University of Groningen. The young athlete's heart Bessem, Bram
|
|
- Allison Stafford
- 5 years ago
- Views:
Transcription
1 University of Groningen The young athlete's heart Bessem, Bram IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2017 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Bessem, B. (2017). The young athlete's heart: An electrocardiographic challenge [Groningen]: Rijksuniversiteit Groningen Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date:
2 CHAPTER THE ELECTROCARDIOGRAM OF HIGH-LEVEL JUNIOR SOCCER PLAYERS; COMPARING THE ESC VS. THE SEATTLE CRITERIA Bram Bessem, Matthijs C. de Bruijn and Wybe Nieuwland Br J Sports Med Aug;49(15):1000-6
3 54 C H A P T E R ABSTRACT Introduction: Sudden cardiac death in young athletes is a devastating event. The screening and detection of potentially life-threatening cardiac pathology by ECG is difficult due to high numbers of false-positive results, especially in the very young. The Seattle ECG criteria (201) were introduced to decrease false-positive results. We compared the Seattle ECG criteria with the European Society of Cardiology ECG criteria of 2005 and 2010 for cardiac screening in high-level junior soccer players. Methods: During the season all data from cardiovascular screenings performed on the youth division of two professional soccer clubs were collected. The total study population consisted of 19 male adolescent professional soccer players, aged years. Five players dropped out of this study. Results: Applying the ESC criteria of 2005 and 2010 to our population resulted in a total of 89 (47%) and 62 (%) abnormal ECGs. When the Seattle ECG criteria were applied, the number of abnormal ECGs was 6 (%). The reduction was mainly due to a reclassification of the long QT cut-off value and the exclusion of right atrial enlargement criteria. All ECGs abnormalities using the Seattle criteria related to T-wave inversion criteria. Conclusion: The Seattle ECG criteria seem very promising for decreasing false-positive screening results for high-level junior soccer players.
4 T H E E L E C T R O C A R D I O G R A M O F H I G H - L E V E L J U N I O R S O C C E R P L A Y E R S ; T H E E S C V S. T H E S E A T T L E C R I T E R I A 55 INTRODUCTION On 19 March 2012 a talented Dutch junior soccer player suffered a cardiac arrest during practice. He was rushed to the hospital, where he died the next day at the age of 1. The loss of a child is a devastating event that has a high impact on the local community. When a child dies during sport activities, which should promote health, the impact is even bigger. Aiming to prevent cardiac events during sports, the European Society of Cardiology (ESC) proposed a screening protocol in This protocol was based on 25 years of experience gained by Corrado et al., and consisted of a questionnaire, a physical examination and an electrocardiogram (ECG). When abnormalities are found, further examination, including an echocardiogram, is warranted. These recommendations triggered a scientific debate about the most appropriate screening strategy. Maron et al. and the American Heart Association stated that the addition of an ECG to screening would be impractical, due to expected high false-positive test results which would lead to unnecessary further testing, anxiety about outcomes for the athlete, and possibly unmerited disqualification from sports. In practice, some sporting programs include ECG screening, others do not. There has been much research to optimize the ECG criteria and minimize false-positive screening results. This caused the ESC ECG criteria to be revised by Corrado et al. in More recently, after an international summit in 2012, a second revision was made by Drezner et al. in 201, known as the Seattle Criteria. We aimed to compare the ECG criteria outcome of the ESC recommendations of 2005 and 2010 and the Seattle ECG criteria of 201 in talented junior soccer players aged years.
5 56 C H A P T E R METHODS During the season all data from cardiovascular screenings performed on the youth division of two professional soccer clubs were collected. All youth teams of both clubs played at the highest national level. The total study population consisted of 19 male adolescent professional soccer players, aged years. Written informed consent was obtained from all participants and their parents/legal guardians, and an Independent Review Board statement was provided. Electrocardiogram (ECG) A standard 12-lead resting ECG was collected by a sports physician (Welch Allyn CardioPerfect software, v ). All ECGs were scored by the principal investigator, using the criteria provided by Corrado et al. in 2005, the revised criteria provided by Corrado et al. in 2010, and the criteria provided by Drezner et al. in It should be noted that the ESC criteria of 2005 and 2010 where developed for athletes aged 12-5 and the Seattle criteria where developed for athletes age Other variables Data on age (at the screening), ethnicity, height, weight and blood pressure were collected. Ethnicity was self-reported. The options of choice were White-Caucasian, Black-African (Morocco / Turkey / Other), Black-Caribbean, Asian, Mixed and Other. Body surface area was calculated using the Mosteller formula ( (L(cm) x M(kg)) / 600). 4 Training intensity was calculated by averaging 5 weekly programs. It was established whether the player was international. Positive screening result When there was an abnormal finding on the questionnaire, the physical examination and/or the electrocardiogram (ECG), the athlete was revered to the (paediatric) cardiologist for further primary examination. These primary examinations included an echocardiogram, exercise testing and a 24hr ECG monitoring. When these tests weren t able to clear the athlete, additional secondary testing was
6 T H E E L E C T R O C A R D I O G R A M O F H I G H - L E V E L J U N I O R S O C C E R P L A Y E R S ; T H E E S C V S. T H E S E A T T L E C R I T E R I A 57 done including, amongst others, a cardiac MRI. When a cardiovascular disease was diagnosed, we excluded the player for this study. For the ECG screening criteria we used the Seattle criteria of 2012 Reference ranges for the echo cor where based on the data provided by Prior and La Gerche. 5 Exclusion criterion Youth players with a known cardiovascular disease or diagnosed with a cardiovascular disease by a (paediatric) cardiologist during the season were excluded. Data analysis Data analysis was performed using Excel (200). RESULTS Population Of the 19 players eligible for the study, four dropped out because they no longer played at a high level at the date of the screening. One player was excluded due to an already diagnosed AVNT. A total of 188 players were included in this study. All players with a positive screening result could be cleared by the (paediatric) cardiologist using only the primary additional testing (echocardiogram, exercise testing and 24hr ECG monitoring). The population was evenly distributed over the different age categories with an age range of years. The average blood pressure was 115/69 mmhg. A total of 29% of the players was of non-caucasian ethnicity, with a total of 15% being of black ethnicity. A relative high number of non- Caucasian players were from Turkey, Morocco or the Caribbean (22/54, 41%). There were 9% international players. For the population demographics, see Table 1.
7 58 C H A P T E R Population Average (SD) Range Age (years) 14.9 (2.2) Height (cm) (1.5) Weight (kg) 55.9 (14.4) BSA (m²) 1.60 (0.27) Blood pressure (mmhg) Systolic 115 (12) Diastolic 69 (9) Training volume (hr/wk) Number Percentage Age category <1yr 5 28% 1-14yr 47 25% 15-16yr 47 25% >16yr 41 22% Ethnicity White - Caucasian 14 71% Black - Total 29 15% Black - African (Other) 7 4% Black - African 6 % Black - African 5 % Black - Afro-Caribbean 11 6% Asian - Other 11 6% Other 1 1% Mixed 11 6% Unknown 2 1% International player 16 9% Table 1. Population demographics (Total N=188) Electrocardiogram (ECG) ECG characteristics The average heart rate was 69 beats/min. No player had a heart rate below 40 beats/min. PQ time ranged from 108ms to 222ms. The QRS time range was 68ms to 117ms. Corrected QT time ranged from 5ms to 468ms. An overview of the ECG characteristics is shown in Table 2.
8 T H E E L E C T R O C A R D I O G R A M O F H I G H - L E V E L J U N I O R S O C C E R P L A Y E R S ; T H E E S C V S. T H E S E A T T L E C R I T E R I A 59 Training-related (group 1) ECG changes Corrado 1 and Drezner divided ECG changes into group-1 and group-2 changes. ECG changes related to training and fitting the athlete s heart profile are included in group 1. Almost three-quarters (72%) of our population had one group-1 change and 64 persons (4%) had more than one group-1 change. Most group-1 changes were seen in the category of sinus arrhythmia (29%), sinus bradycardia (28%) and incomplete RBBB pattern (26%). For an overview of trainingrelated (group 1) ECG changes, see Table.
