Volume 3, Issue 4, December 2019, Page: 86-89
ST Elevation in a Professional Athlete: From the Coronary Care Unit to the Field
Maria Boutsikou, Department of Pediatric, Athens University Medical School, Children’s Hospital “Aghia Sophia”, Athens, Greece; Mediterraneo Hospital, Athens, Greece
Elias Sanidas, Department of Cardiology, Laiko General Hospital, Athens, Greece
Gkiouzelis Giasemis, Agios Paulos General Hospital, Thessaloniki, Greece
George Ziogas, Sportsclinic, Thessaloniki, Greece
George Dangas, Icahn School of Medicine at Mount Sinai, New York, USA
Panagiotis Stamatopoulos, Department of Pediatric, Athens University Medical School, Children’s Hospital “Aghia Sophia”, Athens, Greece
Received: Jul. 10, 2019;       Accepted: Sep. 17, 2019;       Published: Sep. 30, 2019
DOI: 10.11648/j.ccr.20190304.12      View  23      Downloads  10
Abstract
Interpretation of ECG in athletes can be quite challenging as it requires adequate experience to distinguish physiologic changes related to adaptation to training from pathologic findings. ECG interpretation is an important diagnostic tool for high intensity trained athletes. Herein, we present the case of a young high-competitive athlete who presented with a variant ST elevation on 12lead ECG that was initially considered suspicious of myocardial infarction. Diagnostic workup including clinical examination, echocardiogram, 12-lead surface ECG and laboratory tests (troponin and CK-MB) did not confirm the presence of acute coronary syndrome. The patient was monitored for a few hours and was finally discharged with no restrictions regarding training. ECG in the present case resembles Wellen’s syndrome pattern which represents a pre-infarction stage of CAD with a significant proximal left anterior descending artery (LAD) stenosis that will be followed by ACS of anterior wall if left untreated. However, there were no other findings to support the clinical diagnosis of Wellen’s syndrome in our case and the ECG changes were attributed to a physiological adaptation to training. During exercise several ECG adjustments develop as a result of the decreased sympathetic tone and the increased parasympathetic tone combined with the heterogeneity of ventricle repolarization. The preparticipation screening performed by experienced physicians in the field of sports cardiology is crucial in order to recognize physiologic cardiovascular adaptation to exercise and exclude cardiovascular abnormalities.
Keywords
ECG, ST Elevation, Biphasic T Waves, Early Repolarization, Athlete, Training, Wellen’s Syndrome
To cite this article
Maria Boutsikou, Elias Sanidas, Gkiouzelis Giasemis, George Ziogas, George Dangas, Panagiotis Stamatopoulos, ST Elevation in a Professional Athlete: From the Coronary Care Unit to the Field, Cardiology and Cardiovascular Research. Vol. 3, No. 4, 2019, pp. 86-89. doi: 10.11648/j.ccr.20190304.12
Copyright
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Van der Wall EE. ECG screening in athletes: optional or mandatory? Neth Heart J 2015; 23: 353-5.
[2]
Sharma S, Drezner JA, Baggish A et al. International Recommendations for Electrocardiographic Interpretation in Athletes. J Am Coll Cardiol 2017; 69: 1057-1075.
[3]
Pluim BM, Zwinderman AH, van der Laarse A, van der Wall EE. The athlete's heart. A meta-analysis of cardiac structure and function. Circulation 2000; 101: 336-44.
[4]
Sheikh N, Papadakis M, Ghani S et al. Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes. Circulation 2014; 129: 1637-49.
[5]
Sharma S, Merghani A, Mont L. Exercise and the heart: the good, the bad, and the ugly. Eur Heart J 2015; 36: 1445-53.
[6]
Waase MP, Mutharasan RK, Whang W et al. Electrocardiographic Findings in National Basketball Association Athletes. JAMA Cardiol 2018; 3: 69-74.
[7]
de Zwaan C, Bar FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J 1982; 103: 730-6.
[8]
Miner B, Hart EH. Wellens Syndrome. StatPearls. Treasure Island (FL), 2018.
[9]
Agarwal A, Vyas S, Kumar R. Wellen's syndrome: Challenges in diagnosis. Malays Fam Physician 2015; 10: 35-7.
[10]
Drezner JA, Ackerman MJ, Anderson J et al. Electrocardiographic interpretation in athletes: the 'Seattle criteria'. Br J Sports Med 2013; 47: 122-4.
[11]
Grazioli G, Merino B, Montserrat S et al. Usefulness of echocardiography in preparticipation screening of competitive athletes. Rev Esp Cardiol (Engl Ed) 2014; 67: 701-5.
[12]
Mitchell AR, Hurry R, Le Page P, MacLachlan H. Pre-participation cardiovascular screening: is community screening using hand-held cardiac ultrasound feasible? Echo Res Pract 2015; 2: 49-55.
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