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ECG Quiz: Can This College Athlete Compete?

John D. Cantwell, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 4 - APRIL 96


[FIGURE 1]A 20-year-old male college sprinter and hurdler was seen for a cardiology assessment because a preseason cardiac evaluation revealed a heart murmur dating back to early childhood. He was asymptomatic.

The athlete recalled first seeing a physician about the murmur at age 10. He said his physician's diagnosis was congenital aortic stenosis. He typically ran 2.5 miles three or four times a week and trained in the sprints and hurdles.

On physical examination his blood pressure was 120/70 mm Hg and his pulse was 66 per minute and regular. The carotid pulses were grade 3/4 in amplitude and bisferiens in contour (having a shudder at the peak amplitude). His chest was clear on auscultation. The heart was not increased in size, and the apex impulse was not sustained. A grade 2/6 systolic ejection murmur was heard at the base and apex and radiated to the neck. An early systolic ejection click was audible at the apex.

His resting electrocardiogram (ECG) is shown in figure 1. On the Bruce protocol treadmill test he had a duration of 14.2 minutes, stopping because of shin fatigue and reaching a peak heart rate of 191 beats per minute and a blood pressure of 180/70 mm Hg. The exercise ECG was normal to 95% of age-predicted maximum heart rate. He did not have symptoms of chest pain, near syncope, or dyspnea. An echocardiogram revealed a functional bicuspid aortic valve with partial fusion of the right and noncoronary cusps. The instantaneous aortic valve gradient was 28 mm Hg, and the mean gradient was 14 mm Hg. He had mild aortic regurgitation.

What is your interpretation of the ECG? On the basis of this information, would you allow this athlete to compete?

Dr Cantwell is director of preventive medicine and cardiac rehabilitation at Georgia Baptist Medical Center and clinical professor of medicine at Morehouse School of Medicine in Atlanta. He is a member of the editorial board of The Physician and Sportsmedicine and chief medical officer of the 1996 Centennial Olympic Games. Address correspondence to John D. Cantwell, MD, 340 Boulevard NE, Suite 200, Box 413, Atlanta, GA 30312.


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