9 60 C H A P T E R ECG characteristics Age (N=5) Age (N=47) Age (N=47) Age (N=41) Total (N=188) Median (SD) Range Median (SD) Range Median (SD) Range Median (SD) Range Median (SD) Range Percentile Heart Rate beats/min 76 (11) (14) (12) (11) (1) nd th QRS axis **** degree 7 (24) (21) (2) (26) (24) PR time Ms 145 (20) (20) (20) (21) (22) QRS time Ms 80 (9) (9) (10) (11) (11) QTc time Ms 420 (22) (2) (25) (21) (2) R in V1 *** mm (2) 0 11 () 1 14 (2) (2) 0 8 (2) S in V1 *** mm 10 (4) (5) (6) 8 7 (4) (5) S in V2 mm 22 (7) (9) (8) (7) (8) S in V5 mm (1) (2) (2) 0 11 (2) (2) R in V5/V6* mm 17 (5) (6) (5) (4) (5) R or S in standard lead ** mm 14 (4) (5) (5) (4) (4) Table 2. ECG characteristics (Total N=188) * Biggest R was used. ** Biggest R or S was used. *** N=187 due to missing V1 in 1 ECG **** N=184 due to undetermined axis in 4 ECGs
10 T H E E L E C T R O C A R D I O G R A M O F H I G H - L E V E L J U N I O R S O C C E R P L A Y E R S ; T H E E S C V S. T H E S E A T T L E C R I T E R I A 61 Age <1 yr (N=5) Age 1-14 yr (N=47) Age yr (N=47) Age >16 yr (N=41) Total (N=188) Training-related (group 1) ECG changes N % N % N % N % N % Sinus bradycardia < 60/min 5 9 % 1 28 % 11 2 % 2 56 % % Sinus arrhythmia Present 19 6 % 11 2 % 16 4 % 8 20 % % Rhythm Atrial 0 0 % 1 2 % 1 2 % 0 0 % 2 1 % Junctional 0 0 % 0 0 % 0 0 % 1 2 % 1 1 % AV block 1 st degree 1 2 % 1 2 % 1 2 % 2 5 % 5 % 2 nd degree (Mobitz I) 0 0 % 0 0 % 0 0 % 0 0 % 0 0 % Incomplete RBBB % 11 2 % 16 4 % % % Isolated QRS voltage criteria for LVH Sokolow index 5mm 6 11 % 11 2 % % 2 5 % % Early repolarisation 9 17 % 8 17 % 5 11 % 9 22 % 1 16 % Total group 1 changes 4 64 % 70 % 7 79 % 2 78 % % Table. Training-related (group 1) ECG changes
11 62 C H A P T E R The ESC and Seattle criteria Table 4 shows the results of the ECG screening using the criteria published by Corrado et al. in and in 2010, 1 and the criteria published by Drezner et al. in 201. European Society of Cardiology ECG criteria of 2005 Applying the 2005 ESC ECG criteria to our population resulted in89 (47%) abnormal ECGs. The highest numbers of abnormal ECGs are found with the voltage criteria (27%), long QT criteria (15%), right atrial enlargement criteria (10%) and RVH criteria (7%). European Society of Cardiology ECG criteria of 2010 Applying the 2010 ESC criteria results in a total of 62 (2%) abnormal ECGs. This is a reduction of 2% compared with the criteria of The biggest reduction was caused by the exclusion of the isolated voltage criteria. The highest numbers of abnormal ECGs are found with the long QT criteria (15%), right atrial enlargement criteria (10%), RVH criteria (5%) and T-wave inversion criteria (%). Seattle ECG criteria of 201 When applying the 201 Seattle ECG criteria, the number of abnormal ECGs was 6 (%). This is a reduction of 90% compared with the 2010 criteria. The biggest reduction was caused by the adjustment of the long QT cut-off value and the exclusion of the right atrial enlargement criteria. All abnormal ECGs were found with the T-wave inversion criteria.
12 T H E E L E C T R O C A R D I O G R A M O F H I G H - L E V E L J U N I O R S O C C E R P L A Y E R S ; T H E E S C V S. T H E S E A T T L E C R I T E R I A 6 N=188 ESC 2005 ESC 2010 Seattle N (%) 2010 N (%) Seattle N (%) P-wave QRS complex LA enlargement RA enlargement Axis Voltage Abnormal Q- waves Bundle branch block RVH* Negative portion of the P-wave in lead V1 0.1mV in depth and 0.04s in duration Peaked P-wave in leads II and III or V1 0.25mV in amplitude Right axis deviation ( 120 ) Left axis deviation (-0 to -90 ) R/S Standard lead ( 2mV) Negative portion of the P-wave in lead V1 0.1mV in depth and 0.04s in duration Peaked P-wave in leads II and III or V1 0.25mV in amplitude Right axis deviation (>110 ) Left axis deviation (-0 to -90 ) Prolonged P-wave duration of >120ms in leads I or II with negative portion of the P-wave 1mm in depth and 40ms in duration in lead V1-0 (0%) 0 (0%) 0 (0%) 19 (10%) 19 (10%) (1%) 4 (2%) - Left axis deviation (-0 to -90 ) 0 (0%) 0 (0%) 0 (0%) (12%) - - S V1 or V2 ( mv) (19%) - - R V5 or V6 ( mv) (%) - - Total (27%) - - Q-waves 0.04s in duration or 25% of the height of the ensuing R-wave or QS pattern in two or more leads Right bundle branch block or left bundle branch block with QRS duration 120ms Q-waves >4 mm deep in any lead except III, avr Complete bundle branch block (QRS 120ms) and/or hemiblock - IV conduction delay (>110ms) R/R' V1 0.5mV and R/S 1 ST segment ST depression ST segment in two or more leads T-wave inversion/ T-wave QT interval Rhythm Conduction flattening T-wave flattening or inversion in two or more leads R-V1 + S-V5 >10.5mm ST segment in two or more leads T-wave flattening or inversion in two or more leads >mm in depth or >40ms in duration in two or more leads (except for III and avr) 0 (0%) 0 (0%) 0 (0%) Left bundle branch block with QRS 120ms, predominantly negative QRS complex in lead V1 (QS or rs), and upright monophasic R-wave in leads I and V6 0 (0%) 0 (0%) 0 (0%) IV conduction delay ( 140ms) - 4 (2%) 0 (0%) R-V1 + S-V5 >10.5mm & right axis > mm in depth in two or more leads >1mm in depth in two or more leads V2 V6, II and avf, or I and avl (excludes III, avr and V1) 14 (7%) 9 (5%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 9 (5%) 6 (%) 6 (%) Long QT QTc >440ms (Male) QTc >440ms (Male) QTc 470ms (Male) 28 (15%) 28 (15%) 0 (0%) Short QT - QTc 60ms QTc 20ms - 2 (1%) 0 (0%) Premature ventricular complex Ventricular arrhythmias Atrial tachyarrhythmias Premature ventricular beats Severe ventricular arrhythmias Supraventricular tachycardias, atrial flutter or atrial fibrillation Sinus bradycardia Heart rate 40/min Heart rate 0/min or sinus pauses s Ventricular preexcitation** AV-block Brugada pattern - 2 PVCs per 10s tracing - Couplets, triplets and non-sustained ventricular tachycardia 0 (0%) - 0 (0%) 0 (0%) - 0 (0%) - Supraventricular tachycardia, atrialfibrillation, atrial-flutter 0 (0%) - 0 (0%) Heart rate 0/min or sinus pauses s PR <120ms PR <120ms PR <120ms & delta wave & QRS >120ms 0 (0%) 0 (0%) 0 (0%) 8 (4%) 8 (4%) 0 (0%) First (PR 200ms) (%) - - Second Second (other than Mobitz I) Second (other than Mobitz I) 0 (0%) 0 (0%) 0 (0%) Third Third Third 0 (0%) 0 (0%) 0 (0%) - High take-off and downsloping ST segment elevation followed by a negative T-wave in 2 leads in V1 V High take-off and downsloping ST segment elevation followed by a negative T-wave in 2 leads in V1 V - 0 (0%) 0 (0%) Total abnormal ECGs 89 (47%) 62 (2%) 6 (%) Table 4. Results of the ESC ECG criteria of 2005 & 2010 and the Seattle ECG criteria * N=187 due to missing V1 in 1 ECG ** N=185 due to ECG not having sinus rhythm
13 64 C H A P T E R T-wave inversion Data for players with ECGs with T-wave inversions are displayed in Table 5. Seven of the nine players with T-wave inversion showed a convex (domed) ST segment elevation followed by an (end portion) negative T-wave in V1-V/V4. An example is shown in Figure 1. Two of the nine showed T-wave inversion in the lateral leads. All these ECGs are considered abnormal by the ESC criteria of The 2010 ESC and the Seattle criteria both recognize a common early repolarisation variant in black athletes of Afro- Caribbean decent characterized by domed/convex ST segment elevation followed by T wave inversion confined to leads V1-V4 (as shown in Figure 1). Therefore athletes #2, # and #7 would be classified as normal by these criteria. This early repolarisation pattern does not apply to Caucasians, and thus athletes #1, #4, and #9 are classified as abnormal. Likewise, T wave inversion beyond V4 (ie into V5 or V6) is abnormal (athletes #5 and #6). It should also be noted that persistent juvenile T wave inversion in the anterior precordial leads occurs in up to 8% of pre-puberty athletes (ie 14 or younger). 6,7 Thus, this may be contributing to abnormal findings in athletes #1 and #4 (although as neither the ESC criteria nor the Seattle criteria define juvenile T wave inversion, these ECGs are classified as abnormal if following the criteria strictly).
