Clinical assessment of the athlete’s heart: normal and abnormal ECGs in athletes

ESC CardioMed ◽  
2018 ◽  
pp. 2916-2920
Author(s):  
Alessandro Zorzi ◽  
Domenico Corrado
Keyword(s):  
Cardiovascular Disease ◽  
Athlete’S Heart ◽  
Physiological Adaptation ◽  
Ecg Changes ◽  
Increased Risk ◽  
Electrocardiogram Ecg ◽  
Ecg Abnormalities ◽  
Work Up ◽  
And Training ◽  
Athlete's Heart

The electrocardiogram (ECG) of trained athletes may show changes that represent the consequence of the heart’s adaptation to physical exercise (‘athlete’s heart’) such as enlarged cardiac chamber size and increased vagal tone. Physiological ECG changes must be differentiated from the ECG abnormalities secondary to an underlying cardiovascular disease that may be responsible for sudden cardiac death during exercise. The ECG changes of athletes are classified according to their prevalence, relation to exercise training, association with an increased risk of cardiovascular disease, and the need for further investigations: common ECG changes should be considered as a benign sign of physiological adaptation to exercise and do not require additional evaluation; on the other hand, in case of uncommon and training-unrelated abnormalities, which may be associated with an underlying cardiovascular disease, further work-up should be performed. This chapter reviews the abnormalities that may be found in an athlete’s ECG and proposes criteria for interpretation of such changes as normal or abnormal findings.

The electrocardiogram in the athlete

2019 ◽  
pp. 57-68
Author(s):  
Zorzi Alessandro ◽  
Domenico Corrado
Keyword(s):  
Cardiovascular Disease ◽  
Exercise Training ◽  
Cardiac Disease ◽  
Increased Risk ◽  
Exercise Ecg ◽  
Related Group ◽  
Group 2 ◽  
Electrocardiogram Ecg ◽  
Ecg Abnormalities ◽  
And Training

Interpretation of the athlete’s 12-lead electrocardiogram (ECG) should be based on specific criteria because changes that would be considered abnormal in the untrained population may develop in trained athletes as a physiological and benign consequence of the heart’s adaptation to exercise. ECG abnormalities in athletes are classified into two groups—‘common and training-related’ (Group 1) and ‘uncommon and training-unrelated’ (Group 2)—based on their prevalence, relation to exercise training, association with an increased risk of cardiovascular disease, and need for further investigations. The present chapter reviews the abnormalities that may be found in an athlete ECG and proposes criteria for interpretation of such changes as normal variants or abnormal findings that need further assessment to exclude an underlying cardiac disease.

scholarly journals Electrical and structural adaptations of the paediatric athlete’s heart: a systematic review with meta-analysis

2017 ◽  
Vol 52 (4) ◽  
pp. 230-230 ◽  
Author(s):  
Gavin McClean ◽  
Nathan R Riding ◽  
Clare L Ardern ◽  
Abdulaziz Farooq ◽  
Guido E Pieles ◽  
...  
Keyword(s):  
Systematic Review ◽  
Wall Thickness ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Black Athletes ◽  
Ecg Changes ◽  
The Impact ◽  
And Training ◽  
Athlete's Heart

AimTo describe the electrocardiographic (ECG) and echocardiographic manifestations of the paediatric athlete’s heart, and examine the impact of age, race and sex on cardiac remodelling responses to competitive sport.DesignSystematic review with meta-analysis.Data sourcesSix electronic databases were searched to May 2016: MEDLINE, PubMed, EMBASE, Web of Science, CINAHL and SPORTDiscus.Inclusion criteria(1) Male and/or female competitive athletes, (2) participants aged 6–18 years, (3) original research article published in English language.ResultsData from 14 278 athletes and 1668 non-athletes were included for qualitative (43 articles) and quantitative synthesis (40 articles). Paediatric athletes demonstrated a greater prevalence of training-related and training-unrelated ECG changes than non-athletes. Athletes ≥14 years were 15.8 times more likely to have inferolateral T-wave inversion than athletes <14 years. Paediatric black athletes had significantly more training-related and training-unrelated ECG changes than Caucasian athletes. Age was a positive predictor of left ventricular (LV) internal diameter during diastole, interventricular septum thickness during diastole, relative wall thickness and LV mass. When age was accounted for, these parameters remained significantly larger in athletes than non-athletes. Paediatric black athletes presented larger posterior wall thickness during diastole (PWTd) than Caucasian athletes. Paediatric male athletes also presented larger PWTd than females.ConclusionsThe paediatric athlete’s heart undergoes significant remodelling both before and during ‘maturational years’. Paediatric athletes have a greater prevalence of training related and training-unrelated ECG changes than non-athletes, with age, race and sex mediating factors on cardiac electrical and LV structural remodelling.

