Dynamic changes of repolarization pattern associated with deep breathing and exercise in a young athlete: the sign “athletes heart” or concealed heart disease?

Abstract

We described ECG of a 22-year-old healthy man, professional basketball player, who has been training since he was 14. Physical examination was normal. In ECG the following abnormalities of repolarisation were observed: biphasic, positivenegative T waves in leads V3–V6. This changes normalised during deep breathing test. The echocardiogram revealed normal size of the heart’s chambers, left ventricular walls hypertrophy — septum and posterior wall: 14 mm, normal mitral inflow — E/A = 1.1, normal ejection fraction (68%). The exercise test (ExT, 20 METS) was without symptoms. During ExT normalisation of repolarisation abnormalities was observed. From 6^th minute of the recovery phase the repolarisation abnormalities were observed again. In unselected population of young athletes abnormal ECG is observed in 4.8–11.8% of athletes. Negative T waves in precordial leads are observed 2.3% of the young athletes and in 2.7% young, professional athletes. The repolarisation abnormalities described in our patient belong to electrocardiographic spectrum of the early repolarisation pattern mainly seen in black, young athletes.