14 T H E E L E C T R O C A R D I O G R A M O F H I G H - L E V E L J U N I O R S O C C E R P L A Y E R S ; T H E E S C V S. T H E S E A T T L E C R I T E R I A 65 Age (years) HR (/min) Height (cm) Weight (kg) BSA (m²) Ethnicity White - Caucasian Black- Afro- Caribbean Black- Afro- Caribbean White - Caucasian Black- Afro- Caribbean White - Caucasian Black African (Other) Location of T- wave inversion Type of T-wave inversion V1-V4, III Convex ST, end portion T- wave negative; III negative V1-V4 Convex ST, end portion T- wave deep negative V1-V, III Convex ST, end portion T- wave negative; III negative V1-V, III Convex ST, end portion T- wave negative; III negative V1-V5(V6), III, AvF V-V6, II, III, AvF Unknown V1-V4, III (AvF, II) White - Caucasian Convex ST, end portion T- wave negative; III negative All negative, none deep negative V1-V4 Convex ST, end portion T- wave deep negative Convex ST, end portion T- wave deep negative, III (II, AvF) negative V1-V Convex ST, end portion T- wave deep negative Table 5. Description of the players with abnormal repolarisation patterns (Total N=9) DISCUSSION The challenge of limiting false-positive screening results applies particularly in the case of very young athletes. Our study shows that the ECGs of young professional soccer players have a wide range of normal values as well as a high degree of training-related ECG changes, and that use of the Seattle ECG criteria described by Drezner et al. results in a much lower rate of false-positive screening results compared to the ESC ECG criteria of 2005 and
15 66 C H A P T E R ECG characteristics This study shows the ECG characteristics of a highly trained population of professional adolescent soccer players. Only few articles describe normal ECG characteristics in an adolescent population, and even fewer describe an adolescent athletic population such as the one in our study. Rijnbeek et al. described the ECG characteristics of a 200 healthy non-athletic males aged to 16 years. 8 Our athletic population demonstrated a much wider range (for example, looking at the measured PR time, Rijnbeek et al. measured an upper value of 178ms, while the upper values we measured reached 222ms.) Similarly Mason et al. 9 described the ECGs of a population of 79,74 subjects participating in a drug trial; 145 of them were aged years, and 776 are male. In the article Mason describes the median value and the 2 nd and 98 th percentiles for the PR interval (median 141ms, 2 nd 98 th ms), QRS interval (median 89ms, 2 nd 98 th ms) and axis (median 60, 2 nd 98 th 0 102), and QTc time (median 40ms, 2 nd 98 th ms). All median values found by Mason are comparable to our median values, yet if we compare the 2 nd and 98 th percentiles of the PR interval and the QTc time with our population we see that the athletic population has more extreme values than the non-athletic population. When comparing our results with the adolescent athletic population we see similar results. Sharma et al., for example, described the ECGs of 1000 junior athletes (mean age 15.7, range 14 18). 10 When we compare Table 2 of this article with the data displayed in Table 2 of the article by Sharma et al., we see much the same results. When our results are compared to the results found by Somauroo et al., however, we see less profound extreme values. 11 These differences with our results may be explained by the fact that the population of Somauroo consists of soccer players older (mean age 16.7 range ) than the population we describe.
16 T H E E L E C T R O C A R D I O G R A M O F H I G H - L E V E L J U N I O R S O C C E R P L A Y E R S ; T H E E S C V S. T H E S E A T T L E C R I T E R I A 67 Training-related ECG changes This study shows a high degree (72%) of training-related ECG changes, as defined by Corrado et al. and Drezner et al. as group-1 changes. 1, These high numbers of changes are also found by Sharma et al., 10 Bohm et al. 12 and Brosnan et al. 1 (resp. 80%, 66% and 87%). All these studies show much higher amounts of sinus bradycardia than ours though (resp. 28% vs. 80%, 56% and 54%). An explanation for this difference could be a more nervous state of our relative younger population (resp years range vs.15.7 years range 14-18, 21 years range 16-8, and 20 years range 16-5). Table 2b shows that the amount of sinus bradycardia increases with age, and in the >16 age group it is 56%. This amount correlates much better with the percentages found by Sharma et al., Bohm et al. and Brosnan et al. 10,12,1 European Society of Cardiology vs. Seattle criteria One of the major problems with using the ECG as a screening tool is the number of false-positive screening results. European Society of Cardiology ECG criteria of 2005 and 2010 Results on false-positive screening outcome using the ESC ECG criteria of 2005 ranged from 10-40% REF). With increasing knowledge on distinguishing ECG abnormalities resulting from intensive physical training and those potentially associated with an increased cardiovascular risk, a consensus statement on interpretation of electrocardiograms in athletes was published by the ESC in This statement divided ECG abnormalities into a group-1 (common and training-related) and a group- 2 (uncommon and training-unrelated) category. Using this statement let to a decrease in falsepositive screening outcomes of 40-80%. 21,22 The false-positive screening rate using this statement ranged from %. 1,21-27
17 68 C H A P T E R Seattle ECG criteria of 201 In 2012 an international group of experts convened in Seattle to update these ECG criteria into what is known as the Seattle criteria. One of the goals of these criteria was to decrease false-positive screening results. To our knowledge, only Brosnan et al. 1 have evaluated screening results using the Seattle ECG criteria and compared them to the 2010 ESC ECG criteria. Their positive screening outcome was reduced from 17% using the 2010 criteria to 4.2% using the 201 Seattle criteria (reduction of 75%). The reduction was mainly due to a reclassification of the QTc intervals, of the T-wave inversion isolated to V1 2, and of the ECG with either isolated right axis deviation or right ventricular hypertrophy on voltage criteria. Applying the 2005 ESC ECG criteria in our population would result in a positive screening outcome in 47% of cases. This number is unacceptable in the use of a screening tool and leads to many false-positives and unnecessary additional testing. This result is higher than the previously reported 10-40%. The reason for this could be because our population consist of a high number of young (<16yr) high-level soccer players. This young age and sports level could be the reason for the higher number of ECG abnormalities. When applying the 2010 ESC ECG criteria the positive results drop to 2% (a reduction of 2%). This number is much higher than the previously reported %. Reasons for this discrepancy could be that in the 2010 criteria the cut-off values were not clearly defined and therefore could be interpreted differently by investigators. For example, Brosnan et al. 1 used 120 as a cut-off value for IVCD, whereas the consensus statement of recommends a cut-off value of 110. Another example is the description of the cut-off value for short QTc syndrome. In the consensus statement of 2010 different values were mentioned (80ms, 60ms, 0ms), and they recommend 80ms. Brosnan et al. 1 used 60ms for the 2010 ESC ECG criteria cut-off value, whereas Drezner et al. 21 recommend 40ms. Furthermore, most other studies do not describe the used cut-
18 T H E E L E C T R O C A R D I O G R A M O F H I G H - L E V E L J U N I O R S O C C E R P L A Y E R S ; T H E E S C V S. T H E S E A T T L E C R I T E R I A 69 off values and only refer to the 2010 consensus statement, which makes comparison difficult. These possible different interpretations could partly explain why we found a much higher positive screening result compared to other researchers. Another possible explanation for the higher amount of positive screening outcomes could be the above-mentioned high numbers of young (<16yr) highlevel soccer players in our population. Using the Seattle ECG criteria, the positive screening outcome drops to %. This is a reduction of 90% compared to the 2010 criteria. The reduction was mainly due to a reclassification of the long QT cut-off value and the exclusion of the right atrial enlargement criteria. All the positive screening results were found with the T-wave inversion/flattening category. Of the nine ECGs with T-wave flattening/inversion, seven show T-wave inversion/flattening only in the anterior leads (V1-V/V4). Of these seven ECGs, three where of athletes with Black- Afro- Caribbean / Black-African ethnicity and are therefore classified as normal. Of the remaining four ECGs, two where of athletes aged 14 years and younger. As described by Papadakis, Migliore and Drezner,,6,7 the anterior lead T-wave inversion/flattening may be a juvenile pattern in athletes aged 14 years and therefore be a normal finding among these athletes. If we considered these ECGs as normal, the positive screening results with the Seattle ECG criteria would decrease even further, to only 4c (2%) ECGs. Limitations Ideally we would have a higher population size when describing ECG characteristics and screening outcomes. Our population size is small and therefore these results should be looked at with caution. However, it is difficult to find large numbers of high-level athletes, especially below the age of 16. In sports medicine and cardiological literature, only Sharma and Migliore 10 have described larger populations of similar age and sports level.