Cardiovascular adaptation to exercise and sport: (according to type of sport, gender, and ethnicity)

ESC CardioMed ◽  
2018 ◽  
pp. 2913-2916
Author(s):  
Michael Papadakis ◽  
Sanjay Sharma
Keyword(s):  
Female Athletes ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Endurance Athletes ◽  
Physiological Adaptation ◽  
Imaging Studies ◽  
Eccentric Hypertrophy ◽  
Athlete's Heart ◽  
Adaptation To Exercise

‘Athlete’s heart’ is associated with several structural and electrophysiological adaptations, which are reflected on the 12-lead electrocardiogram (ECG) and imaging studies. Most studies investigating cardiac remodelling in athletes are based on cohorts of white, adult, male athletes competing in the most popular sports. Evidence suggests, however, that sporting discipline and the athlete’s gender and ethnicity are important determinants of cardiovascular adaptation to exercise. Athletes competing in endurance sports demonstrate more pronounced adaptations in comparison to athletes performing static or resistance training. The ECG of endurance athletes is more likely to demonstrate repolarization anomalies in the anterior leads and ventricular dilatation on imaging studies, causing considerable overlap with arrhythmogenic right ventricular cardiomyopathy and dilated cardiomyopathy. Female athletes exhibit less pronounced adaptations compared to males, in terms of the prevalence of ECG changes and absolute cardiac dimensions. Importantly, female endurance athletes are more likely to demonstrate eccentric hypertrophy compared to males, suggesting that concentric remodelling or hypertrophy in female endurance athletes is unlikely to be the consequence of physiological adaptation to training. The most pronounced paradigm of ethnically distinct cardiovascular adaptation to exercise stems from black athletes, who exhibit a significantly higher prevalence of repolarization anomalies and left ventricular hypertrophy compared to white athletes, making the differentiation between athlete’s heart and hypertrophic cardiomyopathy challenging in this ethnic group.

Ambulatory (24-hour Holter monitoring, event recorders) and signal-averaged ECG for arrhythmia registration in the athlete’s heart

2019 ◽  
pp. 107-114
Author(s):  
Mahdi Sareban ◽  
Josef Niebauer
Keyword(s):  
Clinical Importance ◽  
Holter Monitoring ◽  
Athlete’S Heart ◽  
Grey Zone ◽  
Diagnostic Uncertainty ◽  
Diagnostic Work ◽  
Work Up ◽  
Opening Up ◽  
Heart Arrhythmias ◽  
Athlete's Heart

Systematic physical exercise leads to structural, functional, and electrical cardiovascular changes summarized in the term ‘athlete’s heart’. Arrhythmias that are common features in the resting ECG of otherwise healthy athletes may be an expression of the athlete’s heart, but on the other hand may be caused by underlying cardiac pathology, opening up a grey zone of diagnostic uncertainty. Differentiating adaptive changes from pathological cardiac conditions is of great clinical importance because some cardiomyopathies are leading causes of sudden cardiac death in athletes. In addition, there is increasing evidence that excessive endurance training may induce intermittent atrial arrhythmias, which can be hard to detect by resting ECG. Therefore this chapter will highlight 24-hour Holter monitoring, event recorders, and signal-averaged ECGs in the emerging field of ambulatory arrhythmia registration as part of the diagnostic work-up of athlete’s heart.

