Study of electrocardiogram in competitive athletes

ABSTRACT Background: Sudden death in athletes is a major concern; the predictors and value of prior investigations remain to be settled. The work aims at studying electrocardiograms (ECG) in competitive athletes to define incidence of abnormalities and any relevant associations Methods: The study included hundred persons engaged in competitive sports for duration not less than 6 months; with training at least 3 days per week and at least two hours per day. Full history especially questioning for syncope, tachycardias or chest pain was obtained as well as family history of sudden death or coronary disease; examination for BP, any cardiac murmurs or arrhythmia. ECG was done for all plus echo Doppler in some cases. RESULTS: During the period from 1/1/2015 to 1/10/2016, 100 athletes were screened by ECG, 54 played isotonic sport while 46 were on isometric sport. Types of sports: isometric (static) (body builders) 46. Isotonic (dynamic) 54 (Bicycling 6, Football 15, Tennis 3, Basketball 16, Volleyball 8, Swimming 4, Boxing 2) . Echo was done in 15, increase in LV size was found in 5 (Diastolic diameter up to 61mm). Follow up by telephone questionnaire was done for all, 5 persons were re-examined after months, no abnormal events were found. Results: Data given total then in isometric (static) group then isotonic (dynamic) group then P value respectively: LV hypertrophy by voltage criteria 18%, 24%, 10.9%, p 0.087. Early repolarization in 5%, 9.3%, 0%, P 0.06. RSR' in V1 (and V2 in some cases) 14%, 20%, 6.5%, P 0.047. Inverted T 3%, 3.7%, 2%, P =1. Total ECG changes of any form 43%, 59%, 23.9%, P 0.001. The significance of finding more ECG changes in isometric (static) athletes is not clear but clinically did not show any effect. Correlation between the 18 athletes with ECG LVH and echocardiography: only 5 of the 18 showed increased diameters by echo but within accepted athletic heart criteria. Two of body builders confessed of taking doping drugs (male hormones) but no clinical abnormal signs were detected. No long QT was found. Discussion: We did not find cases of hypertrophic cardiomyopathy, valvular heart disease, arrhythmogenic syndromes or congenital heart disease. Conclusions: Routine ECG for all competitive athletes is not recommended, it is only indicated if persons have symptoms as syncope or chest pain or tachyarrhythmia Key words: ECG , athletes, SCD. REFERENCES 1. Biffi, A., et al. (2013). "Italian cardiological guidelines for sports eligibility in athletes with heart disease: part 1." Journal of Cardiovascular Medicine 14(7): 477-499. 2. Chaitman, B. R. (2007). "An Electrocardiogram Should Not Be Included in Routine Preparticipation Screening of Young Athletes." Circulation 116(22): 2610-2615. 3. Corrado, D., et al. (2009). "12-lead ECG in the athlete: physiological versus pathological abnormalities." British Journal of Sports Medicine 43(9): 669-676. 4. D'Silva, A. and S. Sharma (2014). "Exercise, the athlete's heart, and sudden cardiac death." The Physician and sportsmedicine 42(2): 100-113. 5. Drezner, J. A., et al. (2013). "Electrocardiographic interpretation in athletes: the ‘Seattle Criteria’: Table 1." British Journal of Sports Medicine 47(3): 122-124. 6. Drezner, J. A., et al. (2013). "Normal electrocardiographic findings: recognising physiological adaptations in athletes." British Journal of Sports Medicine 47(3): 125-136. 7. Kovacs, R. and A. L. Baggish (2016). "Cardiovascular adaptation in athletes." Trends in Cardiovascular Medicine 26(1): 46-52. 8. Leite, S. M., et al. (2016). "Electrocardiographic evaluation in athletes:‘Normal’changes in the athlete's heart and benefits and disadvantages of screening." Revista Portuguesa de Cardiologia 35(3): 169-177. 9. Maron, B. J., et al. (2007). "Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 Update a scientific statement from the American Heart Association Council on nutrition, physical activity, and metabolism: Endorsed by the American College of Cardiology Foundation." Circulation 115(12): 1643-1655. 10. Maron, B. J., et al. (1996). "Cardiovascular Preparticipation Screening of Competitive Athletes A Statement for Health Professionals From the Sudden Death Committee (Clinical Cardiology) and Congenital Cardiac Defects Committee (Cardiovascular Disease in the Young), American Heart Association." Circulation 94(4): 850-856. 11. Scharhag, J., et al. (2013). "Competitive sports and the heart: benefit or risk." Dtsch Arztebl Int 110(1-2): 14-24. 12. Swapna Gurrapu and Estari Mamidala. Medicinal Plants Used By Traditional Medicine Practitionersin the Management of HIV/AIDS-Related Diseases in Tribal Areas of AdilabadDistrict, Telangana Region. The Ame J Sci & Med Res.2016:2(1):239-245. doi:10.17812/ajsmr2101. 13. Sinner, M. F., et al. (2012). "A meta-analysis of genome-wide association studies of the electrocardiographic early repolarization pattern." Heart Rhythm 9(10): 1627-1634. 14. van Dijk, G. P., et al. (2014). "High prevalence of incomplete right bundle branch block in facioscapulohumeral muscular dystrophy without cardiac symptoms." Functional neurology 29(3): 159