The athlete's heart - Memo 42
The Athlete Heart
Each week, our Director of Medicine Dr Harry Mond shares the real findings of unusual traces at CardioScan, and what they reveal. This is one of them:
We have been using the Seattle criteria which extends the limits of normal to include the “fit heart” athlete. Sometimes these changes tease us to report them as abnormal even for an athlete.
Here are a few examples:
This is just below the limit of 30 bpm for an athlete. The T wave changes are probably persistent juvenile but still make you think.
This one blew me away. It was reported as possible infarction, but I had seen it before.
This is the classical appearance of the North African athlete (this one from Senegal – yes check it on the map; it lies to the west). The Seattle Criteria define this as convex or domed ST elevation with T wave inversion in leads V1 to V4 in black African athletes.
The literature is very poor on this subject and I could find no good examples. It is always discussed with Brugada which makes you wonder if there is an incidence of sudden death in these athletes.
So I wrote to Sami Viskin in Israel who should know more about this than anyone else. He says there are two ECG appearances; those with J point elevation (the good one as in our case) and the bad one without J point elevation. There is an increased incidence of sudden death in this group of athletes.
Finally this is also an exaggerated normal appearance in an athlete.