Interpreting the Athlete´s EKG Are All Repolarization Anomalies Created Equal?

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The electric manifestations of athletic training have been described in large athletic populations consisting predominantly of young, white, male athletes, competing in a variety of sports. The 2010 European Society of Cardiology (ESC) recommendations attempted to differentiate between EKG features suggestive of athletic training (type-1 changes) from those that may be indicative of cardiac disease (type-2 changes) and warrant further investigation.1 During the past decade, the use of EKG-based preparticipation cardiac evaluation has gained recognition among a number of sporting organizations, and type-2 EKG patterns are likely to prompt the referral of an increasing number of athletes for comprehensive evaluation before clearance to compete. As such, the development of EKG criteria that are highly sensitive and specific is of paramount importance to ensure that the majority of athletes at potential risk of sudden cardiac death are identified, while minimizing unnecessary investigations or the risk of an erroneous diagnosis.

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The initial estimated prevalence of type-2 changes in the athlete’s EKG was 5%, but several subsequent studies have demonstrated that this figure is a gross underestimate. When the additive effect of various demographic factors such as age, sex, sporting discipline, body habitus, and ethnicity of the athlete are taken into consideration, the prevalence of type-2 EKG change is as high as 40% in certain groups.2 Such figures portray the EKG as a poor tool for discriminating between cardiac physiology and pathology, given that most type-2 EKG patterns do not amount to a diagnosis after investigation (false …

Autor / Fonte:Sanjay Sharma; Michael Papadakis. Circulation. 2015; 131: 128-130 Published online before print November 10, 2014, doi: 10.1161/CIRCULATIONAHA.114.013739