19 70 C H A P T E R A second limitation is the absence of echocardiographic data of the players. The lack of follow-up is another limitation. As described by Pelliccia and Migliore, in a few cases the presence of repolarisation abnormalities in young athletes may represent the initial expression of underlying cardiomyopathies. 7,28 Undetected cardiac abnormalities may therefore be present in players in this population, which may lead to exclusion from this study. This chance is very small though. CONCLUSION ECG characteristics of high-level junior soccer players show more extreme range values than the nonathletic population. The Seattle ECG criteria appear to have a much higher screening specificity than the 2005 and 2010 ESC ECG criteria, and seem very promising for decreasing false-positive ECG screening results for high-level junior soccer players. Future studies should extend these analyses to other age groups and examine the costs and benefits 29 of screening with the Seattle criteria.
20 T H E E L E C T R O C A R D I O G R A M O F H I G H - L E V E L J U N I O R S O C C E R P L A Y E R S ; T H E E S C V S. T H E S E A T T L E C R I T E R I A 71 REFERENCES 1. Corrado D, Pelliccia A, Heidbuchel H, et al. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J. 2010;1(2): Corrado D, Pelliccia A, Bjornstad HH, et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: Proposal for a common European protocol. consensus statement of the study group of sport cardiology of the working group of cardiac rehabilitation and exercise physiology and the working group of myocardial and pericardial diseases of the European society of cardiology. Eur Heart J. 2005;26(5): Drezner JA, Ackerman MJ, Anderson J, et al. Electrocardiographic interpretation in athletes: The 'seattle criteria'. Br J Sports Med. 201;47(): Mosteller RD. Simplified calculation of body-surface area. N Engl J Med. 1987;17(17): Prior DL, La Gerche A. The athlete's heart. Heart. 2012;98(12): Papadakis M, Basavarajaiah S, Rawlins J, et al. Prevalence and significance of T-wave inversions in predominantly caucasian adolescent athletes. Eur Heart J. 2009;0(14): Migliore F, Zorzi A, Michieli P, et al. Prevalence of cardiomyopathy in italian asymptomatic children with electrocardiographic T-wave inversion at preparticipation screening. Circulation. 2012;125(): Rijnbeek PR, Witsenburg M, Schrama E, et al. New normal limits for the paediatric electrocardiogram. Eur Heart J. 2001;22(8): Mason JW, Ramseth DJ, Chanter DO, et al. Electrocardiographic reference ranges derived from 79,74 ambulatory subjects. J Electrocardiol. 2007;40():
21 72 C H A P T E R 10. Sharma S, Whyte G, Elliott P, et al. Electrocardiographic changes in 1000 highly trained junior elite athletes. Br J Sports Med. 1999;(5): Somauroo JD, Pyatt JR, Jackson M, et al. An echocardiographic assessment of cardiac morphology and common ECG findings in teenage professional soccer players: Reference ranges for use in screening. Heart. 2001;85(6): Bohm P, Ditzel R, Ditzel H, et al. Resting ECG findings in elite football players. J Sports Sci. 201;1(1): Brosnan M, La Gerche A, Kalman J, et al. The seattle criteria increase the specificity of preparticipation ECG screening among elite athletes. Br J Sports Med Chaitman BR. An electrocardiogram should not be included in routine preparticipation screening of young athletes. Circulation. 2007;116(22):2610-4; discussion Drezner JA, Asif IM, Owens DS, et al. Accuracy of ECG interpretation in competitive athletes: The impact of using standised ECG criteria. Br J Sports Med. 2012;46(5): Corrado D, Basso C, Pavei A, et al. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296(1): Pelliccia A, Culasso F, Di Paolo FM, et al. Prevalence of abnormal electrocardiograms in a large, unselected population undergoing pre-participation cardiovascular screening. Eur Heart J. 2007;28(16): Maron BJ, Bodison SA, Wesley YE, et al. Results of screening a large group of intercollegiate competitive athletes for cardiovascular disease. J Am Coll Cardiol. 1987;10(6):
22 T H E E L E C T R O C A R D I O G R A M O F H I G H - L E V E L J U N I O R S O C C E R P L A Y E R S ; T H E E S C V S. T H E S E A T T L E C R I T E R I A Bessem B, Groot FP, Nieuwland W. The lausanne recommendations: A dutch experience. Br J Sports Med. 2009;4(9): Snoek JA, Jongman JK, Brandon T, et al. Performance of the lausanne questionnaire and the 2010 european society of cardiology criteria for ECG interpretation in athletes. Eur J Prev Cardiol Uberoi A, Stein R, Perez MV, et al. Interpretation of the electrocardiogram of young athletes. Circulation. 2011;124(6): Weiner RB, Hutter AM, Wang F, et al. Performance of the 2010 european society of cardiology criteria for ECG interpretation in athletes. Heart. 2011;97(19): Gati S, Sheikh N, Ghani S, et al. Should axis deviation or atrial enlargement be categorised as abnormal in young athletes? the athlete's electrocardiogram: Time for re-appraisal of markers of pathology. Eur Heart J Koch S, Cassel M, Linne K, et al. ECG and echocardiographic findings in year-old elite athletes. Eur J Prev Cardiol Riding NR, Salah O, Sharma S, et al. ECG and morphologic adaptations in arabic athletes: Are the european society of cardiology's recommendations for the interpretation of the 12-lead ECG appropriate for this ethnicity? Br J Sports Med Wilson MG, Chatard JC, Carre F, et al. Prevalence of electrocardiographic abnormalities in westasian and african male athletes. Br J Sports Med. 2012;46(5): Price DE, McWilliams A, Asif IM, et al. Electrocardiography-inclusive screening strategies for detection of cardiovascular abnormalities in high school athletes. Heart Rhythm. 201.
