ST Elevation in a Professional Athlete: From the Coronary Care Unit to the Field

Maria Boutsikou; Elias Sanidas; Gkiouzelis Giasemis; George Ziogas; George Dangas; Panagiotis Stamatopoulos

doi:doi:10.11648/j.ccr.20190304.12

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ST Elevation in a Professional Athlete: From the Coronary Care Unit to the Field

Maria Boutsikou, Elias Sanidas, Gkiouzelis Giasemis, George Ziogas, George Dangas, Panagiotis Stamatopoulos

Published in Cardiology and Cardiovascular Research (Volume 3, Issue 4)

Received: 10 July 2019 Accepted: 17 September 2019 Published: 30 September 2019

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Abstract

Interpretation of ECG in athletes can be quite challenging as it requires adequate experience to distinguish physiologic changes related to adaptation to training from pathologic findings. ECG interpretation is an important diagnostic tool for high intensity trained athletes. Herein, we present the case of a young high-competitive athlete who presented with a variant ST elevation on 12lead ECG that was initially considered suspicious of myocardial infarction. Diagnostic workup including clinical examination, echocardiogram, 12-lead surface ECG and laboratory tests (troponin and CK-MB) did not confirm the presence of acute coronary syndrome. The patient was monitored for a few hours and was finally discharged with no restrictions regarding training. ECG in the present case resembles Wellen’s syndrome pattern which represents a pre-infarction stage of CAD with a significant proximal left anterior descending artery (LAD) stenosis that will be followed by ACS of anterior wall if left untreated. However, there were no other findings to support the clinical diagnosis of Wellen’s syndrome in our case and the ECG changes were attributed to a physiological adaptation to training. During exercise several ECG adjustments develop as a result of the decreased sympathetic tone and the increased parasympathetic tone combined with the heterogeneity of ventricle repolarization. The preparticipation screening performed by experienced physicians in the field of sports cardiology is crucial in order to recognize physiologic cardiovascular adaptation to exercise and exclude cardiovascular abnormalities.

Published in	Cardiology and Cardiovascular Research (Volume 3, Issue 4)
DOI	10.11648/j.ccr.20190304.12
Page(s)	86-89
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

ECG, ST Elevation, Biphasic T Waves, Early Repolarization, Athlete, Training, Wellen’s Syndrome

References

[1]	Van der Wall EE. ECG screening in athletes: optional or mandatory? Neth Heart J 2015; 23: 353-5.
[2]	Sharma S, Drezner JA, Baggish A et al. International Recommendations for Electrocardiographic Interpretation in Athletes. J Am Coll Cardiol 2017; 69: 1057-1075.
[3]	Pluim BM, Zwinderman AH, van der Laarse A, van der Wall EE. The athlete's heart. A meta-analysis of cardiac structure and function. Circulation 2000; 101: 336-44.
[4]	Sheikh N, Papadakis M, Ghani S et al. Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes. Circulation 2014; 129: 1637-49.
[5]	Sharma S, Merghani A, Mont L. Exercise and the heart: the good, the bad, and the ugly. Eur Heart J 2015; 36: 1445-53.
[6]	Waase MP, Mutharasan RK, Whang W et al. Electrocardiographic Findings in National Basketball Association Athletes. JAMA Cardiol 2018; 3: 69-74.
[7]	de Zwaan C, Bar FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J 1982; 103: 730-6.
[8]	Miner B, Hart EH. Wellens Syndrome. StatPearls. Treasure Island (FL), 2018.
[9]	Agarwal A, Vyas S, Kumar R. Wellen's syndrome: Challenges in diagnosis. Malays Fam Physician 2015; 10: 35-7.
[10]	Drezner JA, Ackerman MJ, Anderson J et al. Electrocardiographic interpretation in athletes: the 'Seattle criteria'. Br J Sports Med 2013; 47: 122-4.
[11]	Grazioli G, Merino B, Montserrat S et al. Usefulness of echocardiography in preparticipation screening of competitive athletes. Rev Esp Cardiol (Engl Ed) 2014; 67: 701-5.
[12]	Mitchell AR, Hurry R, Le Page P, MacLachlan H. Pre-participation cardiovascular screening: is community screening using hand-held cardiac ultrasound feasible? Echo Res Pract 2015; 2: 49-55.

