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

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 6th 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