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Elite athlete presenting with palpitations

Dr Michael Papadakis, Sports Cardiology Quiz Section Editor



The case

Description

Elite athlete presenting with palpitations:

  • 24-year-old, black Caribbean, elite football player complained of palpitations in the 86th minute of a competitive game.
  • The palpitations lasted around 20 seconds and the player felt able to complete the game.
  • Previously asymptomatic.
  • Used caffeine supplements prior to games.
  • There was no family history of cardiovascular disease, syncope or sudden cardiac death.

An ECG was performed the following day and is shown below:

ECG Quiz

 

 

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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

1. Sharma S, Drezner JA, Baggish A, et al. International recommendations for electrocardiographic interpretation in Athletes. J Am Coll Cardiol. 2017;69(8):1057-1075. doi: https://doi.org/10.1016/j.jacc.2017.01.015.

2. Calore C, Zorzi A, Sheikh N, et al. Electrocardiographic anterior T-wave inversion in athletes of different ethnicities: differential diagnosis between athlete's heart and cardiomyopathy. Eur Heart J 2016;37:2515-2527. doi: 10.1093/eurheartj/ehv591.

3. 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. 2011;32(18):2304-2313. doi: 10.1093/eurheartj/ehr140.

4. Sheikh E, Nabeel, Papadakis E, Michael, Ghani E, Saqib, et al. Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes. Circulation. 2014;129(16):1637-1649. doi: 10.1161/CIRCULATIONAHA.113.006179.

5. Schnell F, Riding N, O’Hanlon R, et al. Recognition and significance of pathological T-wave inversions in athletes. Circulation 2015;131:165-173. doi:10.1161/CIRCULATIONAHA.114.011038.

6. Kebed KY, Bos JM, Anavekar NS, Mulvagh SL, Ackerman MJ, Ommen SR. Hypertrophic cardiomyopathy, athlete's heart, or both: A case of hypertrophic cardiomyopathy regression. Circulation.Cardiovascular imaging. 2015;8:e003312. doi: 10.1161/CIRCIMAGING.115.003312.

7. 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 ofCardiology. Eur Heart J. 2005;26(14):1422

8. Maron BJ, Udelson JE, Bonow RO, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task force 3: Hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and other cardiomyopathies, and myocarditis: A scientific statement from the American heart association and American college of cardiology. J Am Coll Cardiol. 2015;66(21):2362. doi: 10.1016/j.jacc.2015.09.035.

9. Maron BJ, Chaitman BR, Ackerman MJ, et al. Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation. 2004;109:2807- 2816. doi: 10.1161/01.CIR.0000128363.85581.E1

10. Pelliccia A, Corrado D, Bjørnstad HH, et al. Recommendations for participation in competitive sport and leisure-time physical activity in individuals with cardiomyopathies, myocarditis and pericarditis. Eur J Cardiovasc Prev Rehabil. 2006;13:876-85.

Notes to editor

Ms Liz Howard, Cardiac Physiologist, MSc in Sports Cardiology student, Cardiology Clinical Academic Group, St George’s, University of London

Dr Aneil Malhotra, Lecturer in Cardiology, Cardiology Clinical Academic Group, St George’s, University of London

Prof Sanjay Sharma, Prof of Inherited Cardiac Diseases and Sports Cardiology, Cardiology Clinical Academic Group, St George’s, University of London