scholarly journals Electrocardiography in pre-participation screening and current guidelines for participation in competitive sports

2016 ◽  
Vol 144 (1-2) ◽  
pp. 104-110 ◽  
Author(s):  
Ljubica Georgijevic ◽  
Lana Andric
Keyword(s):  
Ventricular Tachycardia ◽  
Qt Interval ◽  
Sinus Bradycardia ◽  
Left Ventricular ◽  
Polymorphic Ventricular Tachycardia ◽  
Ecg Changes ◽  
Sinus Arrhythmia ◽  
Intraventricular Conduction ◽  
Wave Inversion ◽  
St Segment

Electrocardiography (ECG) is especially significant in pre-participation screening due to its ability to discover or to rise a suspicion for certain cardiovascular diseases and conditions that represent a serious health risk in athletes. Common, conditionally benign and training related ECG changes are sinus bradycardia and sinus arrhythmia, first degree atrioventricular block, incomplete right bundle branch block, benign early repolarization, and isolated QRS voltage criteria for left ventricular enlargement. Uncommon ECG changes, unrelated to training, and some specific syndromes are ST segment depression and/or ? 2mm T wave inversion in two or more adjacent leads, intraventricular conduction disorder, Wolf-Parkinson-White syndrome, long QT interval syndrome, short QT interval syndrome, catecholaminergic polymorphic ventricular tachycardia, monomorphic ventricular extrasystole and benign ventricular tachycardia.

scholarly journals Prevalence of Abnormal and Borderline Electrocardiogram Changes in 13, 079 Chinese Amateur Marathon Runners

2020 ◽  
Author(s):  
Xu Wen ◽  
Yumin Huang ◽  
Tonghui Shen ◽  
Yinglan Gong ◽  
Ruiqing Dong ◽  
...  
Keyword(s):  
Qt Interval ◽  
Sinus Bradycardia ◽  
Premature Ventricular Contraction ◽  
Left Ventricular ◽  
Ecg Changes ◽  
Sinus Arrhythmia ◽  
Marathon Runners ◽  
St Segment ◽  
Prolonged Qt Interval ◽  
Prolonged Qt

Abstract The purpose of this study was to assess the prevalence of normal, borderline and abnormal ECG changes in marathon runners. The 12-lead ECG data of 13,079 amateur marathon runners between the ages of 18 and 35 years were included for analysis. The prevalence of ECG abnormalities among different gender groups was compared with chi-square tests. In terms of training-related changes, sinus bradycardia, sinus arrhythmia and left ventricular high voltage were found in approximately 15%, 5% and 3.28% of the participants, respectively. The incidence of right axis deviation in the marathon runners was 1.78%, which was slightly higher than the incidence of left axis deviation (0.88%). No more than 0.1% of the amateur marathon runners exhibited ST segment depression, T wave inversion (TWI), premature ventricular contraction, pathologic Q waves and prolonged QT interval. In conclusion, training-related ECG changes, including sinus bradycardia, sinus arrhythmia and left ventricular high voltage, were common in the amateur marathon runners. Most of abnormal ECG changes, including ST segment depression, TWI, premature ventricular contraction, pathologic Q waves and prolonged QT interval, were infrequently found in the amateur marathon runners.

scholarly journals Prevalence of abnormal and borderline electrocardiogram changes in 13, 079 Chinese amateur marathon runners

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Xu Wen ◽  
Yu-min Huang ◽  
Tong-Hui Shen ◽  
Ying-Lan Gong ◽  
Rui-qing Dong ◽  
...  
Keyword(s):  
Sinus Bradycardia ◽  
Premature Ventricular Contraction ◽  
Left Ventricular ◽  
Ecg Changes ◽  
Sinus Arrhythmia ◽  
Marathon Runners ◽  
St Segment ◽  
Prolonged Qt Interval ◽  
Prolonged Qt ◽  
Ecg Abnormalities

