreting ventricular arrhythmias in asymptomatic athletes. Premature ventricular contractions (PVCs) can occur during normal daily life. Less than 1% of PVCs are seen on Holter assessment and these can increase with age. A minority of athletes may exhibit frequent or complex ventricular arrhythmias with a prevalence similar to sedentary counterparts. However, PVCs may be a marker of underlying heart disease even in asymptomatic individuals. It is important to pay attention to the characteristics of the PVCs including morphology, complexity, multifocal origin, and/or increasing frequency with exercise that may provide clues to an underlying electrical, ischaemic or structural change that may be associated with sudden cardiac death.
22-year-old female competitive tennis player was referred for cardiovascular screening. She was asymptomatic from a cardiovascular perspective and trained during three sessions per week for a duration of approximately 5-6 hours.
There is a family history of sudden cardiac death (father died suddenly at the age of 35 years). Clinical examination demonstrated a heart rate of 40bpm regular with a BP of 110/60mmHg. Cardiac auscultation revealed dual heart sounds with no additional murmurs.
Showing premature ventricular complexes (RBBB, wide QRS+superior axis):
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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.
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Flavio D’Ascenzi, MD, PhD, FESC*; Francesca Anselmi, MD*; Sergio Mondillo, MD*; Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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