T-wave inversions in adolescent athletes

23 March 2014

Organised by:

The case

Description

A 14-year-old, Caucasian boy presents to his general practitioner with occasional sharp chest pains aggravated by movement.
These have been worse over the past few months whilst he has been training hard with the school rowing team.
His past medical history includes asthma for which he takes a salbutamol inhaler.
His sister had surgical correction of tetralogy of Fallot as a baby and his father has hypertension which is well controlled on Ramipril.

This is his 12-lead ECG.

References

[*1] The prevalence, distribution and clinical outcomes of electrocardiographic repolarisation patterns in male athletes of African/Afro-Caribbean origin.
Papadakis M, Carre F, Kervio G, Rawlins J, Panoulas VF, Chandra N, Basavarajaiah S, Carby L, Fonseca T, Sharma S. Eur Heart J 2011;32:2304-13
[*2] The normal ECG in childhood and adolescence.
Dickinson DF. Heart. 2005; 91(12): 1626-1630
[*3] Prevalence and significance of T-wave inversions in predominantly Caucasian adolescent athletes.
Papadakis M, Basavarajaiah S, Rawlins J, Edwards C, Makan J, Firoozi S, Carby L, Sharma S. Eur Heart J. 2009;30:1728-35
[*4] Prevalence of cardiomyopathy in Italian asymptomatic children with electrocardiographic T-wave inversion at preparticipation screening. Migliore F, Zorzi A, Michieli P, Perazzolo Marra M, Siciliano M, Rigato I, Bauce B, Basso C, Toazza D, Schiavon M, Iliceto S, Thiene G, Corrado D. Circulation. 2012;125:529-38.
[*5] Cardiac adaptation to exercise in adolescent athletes of African ethnicity: an emergent elite athletic population.
Sheikh N, Papadakis M, Carre F, Kervio G, Panoulas VF, Ghani S, Zaidi A, Gati S, Rawlins J, Wilson MG, Sharma S.Br J Sports Med 2013;47:585-92.
[*6] Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia. Proposed Modification of the Task Force Criteria. Marcus FI et al. Eur Heart J 2010;31:806–814
[*7] The T wave of the precordial electrocardiogram at different age levels. Suarez RM, Suarez RM Jr. Am Heart J 1946;32:480 – 493.
[*8]Prevalence and Prognostic Significance of T-Wave Inversions in Right Precordial Leads of a 12-Lead Electrocardiogram in the Middle-Aged Subjects. Aro AL et al. Circulation 2012;125:2572-2577

Notes to editor

Dr Lynne Millar, Cardiology Research Fellow
Dr Michael Papadakis, Lecturer in Cardiology, St George’s University of London
Prof Sanjay Sharma, Professor of Clinical Cardiology, St George’s University of London