ECG abnormalities

[neildo]

I am a 21 year old very healthy athlete. i recently had an ECG which showed abnormalities. It is probable that I have LVH with a secondary re polarization abnormality. It also showed an "unknown rhythm/irregular rate". I have normal/healthy blood pressure, and  tests with a stethoscope performed by my doctor examining my chest showed there are no obvious problems. I have been referred to a heart specialist for an echo, ETT (stress) and 24 hour tape.

I am extremely active, training every day in various sports; weightlifting, running, swimming and cycling, yet also rest appropriately. I have been this active since around 15-16 years of age. I have a healthy diet (good fats, protein, low GI carbs), dont smoke, and drink rarely. I am 6 2", 85kgs and around 10-12% body fat - lean and muscluar.

I would like advice as to whether this is anything to worry about hugely? Are these abnormalities likely to be caused by my exercise? I have no family history of heart problems and have never had a since heart problem or chest pains myself.

Thanks in advance, Neil

[neildo]

Thank you for your detailed and in depth response. I shall be seeing a specialist for my echo/ett/24h tape at the end of this month. Hopefully these will show up that I am healthy and have no heart problems, only a very "trained" heart. Thanks again

[kenkeith]

In an athlete's heart there may be a murmur heard due to the force of blood being pumped (strong contractions).  That appears to be negative.

For some insight, cardiovascular remodelling (enlarged left ventricle) in the highly trained athlete is frequently (up to 80%) associated with ECG abnormalities such as sinus bradycardia (heart rate below 60 bpm),  and early repolarization resulting from physiological adaptation of the cardiac autonomic nervous system to training, i.e. increased vagal tone and/or withdrawal of sympathetic activity.

Moreover, the ECG of trained athletes often exhibits pure voltage criteria for left ventricular hypertrophy that reflect the physiological left ventricular changes (hypertrophy), consisting of increased left ventricular wall thickness and chamber size. Although these ECG changes are ‘abnormal’ in a strict statistical sense, they do not imply the presence of cardiovascular disease or an increase of cardiovascular risk in the athlete.

This concern arises because  ECG changes develop in trained athletes as a consequence of sustained physical exercise (‘athlete's heart’); and  there is the misconception that most athletes’ ECG changes overlap significantly with ECG abnormalities seen in the cardiovascular diseases which cause sudden death in the young. The ECG has therefore been considered to be a poor screening tool for cardiovascular disorders in athletes because of its presumed low specificity.