23 74 C H A P T E R 28. Pelliccia A, Di Paolo FM, Quattrini FM, et al. Outcomes in athletes with marked ECG repolarization abnormalities. N Engl J Med. 2008;58(2): Menafoglio A, Di Valentino M, Segatto JM, et al. Costs and yield of a 15-month preparticipation cardiovascular examination with ECG in 1070 young athletes in switzerland: Implications for routine ECG screening. Br J Sports Med
24
25
A new consensus document on electrocardiographic interpretation in athletes: does it help to prevent sudden cardiac death in athletes?
Neth Heart J (2018) 26:127 132 https://doi.org/10.1007/s12471-018-1076-6 POINT OF VIEW A new consensus document on electrocardiographic interpretation in athletes: does it help to prevent sudden cardiac
More informationStudy methodology for screening candidates to athletes risk
1. Periodical Evaluations: each 2 years. Study methodology for screening candidates to athletes risk 2. Personal history: Personal history of murmur in childhood; dizziness, syncope, palpitations, intolerance
More informationCurrent ECG interpretation guidelines in the screening of athletes
REVIEW ARTICLE 7 How to differentiate physiological adaptation to intensive physical exercise from pathologies Current ECG interpretation guidelines in the screening of athletes Gemma Parry-Williams, Sanjay
More informationat least 4 8 hours per week
ECG IN ATHLETS An athlete is defined as an individual who engages in regular exercise or training for sport or general fitness, typically with a premium on performance, and often engaged in individual
More informationECG Underwriting Puzzler Dr. Regina Rosace AVP & Medical Director
December 2018 ECG Underwriting Puzzler Dr. Regina Rosace AVP & Medical Director To obtain best results Select Slide Show from the ribbon at the top of your PowerPoint screen Select From Beginning on the
More information6/19/2018. Background Athlete s heart. Ultimate question. Applying the International Criteria for ECG
Applying the International Criteria for ECG Interpretation in Athletes to a preparticipation screening program DAVE SIEBERT, MD, CAQSM ASSISTANT PROFESSOR DEPARTMENT OF FAMILY MEDICINE UNIVERSITY OF WASHINGTON
More informationHow to Read an Athlete s ECG. Sanjay Sharma BSc (Hons), MD, FRCP, FESC
How to Read an Athlete s ECG Sanjay Sharma BSc (Hons), MD, FRCP, FESC Athlete s EKG Vagotonia Sinus bradycardia Sinus arrhythmia First degree AVB ST-elevation Tall T waves Increased chamber size Left ventricular
More informationThe frontier between normal and abnormal electrocardiogram in athletes
The frontier between normal and abnormal electrocardiogram in athletes ESC Congress 2011 Paris F. Carré University Rennes 1-Pontchaillou Hospital Inserm U642, Rennes - F-35000 Cardiovascular preparticipation
More information2/26/2015.
Gerry Keenan MMS PA-C Associate Professor -Physician Assistant Studies Arizona School of Health Sciences A T Still University Event Medical Director-USA/Karate- Arizona Clinical Director-MEDfest/Healthy
More informationSABIHA GATI AND SANJAY SHARMA
9 The athlete s heart SABIHA GATI AND SANJAY SHARMA Pasieka/Science Photo Library In this article, the authors highlight the spectrum, magnitude and determinants of the athlete s heart and provide a practical
More informationInterpretation and Consequences of Repolarisation Changes in Athletes
Interpretation and Consequences of Repolarisation Changes in Athletes Professor Sanjay Sharma E-mail sasharma@sgul.ac.uk @SSharmacardio Disclosures: None Athlete s ECG Vagotonia Sinus bradycardia Sinus
More informationSports Cardiology Highlights from EuroPRevent 2012 Dublin
Sports Cardiology Highlights from EuroPRevent 2012 Dublin Hein Heidbuchel Cardiology Arrhythmology, University of Leuven, Belgium Past Chair, A Registered Branch of the ESC Sports Cardiology Highlights
More informationProfessor Sanjay Sharma St George s University of London
How to Evaluate an Athlete of Afro- Caribbean Origin. Professor Sanjay Sharma St George s University of London Background: Causes of SCD in Sport Young competitive athlete Personal and family history Physical
More informationHow the New International recommendation for Electrocardiographic interpretation in Athletes would change our practice
v Medical Group Journal of Cardiovascular Medicine and Cardiology ISSN: 2455-2976 DOI CC By Roberto Ferrara 1, Andrea Serdoz 1, Mariangela Peruzzi 2, Elena Cavarretta 2,3 * 1 Department of Physiology and
More informationFrançois Carré Hôpital Pontchaillou -INSERM UMR1099-Université Rennes 1
Normal electrocardiogram variants in Athletes François Carré Hôpital Pontchaillou -INSERM UMR1099-Université Rennes 1 Disclosures No disclosure of interest concerning this lecture The cardiovascular sport
More informationELECTROCARDIOGRAPH. General. Heart Rate. Starship Children s Health Clinical Guideline
General Heart Rate QRS Axis T Wave Axis PR Interval according to Heart Rate & Age P Wave Duration and Amplitude QRS Duration according to Age QT Interval R & S voltages according to Lead & Age R/S ratio
More informationLa valutazione dell atleta: è una strategia salva-vita e costo-efficace?
La valutazione dell atleta: è una strategia salva-vita e costo-efficace? Primo trattato di Medicina Wilson and Jungner s criteria In the 1960s the World Health Organization adopted the Wilson and Jungner
More informationCardiovascular Impacts of long-term endurance exercise: Implications of athlete s heart
Cardiovascular Impacts of long-term endurance exercise: Implications of athlete s heart Dr. Gary Mak 麥耀光心臟科專科醫生 IPP of HK Associa4on of Sports Medicine and Sports Science Director of Pro-Cardio Heart Disease
More informationElectrocardiograms of Collegiate Football Athletes
Electrocardiograms of Collegiate Football Athletes Stephen F. Crouse, PhD, FACSM, Thomas Meade, MD, Brent E. Hansen, MS, John S. Green, PhD, Steven E. Martin, MS Department of Health Kinesiology, Texas
More informationNormal electrocardiographic findings: recognising physiological adaptations in athletes
Scan to access more free content For numbered affiliations see end of article. Correspondence to Jonathan A Drezner, Department of Family Medicine, University of Washington, 1959 NE Pacific Street, Box
More informationNormal ECG And ECHO Findings in Athletes
Normal ECG And ECHO Findings in Athletes Dr.Yahya Kiwan Consultant Interventional Cardiologist Head Of Departement Of Cardiology Canadian Specialist Hospital Sinus Bradycardia The normal heartbeat is initiated
More informationPaediatric ECG Interpretation
Paediatric ECG Interpretation Dr Sanj Fernando (thanks to http://lifeinthefastlane.com/ecg-library/paediatric-ecginterpretation/) 3 yo boy complaining of abdominal pain and chest pain Child ECG vs Adult
More informationKey wards: PR Interval, QT interval, bradycardia.