Abstract Background The 12-lead electrocardiogram (ECG) has been adopted as an important component of preparticipation cardiovascular screening. However, there are still controversies in the screening and few studies with a large sample size have reported the results of ECGs of marathon runners. Therefore, the purpose of this study was to assess the prevalence of normal, borderline, and abnormal ECG changes in marathon runners. Methods The 12-lead ECG data of 13,079 amateur marathon runners between the ages of 18 and 35 years were included for analysis. The prevalence of ECG abnormalities among different gender groups was compared with chi-square tests. Results In terms of training-related changes, sinus bradycardia, sinus arrhythmia, and left ventricular high voltage were found in approximately 15, 5, and 3.28% of the participants, respectively. The incidence of right axis deviation in the marathon runners was 1.78%, which was slightly higher than the incidence of left axis deviation (0.88%). No more than 0.1% of the amateur marathon runners exhibited ST-segment depression, T wave inversion (TWI), premature ventricular contraction, pathologic Q waves, and prolonged QT interval. Conclusions Training-related ECG changes, including sinus bradycardia, sinus arrhythmia, and left ventricular high voltage, were common in amateur marathon runners. Most abnormal ECG changes, including ST-segment depression, TWI, premature ventricular contraction, pathologic Q waves, and prolonged QT interval, were infrequently found in amateur marathon runners. The data also suggested Chinese amateur marathon runners may have a relatively lower prevalence of ECG abnormalities than black and white runners.

scholarly journals Cardiac Involvement in COVID-19 Patients: A Contemporary Review

2021 ◽  
Vol 13 (2) ◽  
pp. 494-517
Author(s):  
Domenico Maria Carretta ◽  
Aline Maria Silva ◽  
Donato D’Agostino ◽  
Skender Topi ◽  
Roberto Lovero ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Chest Pain ◽  
Wave Amplitude ◽  
Acute Myocarditis ◽  
Left Ventricular ◽  
Shortness Of Breath ◽  
Ecg Changes ◽  
Presenting Symptoms ◽  
T Wave ◽  
St Segment

Background: The widely variable clinical manifestations of SARS-CoV2 disease (COVID-19) range from asymptomatic infections to multiple organ failure and death. Among the organs affected is the heart. This does not only affect people who already have previous cardiovascular problems, but also healthy people. This is a reason not to overlook any symptoms or to perform targeted examinations, even if apparently unrelated to the heart, for quick recognition and timely therapy. Aim of the study: This review recapitulates the current state of knowledge on the potential mechanisms and manifestation of myocarditis in patients with COVID-19 infection. Methods: A web-based search of published data was performed for all relevant studies on patients diagnosed with a COVID-19-induced acute myocarditis, and a total of 50 reports were included. The analysis of the studies evaluated highlights a male predominance, with the average age of patients being 55 years. The most common presenting symptoms included fever, shortness of breath, cough, and chest pain. Among ECG changes, non-specific ST-segment and T-wave amplitude alterations and ventricular tachycardia episodes were reported. Finally, we wanted to use a general evaluation without distinguishing between various countries, taking into consideration only the peer or reviewer, regardless of the declared value of the journals that have been published. Results and critical findings: The most common presenting symptoms included fever, shortness of breath, cough, and chest pain. Among ECG changes, non-specific ST-segment and T-wave amplitude alterations and ventricular tachycardia episodes were reported. In most patients, elevated levels of cardiac and inflammatory biomarkers were measured. Left ventricular dysfunction and hypokinesis were commonly exhibited symptoms. Cardiac Magnetic Resonance Imaging (CMRI) confirmed the diagnosis of myocarditis with features of cardiac edema and cardiac injury. Nine patients underwent histopathological examination. Treatment with corticosteroids and immunoglobulins was the most applied strategy following the administration of antivirals. Discussion: Despite the exponentially growing knowledge on the management of COVID-19 infection, current available data on SARS-CoV2-correlated myocarditis are still limited, and several difficulties may be encountered in the differential diagnosis of acute myocarditis in the context of COVID-19 disease. Conclusions: While diagnostic criteria and evaluation strategies for myocarditis are well described, no guidelines for the diagnosis and treatment of myocarditis in COVID-19 patients have yet been established. Therefore, further research is needed to advance the understanding of this disease process and define the most appropriate strategic approach in these patients.

scholarly journals Just Sinus Bradycardia or Something More Serious?