Accuracy of the ECG for differential diagnosis between hypertrophic cardiomyopathy and athlete’s heart: comparison between the European Society of Cardiology (2010) and International (2017) criteria

2017 ◽  
Vol 52 (10) ◽  
pp. 667-673 ◽  
Author(s):  
Alessandro Zorzi ◽  
Chiara Calore ◽  
Riccardo Vio ◽  
Antonio Pelliccia ◽  
Domenico Corrado
Keyword(s):  
Differential Diagnosis ◽  
Hypertrophic Cardiomyopathy ◽  
European Society ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Ecg Changes ◽  
Group 2 ◽  
European Society Of Cardiology ◽  
Athlete's Heart ◽  
Group 1

BackgroundInterpretation of the athlete’s ECG is based on differentiation between benign ECG changes and potentially pathological abnormalities. The aim of the study was to compare the 2010 European Society of Cardiology (ESC) and the 2017 International criteria for differential diagnosis between hypertrophic cardiomyopathy (HCM) and athlete’s heart.MethodsThe study populations included 200 patients with HCM and 563 athletes grouped as follows: ‘group 1’, including normal ECG and isolated increase of QRS voltages, which are considered non-pathologic according to ESC and International criteria; ‘group 2’, including left atrial enlargement or left axis deviation in isolation and Q-waves with an amplitude ≥4 mm but <25% of the ensuing R-wave and a duration <0.04 s which are considered pathologic according to the ESC but not according to the International criteria; and ‘group 3’, including abnormalities which are considered pathologic according to ESC and International criteria.ResultsOverall, the 2010 ESC criteria showed a sensitivity of 95.5% and a specificity of 86.9%. Considering group 2 ECG changes as normal according to the International criteria led to a statistically significant (p<0.001) increase of specificity to 95.9%, associated with a non-significant (p=0.47) reduction of sensitivity to 93%. Among patients with HCM, there was a significant increase of maximal left ventricular wall thickness from group 1 to 3 (p=0.02).ConclusionsThe use of 2017 International criteria is associated with a substantial increase in specificity and a marginal decrease in sensitivity for differential diagnosis between HCM and athlete’s heart.

Brugada Syndrome and Exercise Practice: Current Knowledge, Shortcomings and Open Questions

2017 ◽  
Vol 38 (08) ◽  
pp. 573-581 ◽  
Author(s):  
Giuseppe Mascia ◽  
Elena Arbelo ◽  
James Hernandez-Ojeda ◽  
Francesco Solimene ◽  
Ramon Brugada ◽  
...  
Keyword(s):  
Brugada Syndrome ◽  
Current Knowledge ◽  
Recovery Period ◽  
Hereditary Disease ◽  
Cardiac Events ◽  
Open Questions ◽  
Increased Risk ◽  
Exercise Effect ◽  
Electrocardiogram Ecg ◽  
Ecg Abnormalities

AbstractSince its recognition as a clinical entity in 1992, the Brugada Syndrome (BrS), a hereditary disease characterized by a typical electrocardiogram (ECG) pattern potentially predisposing to sudden cardiac death (SCD), has attracted the attention of many physicians for its circadian pattern of ventricular arrhythmias (VA), mostly occurring at rest. Exercise may potentially worsen the ECG abnormalities in BrS patients, resulting in higher peak J-point amplitudes during the vasovagal reaction of the recovery period, possibly leading to an increased risk of cardiac events. Moreover, the enhanced vagal tone in athletes could be both a BrS risk factor and an exercise effect. Therefore, the true risk of a BrS patient during exercise is still unclear. This review summarizes current knowledge, shortcomings and open questions on BrS and exercise. The paper, in particular, underlines specific considerations including BrS diagnostic criteria and differential diagnosis in athletes, the genetic basis, the autonomic imbalance during exercise practice and the recommendations for athletic participation in this patient group.