bü z ÇtÄ TÜà väx : A Pilot Study Eman Abdo Elaziz Ahmed 1 and Amal Mahmoud Saied 2 Abstract Background: Sudden deaths of young competitive athletes are tragic events that continue to have a considerable
More informationInternational recommendations for electrocardiographic interpretation in athletes
European Heart Journal (2017) 00, 1 19 doi:101093/eurheartj/ehw631 CURRENT OPINION International recommendations for electrocardiographic interpretation in athletes Sanjay Sharma 1 *, Jonathan A Drezner
More informationComparison of three current sets of electrocardiographic interpretation criteria for use in screening athletes
Comparison of three current sets of electrocardiographic interpretation criteria for use in screening athletes Nathan R. Riding PhD 1,2, Nabeel Sheikh MBBS, MRCP 3, Carmen Adamuz MD, PhD 4, Victoria Watt
More informationAppendix D Output Code and Interpretation of Analysis
Appendix D Output Code and Interpretation of Analysis 8 Arrhythmia Code No. Description 8002 Marked rhythm irregularity 8110 Sinus rhythm 8102 Sinus arrhythmia 8108 Marked sinus arrhythmia 8120 Sinus tachycardia
More informationREtrive. REpeat. RElearn Design by. Test-Enhanced Learning based ECG practice E-book
Test-Enhanced Learning Test-Enhanced Learning Test-Enhanced Learning Test-Enhanced Learning based ECG practice E-book REtrive REpeat RElearn Design by S I T T I N U N T H A N G J U I P E E R I Y A W A
More informationFamily Medicine for English language students of Medical University of Lodz ECG. Jakub Dorożyński
Family Medicine for English language students of Medical University of Lodz ECG Jakub Dorożyński Parts of an ECG The standard ECG has 12 leads: six of them are considered limb leads because they are placed
More informationChapter 2 Practical Approach
Chapter 2 Practical Approach There are beginners in electrocardiogram (ECG) analysis who are fascinated by a special pattern (e.g., a bundle-branch block or a striking Q wave) and thereby overlook other
More informationIntroduction. Abbreviations and Definitions
Abbreviations and Definitions HCM DCM LVH ARVC LAD LV LA RV RA IVSd LVPWd LVDd EDV SV EF LA Size LVNC LBBB RBBB RWT Hypertrophic Cardiomyopathy Dilated Cardiomyopathy Left Ventricular Hypertrophy Arrhythmogenic
More informationThe sudden cardiac death (SCD)
Daniel Lithwick, MHA, Christopher B. Fordyce, MD, Barbara N. Morrison, BHK, Hamed Nazzari, MD, PhD, Gena Krikler, Saul H. Isserow, MBBCh, Brett Heilbron, MB ChB, Jack Taunton, MD Pre-participation screening
More informationDr Navin Chandra Clinical Research Fellow in Cardiology St George s University of London
Dr Navin Chandra Clinical Research Fellow in Cardiology St George s University of London Cardiac Adaptation in Athletes Athletic training for prolonged periods may result in physiological adaptations of
More informationECG ABNORMALITIES D R. T AM A R A AL Q U D AH
ECG ABNORMALITIES D R. T AM A R A AL Q U D AH When we interpret an ECG we compare it instantaneously with the normal ECG and normal variants stored in our memory; these memories are stored visually in
More informationDEPARTMENT NAME PRE-PARTICIPATION SCREENING THE SPORTS PHYSICAL
PRE-PARTICIPATION SCREENING THE SPORTS PHYSICAL Michele Krenek, MSN, RN, FNP-C TCHAPP Conference, Houston, TX April 4, 2019 PRE-PARTICIPATION SPORTS SCREENING According to the AHA the definition of the
More informationPlease check your answers with correct statements in answer pages after the ECG cases.
ECG Cases ECG Case 1 Springer International Publishing AG, part of Springer Nature 2018 S. Okutucu, A. Oto, Interpreting ECGs in Clinical Practice, In Clinical Practice, https://doi.org/10.1007/978-3-319-90557-0
More informationMiscellaneous Stuff Keep reading the Outline
Miscellaneous Stuff Keep reading the Outline Welcome to the 5-Step Method ECG #: Mearurements: Rhythm (s): Conduction: Waveform: Interpretation: A= V= PR= QRS= QT= Axis= 1. Compute the 5 basic measurements:
More informationEVALUATION OF ELECTROCARDIOGRAPHIC FINDINGS IN ATHLETES
EVALUATION OF ELECTROCARDIOGRAPHIC FINDINGS IN ATHLETES UNIT OF INHERITED CV DISEASES HEART CENTER OF THE YOUNG AND ATHLETES A DPT OF CARDIOLOGY UNIVERSITY OF ATHENS EVALUATION OF ELECTROCARDIOGRAPHIC
More informationRonald J. Kanter, MD Director, Electrophysiology Miami Children s Hospital Professor Emeritus, Duke University Miami, Florida
S306- Pediatric Electrocardiography: A Potpourri Ronald J. Kanter, MD Director, Electrophysiology Miami Children s Hospital Professor Emeritus, Duke University Miami, Florida Disclosure of Relevant Relationship
More informationEKG screening in athletics
Use of PPE EKG screening in athletics Stefan Montgomery MD, ATC 4/27/18 The overall role of the preparticipation physical evaluation (PPE) is to evaluate the health of the athlete to optimize safe sports
More informationReading Assignment (p1-91 in Outline ) Objectives What s in an ECG?
Reading Assignment (p1-91 in Outline ) Objectives What s in an ECG? The 5-Step Method ECG #: Mearurements: Rhythm (s): Conduction: Waveform: Interpretation: A= V= PR= QRS= QT= Axis= 1. Compute the 5 basic
More informationAbnormal ECG patterns and significance in a group of mountaineers
Original Article Abnormal ECG patterns and significance in a group of mountaineers Wg Cdr V Vasdev*, Wg Cdr DS Chadha +, Gp Capt P Kharbanda #, Lt Col SK Datta**, Air Cmde RK Ganjoo AVSM VSM ++ ABSTRACT
More informationSudden Cardiac Death in Sports: Causes and Current Screening Recommendations
Sports Cardiology Sudden Cardiac Death in Sports: Causes and Current Screening Recommendations Domenico Corrado, MD, PhD Inherited Arrhytmogenic Cardiomyopathy Unit Department of Cardiac, Thoracic and
More informationDiploma in Electrocardiography
The Society for Cardiological Science and Technology Diploma in Electrocardiography The Society makes this award to candidates who can demonstrate the ability to accurately record a resting 12-lead electrocardiogram
More informationThe Electrocardiogram part II. Dr. Adelina Vlad, MD PhD
The Electrocardiogram part II Dr. Adelina Vlad, MD PhD Basic Interpretation of the ECG 1) Evaluate calibration 2) Calculate rate 3) Determine rhythm 4) Determine QRS axis 5) Measure intervals 6) Analyze
More informationReuse of this item is permitted through licensing under the Creative Commons:
H. Dhutia, A. Malhotra, V. Gabus, A. Merghani, G. Finocchiaro, L. Millar, R. Narain, M. Papdakis, H. Naci, M. Tome, S. Sharma Cost implications of using different ECG criteria for screening young athletes
More informationAddition of the Electrocardiogram to the Preparticipation Examination of College Athletes
ORIGINAL RESEARCH Addition of the Electrocardiogram to the Preparticipation Examination of College Athletes Vy-Van Le, MD,* Matthew T. Wheeler, MD, PhD,* Sandra Mandic, PhD,* Frederick Dewey, MD,* Holly
More informationAthletes with cardiac disease; dead and buried or chance for resurrection?
Athletes with cardiac disease; dead and buried or chance for resurrection? EuroPRevent 2011 Geneva F. Carré University Rennes 1-Pontchaillou Hospital Inserm U642, Rennes - F-35000 Risk of physical activity
More information12-Lead ECG Interpretation. Kathy Kuznar, RN, ANP
12-Lead ECG Interpretation Kathy Kuznar, RN, ANP The 12-Lead ECG Objectives Identify the normal morphology and features of the 12- lead ECG. Perform systematic analysis of the 12-lead ECG. Recognize abnormalities
More informationIf the P wave > 0.12 sec( 3 mm) usually in any lead. Notched P wave usually in lead I,aVl may be lead II Negative terminal portion of P wave in V1, 1
If the P wave > 0.12 sec( 3 mm) usually in any lead. Notched P wave usually in lead I,aVl may be lead II Negative terminal portion of P wave in V1, 1 mm depth and 3 mm width( most specific) Since Mitral
More informationExercise guidelines in athletes with isolated repolarisation abnormalities and structurally normal heart.