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Kelly R. Egan ◽  
J. Carter Ralphe ◽  
Larry Weinhaus ◽  
Kathleen R. Maginot
Keyword(s):  
Ventricular Tachycardia ◽  
Sinus Bradycardia ◽  
Pacemaker Implantation ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Polymorphic Ventricular Tachycardia ◽  
Beta Blockade ◽  
Left Ventricular Myocardium ◽  
Exercise Induced ◽  
Well Child Visit

An asymptomatic 5-year-old girl presented with bradycardia during a routine well-child visit. Further evaluation revealed profound sinus bradycardia, exercise-induced bidirectional ventricular tachycardia, and supraventricular tachycardia. An echocardiogram showed heavy trabeculations in the left ventricular myocardium. This patient’s presentation suggested catecholaminergic polymorphic ventricular tachycardia and left ventricular noncompaction. Genetic testing revealed mutations in the cardiac ryanodine receptor (RyR2), calsequestron (CASQ2), and titin (TTN). She was effectively treated with beta-blockade to suppress tachyarrhythmias and pacemaker implantation to treat her bradycardia.

scholarly journals Catecholaminergic polymorphic ventricular tachycardia complicated by dilated cardiomyopathy: a case report

2020 ◽  
Author(s):  
Granitz Christina ◽  
Jirak Peter ◽  
Strohmer Bernhard ◽  
Pölzl Gerhard
Keyword(s):  
Heart Failure ◽  
Ventricular Tachycardia ◽  
Dilated Cardiomyopathy ◽  
Sinus Bradycardia ◽  
Clinical Care ◽  
Structural Heart Disease ◽  
Catecholaminergic Polymorphic Ventricular Tachycardia ◽  
Polymorphic Ventricular Tachycardia ◽  
Myocardial Inflammation ◽  
As Stress

Abstract Background  Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a severe genetic arrhythmogenic disorder characterized by adrenergically induced ventricular tachycardia manifesting as stress-induced syncope and sudden cardiac death. While CPVT is not associated with dilated cardiomyopathy (DCM) in most cases, the combination of both disease entities poses a major diagnostic and therapeutic challenge. Case summary  We present the case of a young woman with CPVT. The clinical course since childhood was characterized by repetitive episodes of exercise-induced ventricular arrhythmias and a brady-tachy syndrome due to rapid paroxysmal atrial fibrillation and sinus bradycardia. Medical treatment included propranolol and flecainide until echocardiography showed a dilated left ventricle with severely depressed ejection fraction when the patient was 32 years old. Cardiac magnetic resonance imaging revealed non-specific late gadolinium enhancement. Myocardial inflammation, however, was excluded by subsequent endomyocardial biopsy. Genetic analysis confirmed a mutation in the cardiac ryanodine receptor but no pathogenetic variant associated with DCM. Guideline-directed medical therapy for HFrEF was limited due to symptomatic hypotension. Over the next months, the patient developed progressive heart failure symptoms that were finally managed by heart transplantation. Discussion  Management in patients with CPVT and DCM is challenging, as Class I antiarrhythmic drugs are not recommended in structural heart disease and prophylactic internal cardioverter-defibrillator implantation without adjuvant antiarrhythmic therapy can be detrimental. Regular echocardiographic screening for DCM is recommendable in patients with CPVT. A multidisciplinary team of heart failure specialists, electrophysiologists, geneticists, and imaging specialists is needed to collaborate in the delivery of clinical care.