scholarly journals Electrocardiographic and Echocardiographic Insights From a Prospective Registry of Asian Elite Athletes

2022 ◽  
Vol 8 ◽  
Author(s):  
Tee Joo Yeo ◽  
Mingchang Wang ◽  
Robert Grignani ◽  
James McKinney ◽  
Lay Pheng Koh ◽  
...  
Keyword(s):  
Female Athletes ◽  
Elite Athletes ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Left Ventricular Cavity ◽  
Male Athletes ◽  
Endurance Sport ◽  
Electrocardiogram Ecg ◽  
Athlete's Heart

Background: Asian representation in sport is increasing, yet there remains a lack of reference values for the Asian athlete's heart. Consequently, current guidelines for cardiovascular screening recommend using Caucasian athletes' norms to evaluate Asian athletes. This study aims to outline electrocardiographic and echocardiographic characteristics of the Asian athlete's heart using a Singaporean prospective registry of Southeast (SE) Asian athletes.Methods and Results: One hundred and fifty elite athletes, mean age of 26.1 ± 5.7 years (50% males, 88% Chinese), were evaluated using a questionnaire, 12-lead electrocardiogram (ECG) and transthoracic echocardiogram. All ECGs were analyzed using the 2017 International Recommendations. Echocardiographic data were presented by gender and sporting discipline. The prevalence of abnormal ECGs among SE Asian athletes was 6.7%—higher than reported figures for Caucasian athletes. The abnormal ECGs comprised mainly anterior T wave inversions (ATWI) beyond lead V2, predominantly in female athletes from mixed/endurance sport (9.3% prevalence amongst females). None had echocardiographic structural abnormalities. Male athletes had reduced global longitudinal strain compared to females (−18.7 ± 1.6 vs. −20.7 ± 2.1%, p &lt; 0.001). Overall, SE Asian athletes had smaller left ventricular cavity sizes and wall thickness compared to non-Asian athletes.Conclusion: SE Asian athletes have higher abnormal ECG rates compared to Caucasian athletes, and also demonstrate structural differences that should be accounted for when interpreting their echocardiograms compared to athletes of other ethnicities.

Cardiovascular adaptation to exercise and sport: (according to type of sport, gender, and ethnicity)

ESC CardioMed ◽  
2018 ◽  
pp. 2913-2916
Author(s):  
Michael Papadakis ◽  
Sanjay Sharma
Keyword(s):  
Female Athletes ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Endurance Athletes ◽  
Physiological Adaptation ◽  
Imaging Studies ◽  
Eccentric Hypertrophy ◽  
Athlete's Heart ◽  
Adaptation To Exercise

‘Athlete’s heart’ is associated with several structural and electrophysiological adaptations, which are reflected on the 12-lead electrocardiogram (ECG) and imaging studies. Most studies investigating cardiac remodelling in athletes are based on cohorts of white, adult, male athletes competing in the most popular sports. Evidence suggests, however, that sporting discipline and the athlete’s gender and ethnicity are important determinants of cardiovascular adaptation to exercise. Athletes competing in endurance sports demonstrate more pronounced adaptations in comparison to athletes performing static or resistance training. The ECG of endurance athletes is more likely to demonstrate repolarization anomalies in the anterior leads and ventricular dilatation on imaging studies, causing considerable overlap with arrhythmogenic right ventricular cardiomyopathy and dilated cardiomyopathy. Female athletes exhibit less pronounced adaptations compared to males, in terms of the prevalence of ECG changes and absolute cardiac dimensions. Importantly, female endurance athletes are more likely to demonstrate eccentric hypertrophy compared to males, suggesting that concentric remodelling or hypertrophy in female endurance athletes is unlikely to be the consequence of physiological adaptation to training. The most pronounced paradigm of ethnically distinct cardiovascular adaptation to exercise stems from black athletes, who exhibit a significantly higher prevalence of repolarization anomalies and left ventricular hypertrophy compared to white athletes, making the differentiation between athlete’s heart and hypertrophic cardiomyopathy challenging in this ethnic group.

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