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ECG Quiz Question

ECG Variations in College Athletes

John D. Cantwell, MD; Allen L. Dollar, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 27 - NO. 9 - SEPTEMBER 1999


At Georgia Institute of Technology, the sports preparticipation evaluation includes a cardiovascular questionnaire and careful examination of the heart, listening especially for systolic murmurs that intensify with Valsalva's maneuver and/or standing, which could indicate hypertrophic cardiomyopathy (1,2).

Cardiovascular exam protocols vary from school to school. At Georgia Tech, all incoming freshman athletes undergo resting electrocardiography (ECG), mainly to screen for long QT intervals and deep Q waves or extreme hypertrophy. A prolonged QT interval might reflect an increased risk for sudden death (3). Hypertrophy can be physiologic, but extreme hypertrophy might signal underlying cardiomyopathy. The initial ECG can also serve as a baseline for comparison should an athlete develop new-onset chest pain. Limited echocardiography is done to screen for hypertrophic cardiomyopathy and Marfan syndrome signs.

Patient 1. The resting ECG of an asymptomatic 18-year-old football player is shown in figure 1. His cardiovascular questionnaire was negative, and cardiac auscultation was normal. His height was 6 ft 4 3/4 in. and his weight was 215 lb. Resting blood pressure was 116/78 mm Hg and his pulse was 64 per minute.

[Figure 1]

Patient 2. The resting ECG of an asymptomatic 17-year-old football player is shown in figure 2. He was 5 ft 10 1/2 in. tall and weighed 158 lb. His resting blood pressure was 112/64 mm Hg and his pulse was 68 per minute. A grade 1 short systolic ejection murmur localized to the upper right sternal border was abolished with Valsalva's maneuver and seemed of no hemodynamic significance.

[Figure 2]

Patient 3. The resting ECG of a 19-year-old asymptomatic basketball player is shown in figure 3. He was 6 ft 5 in. tall and weighed 232 lb. His resting blood pressure was 130/80 mm Hg and his pulse was 66 per minute and regular. He had no heart murmur or gallop rhythm.

[Figure 3]

What is your interpretation of the ECGs? Would you allow these athletes to compete? What further tests, if any, would you consider?

Dr Cantwell and Dr Dollar are cardiologists at Cardiology of Georgia, PC, in Atlanta. Dr Cantwell is a clinical professor of medicine at Morehouse School of Medicine, in Atlanta, an editorial board member of The Physician and Sportsmedicine, and the cardiovascular consultant to the Georgia Tech Athletic Department. Address correspondence to John D. Cantwell, MD, Cardiology of Georgia, PC, 95 Collier Rd NW, Suite 2075, Atlanta, GA 30309.


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