![]() ![]() The arrhythmias present in very fit young people may be even more dramatic but equally benign. ![]() On the ECG under consideration, there is a marked sinus arrhythmia. Benign arrhythmias are common on the ECGs of athletes Tall R and deep S waves in isolation, are not an indication for further investigation in a young person. In contrast, the same findings associated with widespread repolarization abnormalities (T wave inversion) in ECG (B) would be a cause for concern and would merit further investigation. ECG (A) below does not cause great concern in a young sportsman. However, the great majority of HOCM cases will demonstrate ST changes and/or pathological deviation of the cardiac axis in association with the R and S wave changes of hypertrophy. The perceived risk here is that we could miss a case of hypertrophic obstructive cardiomyopathy (HOCM), a condition associated with left ventricular hypertrophy and sudden death. When considered in clinical context, the R waves and S waves on his ECG are normal. He probably does have a degree of left ventricular hypertrophy but this is expected as a normal consequence of regular training. The young mans ECG easily satisfies the published criteria for left ventricular hypertrophy (see below). There is some doubt, however, as to whether these criteria are in any way applicable to the young. The criteria are reasonably specific and have been validated in the old and middle aged subjects in recent years using cardiac MRI. The criteria (Sokolow-Lyon criterion) for pathological ventricular hypertrophy were established in post-mortem comparisons of heart size to ante-mortem ECGs. In general terms, the height of the R waves in the left lateral chest leads and the depth of the S waves in the right sided chest leads correlate with the muscle mass of the left ventricle. The young have tall R waves and deep S waves When analyzing the ECG of young men, particularly those who are physically trained we must keep 5 (maybe 6) things in mind 1. The answers to these questions are no and yes (if selected). Cardiovascular examination is completely normal.Īs indicated by the reviewing doctor below, his ECG is strikingly different from those we are used to looking at in clinical practice but is it any cause for concern? Will he be able to play next Saturday? On examination, he is 6′ tall and weighs 145 pounds. His mother is concerned about a lack of energy obvious in several recent matches. He plays multiple contact sports and trains regularly. It is taken from a schoolboy aged 16 years. Getting an ECG is easy, reading them in the young is challenging. There is currently interest in the application of ECG screening to young sports people. It is not endorsed by any clinical body and should not guide clinical practice. It contains the personal views of the author and is designed to generate discussion only. ![]()
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