scholarly journals The mortal cause of sudden ECG changes in patients with chronic aortic insufficiency: Aortic dissection

2019 ◽  
Vol 11 (1) ◽  
pp. 68-70
Author(s):  
Mahmut Yesin ◽  
Turgut Karabağ ◽  
Macit Kalçık ◽  
Süleyman Karakoyun ◽  
Metin Çağdaş ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Signs And Symptoms ◽  
Aortic Insufficiency ◽  
Ecg Changes ◽  
St Segment Elevation ◽  
T Wave ◽  
Wave Inversion ◽  
St Segment ◽  
High Index Of Suspicion

The symptoms of aortic dissection (AD) may be highly variable and may mimic other much common conditions. Thus, a high index of suspicion should be maintaned, especially when the risk factors for AD are present or signs and symptoms suggest this possibility. However, sometimes AD may be asymptomatic or progression may be subclinical. Various electrocardiographical (ECG) changes may be seen in AD patients such as ST segment elevation in aVR as well as ST segment depression and T-wave inversion. In this case report, we reported a patient with acute AD whose ECG revealed ST segment elevation in aVR lead in addition to diffuse ST segment depression in other leads.

Abstract 4840: Tako-Tsubo Cardiomyopathy without Apical Ballooning - Results of the German Tako-Tsubo Registry

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Anastasios Athanasiadis ◽  
Birke Schneider ◽  
Johannes Schwab ◽  
Uta Gottwald ◽  
Ellen Hoffmann ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Ejection Fraction ◽  
Wall Motion ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
T Wave ◽  
Wave Inversion ◽  
St Segment ◽  
Tako Tsubo Cardiomyopathy

Background : The German tako-tsubo cardiomyopathy (TTC) registry has been initiated to further evaluate this syndrome in a western population. We aimed to assess different patterns of left ventricular involvement in TTC. Methods : Inclusion criteria were: 1) acute chest symptoms, 2) reversible ECG changes (ST-segment elevation±T-wave inversion), 3) reversible left ventricular dysfunction with a wall motion abnormality not corresponding to a single coronary artery territory, 4) no significant coronary artery stenoses. Results : A total of 258 patients (pts) from 33 centers were included with a mean age of 68±12 years. Left ventriculography revealed the typical pattern of apical ballooning in 170 pts (66%) and an atypical mid-ventricular ballooning with normal wall motion of the apical and basal segments in 88 pts (34%). Mean age (68±11 vs 67±13 years) and gender distribution (150 women/20 men vs 80 women/8 men) were similar in both groups. Triggering events were present in 78% of the pts with apical ballooning (35% emotional, 34 physical and 9% combination) and in 75% of the pts with mid-ventricular ballooning (39% emotional, 25% physical and 11% combination). As assessed by left ventriculography, ejection fraction was significantly lower in pts with mid-ventricular ballooning (50±15% vs 45±13%, p=0.006). There was no difference in right ventricular involvement. Creatine kinase and troponin I were comparable in both groups. The ECG on admission showed ST-segment elevation in 87% of pts with apical ballooning and in 78% of pts with mid-ventricular ballooning. T-wave inversion was seen in 70% of the pts irrespective of the TTC variant. A Q-wave was significantly less present in pts with mid-ventricular ballooning (30% vs 16%, p=0.04). The QTc interval during the first 3 days was not different among both groups. Conclusion : A variant form with mid-ventricular ballooning was observed in one third of the pts with TTC. Left ventricular ejection fraction was significantly lower in these pts, although they revealed significantly less Q-waves on the admission ECG. All other parameters were similar and confirm the concept that apical and mid-ventricular ballooning represent two different manifestations of the same syndrome.

scholarly journals A STEMI gone viral

2017 ◽  
Vol 4 (3) ◽  
pp. 34
Author(s):  
William Wung ◽  
Alison G Chang ◽  
Thomas WR Smith
Keyword(s):  
Coronary Artery Disease ◽  
Ventricular Tachycardia ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Left Ventricular Ejection ◽  
Electrical Storm ◽  
Ecg Changes ◽  
Artery Disease