Exercise guidelines in athletes with isolated repolarisation abnormalities and structurally normal heart. Hanne Rasmusen Consultant cardiologist, PhD Dept. of Cardiology Bispebjerg University Hospital
More informationINTERNATIONAL RUGBY BOARD Putting players first
The information in this Cardiac Screening Guideline is presented as guidance for Unions, Medical Practitioners and Rugby athletes. The Cardiac Screening recommendations will not be mandated for Unions
More informationAbnormal electrocardiographic findings in athletes: recognising changes suggestive of cardiomyopathy
Scan to access more free content For numbered affiliations see end of article Correspondence to Jonathan A Drezner, Department of Family Medicine, University of Washington, 1959 NE Pacific Street, Box
More informationGeneral Introduction to ECG. Reading Assignment (p2-16 in PDF Outline )
General Introduction to ECG Reading Assignment (p2-16 in PDF Outline ) Objectives 1. Practice the 5-step Method 2. Differential Diagnosis: R & L axis deviation 3. Differential Diagnosis: Poor R-wave progression
More informationMyocardial Infarction. Reading Assignment (p66-78 in Outline )
Myocardial Infarction Reading Assignment (p66-78 in Outline ) Objectives 1. Why do ST segments go up or down in ischemia? 2. STEMI locations and culprit vessels 3. Why 15-lead ECGs? 4. What s up with avr?
More information10 ECGs No Practitioner Can Afford to Miss. Objectives
10 ECGs No Practitioner Can Afford to Miss Mary L. Dohrmann, MD Professor of Clinical Medicine Division of Cardiovascular Medicine University of Missouri School of Medicine No disclosures Objectives 1.
More informationPennsylvania Academy of Family Physicians Foundation & UPMC 43rd Refresher Course in Family Medicine CME Conference March 10-13, 2016
Pennsylvania Academy of Family Physicians Foundation & UPMC 43rd Refresher Course in Family Medicine CME Conference March 10-13, 2016 Disclosures: EKG Workshop Louis Mancano, MD Speaker has no disclosures
More informationECG Interpretation Cat Williams, DVM DACVIM (Cardiology)
ECG Interpretation Cat Williams, DVM DACVIM (Cardiology) Providing the best quality care and service for the patient, the client, and the referring veterinarian. GOAL: Reduce Anxiety about ECGs Back to
More informationECG interpretation basics
ECG interpretation basics Michał Walczewski, MD Krzysztof Ozierański, MD 21.03.18 Electrical conduction system of the heart Limb leads Precordial leads 21.03.18 Precordial leads Precordial leads 21.03.18
More informationCardiac hypertrophy and how it may break an athlete s heart e the Cypriot case
Eur J Echocardiography (2005) 6, 301e307 Cardiac hypertrophy and how it may break an athlete s heart e the Cypriot case C.E. Chee a,1, C.P. Anastassiades a,1, A.G. Antonopoulos b, A.A. Petsas b, L.C. Anastassiades
More informationDr. Schroeder has no financial relationships to disclose
Valerie A Schroeder MD MS Assistant Professor University of Kansas Medical Center READING THE WAVES- THE HEART S ELECTRICAL MESSAGE FINANCIAL DISCLOSURE Dr. Schroeder has no financial relationships to
More informationCLINICAL RESEARCH ON CARDIOVASCULAR ALTERATION ON 86 S PROFESSIONAL ATHLETES IN IRAN
CLINICAL RESEARCH ON CARDIOVASCULAR ALTERATION ON 86 S PROFESSIONAL ATHLETES IN IRAN Lotfali Pourkazemi 1 * and Roghieh Razeghi Jadid 2 1 Sports Medicine Federation of Iran 2 Department of Herbal Sciences,
More information2017 EKG Workshop Advanced. Family Medicine Review Course Lou Mancano, MD, FAAFP Reading Health System Family and Community Medicine Reading, PA
2017 EKG Workshop Advanced Family Medicine Review Course Lou Mancano, MD, FAAFP Reading Health System Family and Community Medicine Reading, PA Part II - Objective Describe a useful approach to interpreting
More informationPAEDIATRIC ACUTE CARE GUIDELINE. ECG Interpretation
Princess Margaret Hospital for Children PAEDIATRIC ACUTE CARE GUIDELINE ECG Interpretation Scope (Staff): Scope (Area): All Emergency Department Clinicians Emergency Department This document should be
More informationDegrees AV blocks in athletes
Degrees AV blocks in athletes Name: BCA Age: 22yo Sex: Male Race: Black Weight: 82 kg Height: 1.96m Biotype: Athletic rofession: professional basketball player Date: 2/09/2001 Clinical diagnosis: athlete
More informationSUDDEN CARDIAC DEATH IN ATHLETES
SUDDEN CARDIAC DEATH IN ATHLETES Alix Dufresne, MD, FACP, FACC, FESC Cardiology Division Chief, Interfaith Medical Center Director Cardiology Clinic, Kingsbrook Jewish Center PURPOSE AND OBJECTIVES PURPOSE
More informationInternational Criteria for Electrocardiographic Interpretation in Athletes
International Criteria for Electrocardiographic Interpretation in Athletes Jonathan A. Drezner, MD* 1, Sanjay Sharma, MD* 2, Aaron Baggish, MD 3, Michael Papadakis, MD 2, Mathew G. Wilson, PhD 4, Jordan
More informationECG Interpretation Made Easy
ECG Interpretation Made Easy Dr. A Tageldien Abdellah, MSc MD EBSC Lecturer of Cardiology- Hull University Hull York Medical School 2007-2008 ECG Interpretation Made Easy Synopsis Benefits Objectives Process
More informationUNDERSTANDING YOUR ECG: A REVIEW
UNDERSTANDING YOUR ECG: A REVIEW Health professionals use the electrocardiograph (ECG) rhythm strip to systematically analyse the cardiac rhythm. Before the systematic process of ECG analysis is described
More informationPAEDIATRIC ECG Dimosthenis Avramidis, MD.
PAEDIATRIC ECG Dimosthenis Avramidis, MD. Consultant Mitera Children s Hospital Athens Greece S. Associate 1st Cardiology Dpt Evangelismos Hospital Athens Greece 5 y/o with sinus tach Background ECG changes
More informationPrevalence and QT Interval of Early Repolarization. in a Hospital-based Population
Original Article in a Hospital-based Population Hideki Hayashi MD PhD, Akashi Miyamoto MD, Katsuya Ishida MD, Tomohide Yoshino MD, Yoshihisa Sugimoto MD PhD, Makoto Ito MD PhD, Minoru Horie MD PhD Department
More informationElectrical System Overview Electrocardiograms Action Potentials 12-Lead Positioning Values To Memorize Calculating Rates
Electrocardiograms Electrical System Overview James Lamberg 2/ 74 Action Potentials 12-Lead Positioning 3/ 74 4/ 74 Values To Memorize Inherent Rates SA: 60 to 100 AV: 40 to 60 Ventricles: 20 to 40 Normal
More informationSupraventricular Arrhythmias. Reading Assignment. Chapter 5 (p17-30)
Supraventricular Arrhythmias Reading Assignment Chapter 5 (p17-30) The Supraventricular Rhythms In Our Lives Site of Origin Single Events Slow Rates Intermediate Rates Fast Rates (>100 bpm) Sinus Sinus
More informationBasic electrocardiography reading. R3 lee wei-chieh
Basic electrocardiography reading R3 lee wei-chieh The Normal Conduction System Lead Placement avf Limb Leads Precordial Leads Interpretation Rate Rhythm Interval Axis Chamber abnormality QRST change What
More informationBundle Branch & Fascicular Blocks. Reading Assignment (p53-58 in Outline )
Bundle Branch & Fascicular Blocks Reading Assignment (p53-58 in Outline ) Objectives 1. QRS analysis of Right and Left BBB 2. Uncomplicated vs complicated BBB 3. Diagnosis of RBBB with LAFB and LPFB 4.