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APA Style

Maria Boutsikou, Elias Sanidas, Gkiouzelis Giasemis, George Ziogas, George Dangas, et al. (2019). ST Elevation in a Professional Athlete: From the Coronary Care Unit to the Field. Cardiology and Cardiovascular Research, 3(4), 86-89. https://doi.org/10.11648/j.ccr.20190304.12

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ACS Style

Maria Boutsikou; Elias Sanidas; Gkiouzelis Giasemis; George Ziogas; George Dangas, et al. ST Elevation in a Professional Athlete: From the Coronary Care Unit to the Field. Cardiol. Cardiovasc. Res. 2019, 3(4), 86-89. doi: 10.11648/j.ccr.20190304.12

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AMA Style

Maria Boutsikou, Elias Sanidas, Gkiouzelis Giasemis, George Ziogas, George Dangas, et al. ST Elevation in a Professional Athlete: From the Coronary Care Unit to the Field. Cardiol Cardiovasc Res. 2019;3(4):86-89. doi: 10.11648/j.ccr.20190304.12

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@article{10.11648/j.ccr.20190304.12,
  author = {Maria Boutsikou and Elias Sanidas and Gkiouzelis Giasemis and George Ziogas and George Dangas and Panagiotis Stamatopoulos},
  title = {ST Elevation in a Professional Athlete: From the Coronary Care Unit to the Field},
  journal = {Cardiology and Cardiovascular Research},
  volume = {3},
  number = {4},
  pages = {86-89},
  doi = {10.11648/j.ccr.20190304.12},
  url = {https://doi.org/10.11648/j.ccr.20190304.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20190304.12},
  abstract = {Interpretation of ECG in athletes can be quite challenging as it requires adequate experience to distinguish physiologic changes related to adaptation to training from pathologic findings. ECG interpretation is an important diagnostic tool for high intensity trained athletes. Herein, we present the case of a young high-competitive athlete who presented with a variant ST elevation on 12lead ECG that was initially considered suspicious of myocardial infarction. Diagnostic workup including clinical examination, echocardiogram, 12-lead surface ECG and laboratory tests (troponin and CK-MB) did not confirm the presence of acute coronary syndrome. The patient was monitored for a few hours and was finally discharged with no restrictions regarding training. ECG in the present case resembles Wellen’s syndrome pattern which represents a pre-infarction stage of CAD with a significant proximal left anterior descending artery (LAD) stenosis that will be followed by ACS of anterior wall if left untreated. However, there were no other findings to support the clinical diagnosis of Wellen’s syndrome in our case and the ECG changes were attributed to a physiological adaptation to training. During exercise several ECG adjustments develop as a result of the decreased sympathetic tone and the increased parasympathetic tone combined with the heterogeneity of ventricle repolarization. The preparticipation screening performed by experienced physicians in the field of sports cardiology is crucial in order to recognize physiologic cardiovascular adaptation to exercise and exclude cardiovascular abnormalities.},
 year = {2019}
}

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TY  - JOUR
T1  - ST Elevation in a Professional Athlete: From the Coronary Care Unit to the Field
AU  - Maria Boutsikou
AU  - Elias Sanidas
AU  - Gkiouzelis Giasemis
AU  - George Ziogas
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AU  - Panagiotis Stamatopoulos
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DO  - 10.11648/j.ccr.20190304.12
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
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PB  - Science Publishing Group
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UR  - https://doi.org/10.11648/j.ccr.20190304.12
AB  - Interpretation of ECG in athletes can be quite challenging as it requires adequate experience to distinguish physiologic changes related to adaptation to training from pathologic findings. ECG interpretation is an important diagnostic tool for high intensity trained athletes. Herein, we present the case of a young high-competitive athlete who presented with a variant ST elevation on 12lead ECG that was initially considered suspicious of myocardial infarction. Diagnostic workup including clinical examination, echocardiogram, 12-lead surface ECG and laboratory tests (troponin and CK-MB) did not confirm the presence of acute coronary syndrome. The patient was monitored for a few hours and was finally discharged with no restrictions regarding training. ECG in the present case resembles Wellen’s syndrome pattern which represents a pre-infarction stage of CAD with a significant proximal left anterior descending artery (LAD) stenosis that will be followed by ACS of anterior wall if left untreated. However, there were no other findings to support the clinical diagnosis of Wellen’s syndrome in our case and the ECG changes were attributed to a physiological adaptation to training. During exercise several ECG adjustments develop as a result of the decreased sympathetic tone and the increased parasympathetic tone combined with the heterogeneity of ventricle repolarization. The preparticipation screening performed by experienced physicians in the field of sports cardiology is crucial in order to recognize physiologic cardiovascular adaptation to exercise and exclude cardiovascular abnormalities.
VL  - 3
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Author Information

Maria Boutsikou

Department of Pediatric, Athens University Medical School, Children’s Hospital “Aghia Sophia”, Athens, Greece
Elias Sanidas

Department of Cardiology, Laiko General Hospital, Athens, Greece
Gkiouzelis Giasemis

Agios Paulos General Hospital, Thessaloniki, Greece
George Ziogas

Sportsclinic, Thessaloniki, Greece
George Dangas

Icahn School of Medicine at Mount Sinai, New York, USA
Panagiotis Stamatopoulos

Department of Pediatric, Athens University Medical School, Children’s Hospital “Aghia Sophia”, Athens, Greece

