In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more.
COVID-19 and Cardiology Read more

Anterior T wave inversion in an athlete: Athlete’s heart or cardiac pathology?

Dr Michael Papadakis, Sports Cardiology Quiz Section Editor



The case

Description

Repolarisation abnormalities in an athlete:

  • A 22 year old Caucasian international rugby player was referred following pre participation cardiac screening
  • He was asymptomatic, training on average 13 hours per week
  • There was no family history of premature cardiovascular disease or sudden cardiac death

His 12 lead ECG is shown below:

ECGImage_QuizMay2017.JPG

 

Test your knowledge

 

Interested in learning more? Access the ESC e-learning platform and discover the EAPC Sports Cardiology online courses.

Not yet an EAPC member?

JOIN NOW

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

1. Marcus F, McKenna W, Sherrill D et al. Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia. Proposed Modification of the Task Force Criteria. Circulation. 121:1533-1541, 2016
2. Calore C, Zorzi A, Sheikh et al. Electrocardiographic anterior T-wave inversion in athletes of different ethnicities: differential diagnosis between athlete's heart and cardiomyopathy. Eur Heart J. 37:2515-2527, 2016
3. Zaidi A, Sheikh N, Jongman JK. Clinical differentiation between physiological remodelling and Arrhythmogenic Right Ventricular Cardiomyopathy in athletes with marked electrocardiographic repolarisation anomalies. JACC. 65:2702-2711, 2015.
4. Sharma S, Drezner J, Baggish A et al. International Recommendations for Electrocardiographic Interpretation in Athletes. JACC.
5. Papadakis M, Basavarajaiah S, Rawlins, J. Prevalence and significance of T wave inversions in predominantly Cacucasian adolescent athletes. Eur Heart J. 14: 1728-1735, 2009.
6. Migliore F, Zorzi A, Michieli P. Prevalence of cardiomyopathy in Italian asymptomatic children with electrocardiographic T wave inversion at pre participation screening. Circulation 12:529-38, 2012.
7. Papadakis M, Carre F, Kervio G et al. The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African/Afro-Caribbean origin. Eur Heart J. 32:2304-2313, 2011
8. Brosnan M, La Gerche A, Kalman J et al. Comparison of frequency of significant electrocardiographic abnormalities in endurance versus non-endurance athletes. Am J Cardiol. 113: 1567-1573, 2014.
9. Malhotra A, Dhutia H, Gati S et al. Prevalence and significance of anterior T wave inversion in young white athletes and non-athletes. JACC. 69:1-9, 2016
10. Priori SG, Blomstrӧm-Lundqvist C, Mazzanti A et al. 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the management of patients with ventricular arrhythmias and the prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Eur Heart 36: 2793-2867, 2015
11. Papadakis M, Basavarajaiah S, Rawlins J et al. Prevalence and significance of T wave inversions in predominantly Caucasian adolescent athletes. Eur Heart J. 30:1728-1735, 2009.
12. Calo L, Sperandii F, Martino A et al. Echocardiographic findings in 2261 peri-pubertal athletes with or without inverted T waves at electrocardiogram. Heart. 101: 193-200, 2015.
13. Maron BJ. Sudden death in young athletes. N Engl J Med 2000;349:1064–75
14. Sarto P, Merlo L, Noventa D. Electrocardiographic changes associated with training and discontinuation of training in an athlete with hypertrophic cardiomyopathy. 93: 518-519, 2004.
15. Zorzi A, ElMaghawry M, Rigato I. Exercise-induced normalisation of right precordial negative T waves in arrhythmogenic right ventricular cardiomyopathy. Am J Cardiol. 112: 411-415, 2013.
16. Wilson MG, Sharma S, Carré F et al. Significance of deep T wave inversions in asymptomatic athletes with normal cardiovascular examinations: practical solutions for managing the diagnostic conundrum. Br J Sports Med. 46: 51-58, 2012.
17. Schnell F, Riding N, O’Hanlon R et al. Recognition and significance of pathological T wave inversions in athletes. Circulation. 131: 165-173, 2015.
18. Ackerman MJ, Priori SG, Willems S et al. HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies. This document was developed as a partnership between the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA). Heart Rhythm. 8:1308-39, 2011
19. Pelliccia A, Di Paolo FM, Quattrini FM et al. Outcomes in athletes with marked ECG repolarization abnormalities. N Engl J Med. 10:152-61, 2008.
20. Pelliccia A, Fagard R, Bjørnstad HH et al. 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. Eur Heart J. 26:1422-45, 2005

Notes to editor

Dr Joyee Basu, BMBCh, MA (Oxon), MRCP, CRY Cardiology Research Fellow, Cardiology Clinical Academic Group, St George’s, University of London, UK

Dr Michael Papadakis, MD, MRCP, FESC, Senior Lecturer in cardiology, Cardiology Clinical Academic Group, St George’s, University of London, UK

Dr Svetlana Pitman, St George’s, University of London, UK