A 65-year-old male with a history of coronary artery disease and ankylosing spondylitis presented with focal ECG changes and elevated cardiac biomarkers suggestive of an acute lateral ST-elevation myocardial infarction. Emergent coronary angiography surprisingly showed non-obstructive coronary artery disease. Further workup including a cardiac MRI, viral serologies, and an endomyocardial biopsy was consistent with focal Coxsackie viral myocarditis. The patient subsequently developed recurrent, pulseless ventricular tachycardia requiring multiple rounds of ACLS, and his left ventricular ejection fraction acutely dropped from 55% to 20%. An emergent intra-aortic balloon pump was placed, and an intravenous lidocaine infusion and high-dose corticosteroids were started for the patient’s electrical storm and myocarditis, respectively. The patient was eventually discharged in stable condition with an implantable cardiac defibrillator. No further episodes of ventricular tachycardia were noted at six-month follow-up. In patients with acute ECG changes, elevated cardiac biomarkers, and no evidence of obstructive coronary artery disease, myocarditis should be considered as a leading diagnosis given the potentially life-threatening sequelae as seen in our patient.

Isolated left ventricular apical hypoplasia in a young child

2021 ◽  
Vol 14 (1) ◽  
pp. e239297
Author(s):  
H Ravi Ramamurthy ◽  
Onkar Auti ◽  
Vimal Raj ◽  
Kiran Viralam
Keyword(s):  
Left Ventricle ◽  
Left Ventricular ◽  
Long Term Outcomes ◽  
Wave Inversion ◽  
St Segment ◽  
Cardiac Apex ◽  
The Right ◽  
First Time ◽  
Left Lead

A 16-month-old, healthy, asymptomatic male child presented with a diagnosis of dilated cardiomyopathy. Cardiovascular examination and chest radiograph were normal. ECG revealed sinus rhythm, and the augmented vector left lead showed raised ST segment, T wave inversion and q waves. Echocardiography showed a globular left ventricle with notched cardiac apex, abnormal echogenicity in the left ventricular apical myocardium, single papillary muscle and normal biventricular function. Cardiac MRI scan revealed a globular left ventricle with fibrofatty changes and retraction of the apex, the papillary muscles closely approximated, and the right ventricle wrapping around the apex of the left ventricle. This is described as isolated left ventricular apical hypoplasia. Diagnosis of this rare entity can be made by MRI, and it has been diagnosed largely in adults. The pathophysiology and long-term outcomes are unknown. We characterise the echocardiography findings of this rare anomaly in a child for the first time in the literature.

ECG features and arrhythmias in takotsubo syndrome

ESC CardioMed ◽  
2018 ◽  
pp. 1298-1301
Author(s):  
Federico Migliore ◽  
Sebastiano Gili ◽  
Domenico Corrado
Keyword(s):  
Left Ventricular ◽  
Stunned Myocardium ◽  
Takotsubo Syndrome ◽  
St Segment Elevation ◽  
T Wave ◽  
Wave Inversion ◽  
Qt Interval Prolongation ◽  
St Segment ◽  
Reversible Left Ventricular Dysfunction ◽  
Repolarization Abnormalities

Takotsubo syndrome (TTS) is typically characterized by dynamic electrocardiographic (ECG) repolarization changes, which consist of mild ST-segment elevation on presentation (acute phase) followed by T-wave inversion with QT interval prolongation within 24–48 h after presentation (subacute phase). It is noteworthy that subacute ECG repolarization abnormalities of TTS resemble those of the so-called Wellens’ ECG pattern, which is characterized by transient T-wave inversion in the anterior precordial leads as a result of either myocardial ischaemia or other non-ischaemic conditions, all characterized by a reversible left ventricular dysfunction (‘stunned myocardium’).

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