More informationECG and echocardiographic findings in year-old elite athletes
Humanwissenschaftliche Fakultät Sarah Koch Michael Cassel Karsten Linne Frank Mayer Juergen Scharhag ECG and echocardiographic findings in 10 15-year-old elite athletes Suggested citation referring to
More informationHR: 50 bpm (Sinus) PR: 280 ms QRS: 120 ms QT: 490 ms Axis: -70. Sinus bradycardia with one ventricular escape (*)
1? HR: 50 bpm (Sinus) PR: 280 ms QRS: 120 ms QT: 490 ms Axis: -70 1 Sinus P waves? 2 sinus cycles The pause (2 sinus cycles) suggests that the sinus fired (?) but did not conduct to the atria (i.e., missing
More informationDR QAZI IMTIAZ RASOOL OBJECTIVES
PRACTICAL ELECTROCARDIOGRAPHY DR QAZI IMTIAZ RASOOL OBJECTIVES Recording of electrical events in heart Established electrode pattern results in specific tracing pattern Health of heart i. e. Anatomical
More informationECG Cases and Questions. Ashish Sadhu, MD, FHRS, FACC Electrophysiology/Cardiology
ECG Cases and Questions Ashish Sadhu, MD, FHRS, FACC Electrophysiology/Cardiology 32 yo female Life Insurance Physical 56 yo male with chest pain Terminology Injury ST elevation Ischemia T wave inversion
More informationThe ECG in healthy people
The ECG in healthy people The normal cardiac rhythm 3 The heart rate 3 Extrasystoles 7 The P wave 7 The PR interval The QRS complex 3 The ST segment 29 The T wave 33 The QT interval 42 The ECG in athletes
More informationThe Athlete s Heart in Adolescent Africans
Journal of the American College of Cardiology Vol. 59, No. 11, 2012 2012 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2011.12.008
More informationREF ENG Rev F1. Physician s. Guide to VERITAS WITH ADULT AND PEDIATRIC RESTING ECG INTERPRETATION
REF 9515-001-50-ENG Rev F1 Physician s Guide to VERITAS WITH ADULT AND PEDIATRIC RESTING ECG INTERPRETATION Copyright 2015 by Mortara Instrument, Inc. 7865 N. 86th Street Milwaukee, Wisconsin 53224 This
More informationPrevalence of asymptomatic ECG abnormalities in Ground Duty Personnel in a forward Air Force Base
Short Communication Prevalence of asymptomatic ECG abnormalities in Ground Duty Personnel in a forward Air Force Base A Singhal*, MS Natraja + Abstract To find out the prevalence of various ECG abnormalities
More informationJonathan Kim MD, FACC
Jonathan Kim MD, FACC Assistant Professor, Division of Cardiology, Emory University Adjunct Assistant Professor, School of Applied Physiology, Georgia Tech Team Cardiologist, Sports Medicine, Emory University
More informationStep by step approach to EKG rhythm interpretation:
Sinus Rhythms Normal sinus arrhythmia Small, slow variation of the R-R interval i.e. variation of the normal sinus heart rate with respiration, etc. Sinus Tachycardia Defined as sinus rhythm with a rate
More informationIt is occasionally problematic to differentiate ST-segment
CLINICAL INVESTIGATION Differential Diagnosis of Acute Pericarditis From Normal Variant Early Repolarization and Left Ventricular Hypertrophy With Early Repolarization: An Electrocardiographic Study Ravindra
More informationElectrocardiography Abnormalities (Arrhythmias) 7. Faisal I. Mohammed, MD, PhD
Electrocardiography Abnormalities (Arrhythmias) 7 Faisal I. Mohammed, MD, PhD 1 Causes of Cardiac Arrythmias Abnormal rhythmicity of the pacemaker Shift of pacemaker from sinus node Blocks at different
More informationVariabilityininterpretationofthe electrocardiogram in young athletes: an unrecognized obstacle for electrocardiogrambased screening protocols
Europace (2015) 17, 1435 1440 doi:10.1093/europace/euu385 CLINICAL RESEARCH Electrocardiology and risk stratification Variabilityininterpretationofthe electrocardiogram in young athletes: an unrecognized
More informationABCs of ECGs. Shelby L. Durler
ABCs of ECGs Shelby L. Durler Objectives Review the A&P of the cardiac conduction system Placement and obtaining 4-lead and 12-lead ECGs Overview of the basics of ECG rhythm interpretation Intrinsic
More information1 st Degree Block Prolonged P-R interval caused by first degree heart block (lead II)
AV Heart Blocks 1 st degree A condition of a rhythm, not a true rhythm Need to always state underlying rhythm 2 nd degree Type I - Wenckebach Type II Classic dangerous to the patient Can be variable (periodic)
More informationPECTUS EXCAVATUM WITH SPONTANEOUS TYPE 1 ECG BRUGADA PATTERN OR BRUGADA LIKE PHENOTYPE: ANOTHER BRUGADA ECG PHENOCOPY
PECTUS EXCAVATUM WITH SPONTANEOUS TYPE 1 ECG BRUGADA PATTERN OR BRUGADA LIKE PHENOTYPE: ANOTHER BRUGADA ECG PHENOCOPY ANDRÉS RICARDO PÉREZ RIERA MD Chief of the Sector of Electro-Vectocardiography of the
More information12 Lead ECG Interpretation: The Basics and Beyond
12 Lead ECG Interpretation: The Basics and Beyond Cindy Weston, DNP, RN, CCRN, CNS-CC, FNP-BC Assistant Professor Texas A&M University College of Nursing cweston@tamhsc.edu Objectives Review the basics
More informationECG INTERPRETATION MANUAL
Lancashire & South Cumbria Cardiac Network ECG INTERPRETATION MANUAL THE NORMAL ECG Lancashire And South Cumbria Cardiac Physiologist Training Manual THE NORMAL ECG E.C.G CHECKLIST 1) Name, Paper Speed,
More informationElectrocardiography for Healthcare Professionals. Chapter 14 Basic 12-Lead ECG Interpretation
Electrocardiography for Healthcare Professionals Chapter 14 Basic 12-Lead ECG Interpretation 2012 The Companies, Inc. All rights reserved. Learning Outcomes 14.1 Discuss the anatomic views seen on a 12-lead
More informationECGs: Everything a finalist needs to know. Dr Amy Coulden As part of the Simply Finals series
ECGs: Everything a finalist needs to know Dr Amy Coulden As part of the Simply Finals series Aims and objectives To be able to interpret basic ECG abnormalities To be able to recognise commonly tested
More informationThe ABC of Pediatric ECG
The ABC of Pediatric ECG Mohamed Hamdan, MD, FAAP, FACC Assistant Professor of Pediatrics Columbia University College of Physicians and Surgeons, NY, USA Consultant Pediatric Cardiologist & Co-Director
More informationStudy Day 1 Study Days 2 to 9 Sequence 1 Placebo for moxifloxacin Study Days 2 to 8: placebo for pazopanib (placebopaz) 800 mg;
The study listed may include approved non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationInterpreting the Athlete secg: Current State and Future Perspectives
Curr Treat Options Cardio Med (2018) 20: 104 DOI 10.1007/s11936-018-0693-0 Sports Cardiology (M Papadakis, Section Editor) Interpreting the Athlete secg: Current State and Future Perspectives Joyee Basu,
More informationCardiac Screening before Participation in Sports
Clinical Decisions Interactive at nejm.org Cardiac Screening before Participation in Sports This interactive feature addresses the approach to a clinical issue. A case vignette is followed by specific
More informationMINOR ELECTROCARDIOGRAM ABNORMALITIES AND CARDIOVASCULAR DISEASES.
UDC 616.13. Abdiramasheva K.S. teacher International kazakh-turkish university named H.A.Yasavi, Turkestan, Kazakhstan MINOR ELECTROCARDIOGRAM ABNORMALITIES AND CARDIOVASCULAR DISEASES. The category of
More information2017 EKG Workshop Basic. Family Medicine Review Course Lou Mancano, MD, FAAFP Reading Health System Family and Community Medicine Reading, PA
2017 EKG Workshop Basic Family Medicine Review Course Lou Mancano, MD, FAAFP Reading Health System Family and Community Medicine Reading, PA Part I - Objectives Discuss a systematic approach to EKG interpretation
More information