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APA Style

Maria Boutsikou, Elias Sanidas, Gkiouzelis Giasemis, George Ziogas, George Dangas, et al. (2019). ST Elevation in a Professional Athlete: From the Coronary Care Unit to the Field. Cardiology and Cardiovascular Research, 3(4), 86-89. https://doi.org/10.11648/j.ccr.20190304.12

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ACS Style

Maria Boutsikou; Elias Sanidas; Gkiouzelis Giasemis; George Ziogas; George Dangas, et al. ST Elevation in a Professional Athlete: From the Coronary Care Unit to the Field. Cardiol. Cardiovasc. Res. 2019, 3(4), 86-89. doi: 10.11648/j.ccr.20190304.12

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AMA Style

Maria Boutsikou, Elias Sanidas, Gkiouzelis Giasemis, George Ziogas, George Dangas, et al. ST Elevation in a Professional Athlete: From the Coronary Care Unit to the Field. Cardiol Cardiovasc Res. 2019;3(4):86-89. doi: 10.11648/j.ccr.20190304.12

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@article{10.11648/j.ccr.20190304.12,
  author = {Maria Boutsikou and Elias Sanidas and Gkiouzelis Giasemis and George Ziogas and George Dangas and Panagiotis Stamatopoulos},
  title = {ST Elevation in a Professional Athlete: From the Coronary Care Unit to the Field},
  journal = {Cardiology and Cardiovascular Research},
  volume = {3},
  number = {4},
  pages = {86-89},
  doi = {10.11648/j.ccr.20190304.12},
  url = {https://doi.org/10.11648/j.ccr.20190304.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20190304.12},
  abstract = {Interpretation of ECG in athletes can be quite challenging as it requires adequate experience to distinguish physiologic changes related to adaptation to training from pathologic findings. ECG interpretation is an important diagnostic tool for high intensity trained athletes. Herein, we present the case of a young high-competitive athlete who presented with a variant ST elevation on 12lead ECG that was initially considered suspicious of myocardial infarction. Diagnostic workup including clinical examination, echocardiogram, 12-lead surface ECG and laboratory tests (troponin and CK-MB) did not confirm the presence of acute coronary syndrome. The patient was monitored for a few hours and was finally discharged with no restrictions regarding training. ECG in the present case resembles Wellen’s syndrome pattern which represents a pre-infarction stage of CAD with a significant proximal left anterior descending artery (LAD) stenosis that will be followed by ACS of anterior wall if left untreated. However, there were no other findings to support the clinical diagnosis of Wellen’s syndrome in our case and the ECG changes were attributed to a physiological adaptation to training. During exercise several ECG adjustments develop as a result of the decreased sympathetic tone and the increased parasympathetic tone combined with the heterogeneity of ventricle repolarization. The preparticipation screening performed by experienced physicians in the field of sports cardiology is crucial in order to recognize physiologic cardiovascular adaptation to exercise and exclude cardiovascular abnormalities.},
 year = {2019}
}

Copy | Download

TY  - JOUR
T1  - ST Elevation in a Professional Athlete: From the Coronary Care Unit to the Field
AU  - Maria Boutsikou
AU  - Elias Sanidas
AU  - Gkiouzelis Giasemis
AU  - George Ziogas
AU  - George Dangas
AU  - Panagiotis Stamatopoulos
Y1  - 2019/09/30
PY  - 2019
N1  - https://doi.org/10.11648/j.ccr.20190304.12
DO  - 10.11648/j.ccr.20190304.12
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 86
EP  - 89
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20190304.12
AB  - Interpretation of ECG in athletes can be quite challenging as it requires adequate experience to distinguish physiologic changes related to adaptation to training from pathologic findings. ECG interpretation is an important diagnostic tool for high intensity trained athletes. Herein, we present the case of a young high-competitive athlete who presented with a variant ST elevation on 12lead ECG that was initially considered suspicious of myocardial infarction. Diagnostic workup including clinical examination, echocardiogram, 12-lead surface ECG and laboratory tests (troponin and CK-MB) did not confirm the presence of acute coronary syndrome. The patient was monitored for a few hours and was finally discharged with no restrictions regarding training. ECG in the present case resembles Wellen’s syndrome pattern which represents a pre-infarction stage of CAD with a significant proximal left anterior descending artery (LAD) stenosis that will be followed by ACS of anterior wall if left untreated. However, there were no other findings to support the clinical diagnosis of Wellen’s syndrome in our case and the ECG changes were attributed to a physiological adaptation to training. During exercise several ECG adjustments develop as a result of the decreased sympathetic tone and the increased parasympathetic tone combined with the heterogeneity of ventricle repolarization. The preparticipation screening performed by experienced physicians in the field of sports cardiology is crucial in order to recognize physiologic cardiovascular adaptation to exercise and exclude cardiovascular abnormalities.
VL  - 3
IS  - 4
ER  -

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