gms | German Medical Science

Objective: Minimal repolarization ECG changes are quite common in young sportsmen and are generally considered as a benign condition due to cardiovascular adaptation to physical exercise resulting from increased vagal tone. Nevertheless, in some cases other conditions are reasonable and they may have a pathological basis. We present a clinical case of an asymptomatic 17 year old active soccer player, who was referred to the examination because of the minimally inverted T-waves occasionally found on the resting ECG.

Material/Methods: He was born from the physiological pregnancy, with no family history of myocardiopathy, congenital heart disease or sudden death. His somatic development was adequate with just common childhood diseases, with no operations or serious injuries. He was actively involved in playing soccer from the 3 grade of elementary school, being a member of a national junior representative team, with training program on a regular basis – about 3 hours daily, at least 5 times in a week with at least 1 full-time game played through a weekend and pre-season medical screening annually.

Results: He was referred to the cardiologist because of the minimally inverted T-waves (<2 mm) in inferior and lateral leads with no other abnormalities on the resting ECG. Echocardiography was normal with no features of left ventricular hypertrophy, LVOTO, RVOTO or valvular disease, with normal systolic and diastolic function. There were no signs of ischaemia during the maximal cycle ergometer testing, but stress myocardial perfusion scintigraphy showed discrete perfusion defects in anterior and lateral segments. He was admitted to the cathlab with normal coronary anatomy on angiography, but cardiac CT angiography, which was performed later, revealed a muscle bridging in the proximal part of LAD. Athlete gave on his parents’ advice and refused further investigations and procedures. He stopped his further sports career continuing playing soccer only recreationally.

Conclusion: The significance of minor T-wave changes such as flat and/or minimally inverted (<2 mm) T-waves in two or more leads (mostly inferior and/or lateral) is unclear. Like deep inverted T-waves, minor T-wave abnormalities are infrequently encountered in the athlete heart, but are common in cardiomyopathy and may be in myocardial bridging as well, like in presented case. ECG abnormalities are unlikely to be caused by bridging alone, particularly because stress myocardial scintigraphy showed myocardial perfusion defects and coronary angiography was normal. In this regard, athletes with post-pubertal persistence of T-wave inversion beyond V1 require further clinical evaluation to exclude an underlying structural heart disease.