Sports Cardiology Casebook	2
	Foreword	5
	Contents	7
	Contributors	10
	Introduction	14
	References	16
	1 A 27-Year-Old Professional Cyclist with Palpitations on Effort	18
	Family and Personal History	18
	Physical Examination	18
	12-Lead ECG	18
	Diagnostic Testing	19
	Recommendations and Treatment	22
	Clinical Course	22
	Discussion	23
	References	24
	2 Impaired Performance in a Master Long-Distance Runner	26
	History	26
	Athletic History	26
	Family History	26
	Medication	26
	Physical Examination	27
	12-Lead ECG	27
	Maximal Exercise Test with Gas Analysis	27
	Trans-Thoracic Echocardiography	28
	Stress Echocardiography	30
	Diagnosis and Recommendations	30
	Discussion	30
	References	31
	3 A 26-Year-Old Cyclist with Syncope on Effort	32
	Family and Personal History	32
	Medical History	32
	Physical Examination	32
	12-Lead ECG	32
	Echocardiography	33
	Exercise Electrocardiography	34
	Clinical Course	34
	Discussion	35
	Recommendations for Sports Participation in Patients with ARVC	37
	References	37
	4 A 32-Year-Old Female Soccer Player with Unexplained Syncope	39
	Previous Medical History	39
	Physical Examination and Diagnostic Testing	39
	Clinical Course	39
	Family History	41
	Type and Level of Sports Activity Performed	41
	Physical Examination	41
	12-Lead ECG	41
	Diagnostic Testing	42
	ECG Holter-Monitoring (48h)	42
	Blood Pressure (BP)-Monitoring	43
	Late Potentials (HV)-ECG	43
	Exercise -- Testing	43
	Echocardiography	44
	Ajmalin -- Testing	44
	Sleep Apnea Monitoring	45
	Cardiac CT Scan	45
	Cardiac Magnetic Resonance	45
	Tilt Table Testing	45
	Neurologist Consultation	46
	Cerebral Doppler	47
	Cerebral MRI	48
	Ophthalmologist Examination	48
	Laboratory Results	48
	Final Diagnosis and Recommendations	48
	Discussion	48
	References	49
	5 A 23-Year-Old Top-Level Soccer Player Suffering Syncope on Effort	50
	Medical History	50
	Physical Examination	50
	12-Lead ECG	50
	Echocardiography	50
	Exercise Electrocardiography	50
	Holter Monitoring	51
	Other Diagnostic Testing	52
	Clinical Course	52
	Other Diagnostic Testing	53
	Treatment	53
	Subsequent Clinical Course	53
	Discussion	54
	References	55
	6 A 21-Year-Old Female Beach Volleyball Player with Palpitations and Pre-syncope on Effort	56
	Medical History	56
	Physical Examination	56
	12-Lead ECG	56
	Diagnostic Testing	56
	Clinical Course and Recommendations	57
	Subsequent Follow-Up	58
	Discussion	60
	Summary of the Recommendations for Sports Participation in Athletes with AVNRT [ 3 , 5 ]	60
	References	61
	7 A 49-Year-Old Male Marathon Runner with Exercise Induced Prolonged Palpitations	62
	Family and Personal History	62
	Medical History	62
	12-Lead ECG	62
	Echocardiography	62
	Exercise Electrocardiography	63
	ECG Holter Monitoring	64
	Diagnosis and Treatment	64
	2nd Cardiovascular Evaluation	65
	Physical Examination	65
	12-Lead ECG	65
	Other Testing	65
	Treatment	65
	Clinical Course	66
	Discussion	67
	Suggested Recommendations for Sports Participation in Adult and Senior Athletes with Atrial Fibrillation (AF)	68
	References	69
	8 A Female Cyclist with Prolonged Palpitations on Effort	71
	Medical History	71
	Physical Examination	71
	Electrocardiogram	71
	Echocardiography	71
	ECG Holter Monitoring	71
	Electrophysiological Study	72
	Second Clinical Evaluation	73
	Diagnosis and Recommendation	73
	Discussion	75
	References	76
	9 The Girl with Systolic Murmur on the Left Sternal Border	77
	Family and Personal History	77
	Physical Examination	77
	12-Lead ECG	77
	Diagnostic Course	77
	Cardiology Consultation	78
	12-Lead ECG	78
	Echocardiography	78
	Diagnosis	80
	What is the Risk for Our Patient of Continuing her Sport?	80
	Recommendations	80
	Discussion	80
	References	81
	10 Elite Tennis Player with a Complete Atrio-Ventricular Block	82
	Medical History	82
	Physical Examination	82
	12-lead electrocardiogram	82
	M-mode Echocardiogram	82
	Electrophysiologic Study	83
	Diagnosis and Recommendation	83
	Clinical Course	84
	24-Hour ECG Monitoring	84
	Exercise Testing	84
	Clinical Outcome	84
	Medical History	85
	12-Lead ECG	85
	24-Hour Holter ECG Monitoring	85
	Doppler-Echocardiography	85
	Discussion	86
	References	88
	11 A Young Canoeist with an Abnormal Electrocardiogram	89
	Family and Personal History	89
	Physical Examination	89
	12-Lead ECG	89
	Echocardiography	89
	Exercise Electrocardiography	90
	ECG Holter Monitoring	90
	Additional Diagnostic Testing	91
	Clinical Course	92
	Discussion	93
	References	96
	12 ECG Repolarization Abnormalities in an African Descent Athlete: Pathologic or Physiologic Finding?	97
	Medical History	97
	Physical Examination	97
	12-Lead ECG	97
	Echocardiography	97
	Cardiac Magnetic Resonance (CMR)	99
	Diagnosis and Recommendations	99
	Discussion	100
	References	102
	13 A 16-Year-Old Female Runner with Prolonged QT Interval	104
	Medical History	104
	Physical Examination	104
	12-Lead ECG	104
	Other Diagnostic Testing	104
	Diagnosis and Recommendations	106
	Discussion	107
	Pitfalls in the Measurements of QT Interval in Athletes	107
	Diagnosis of LQTS in Asymptomatic Athletes	108
	Management	109
	References	109
	14 Athlete with Variable QTc Interval and Abnormal T Wave Pattern	111
	Family and Personal History	111
	Physical Examination	111
	12-Lead ECG	111
	Echocardiography	111
	Exercise Electrocardiography	112
	ECG Holter Monitoring	113
	Family Screening	114
	Cardiac Magnetic Resonance	115
	Diagnosis and Recommendations	115
	Clinical Course	116
	Genetic Analysis	117
	Follow-Up	117
	Discussion	117
	References	119
	15 Young Triathlete with Unusual ST-Segment Elevation in Precordial Leads	120
	Family and Personal History	120
	Physical Examination	120
	12-Lead ECG	120
	Exercise Electrocardiography	121
	Flecainide Testing	121
	Echocardiography	122
	Diagnosis	123
	Discussion	123
	Recommendations for Sports Participation in Brugada Patients	124
	Early Repolarization Pattern in Athletes	125
	References	126
	16 A 17-Year-Old Competitive Soccer Player with Pre-excitation Pattern on 12-Lead ECG	127
	Family and Personal History	127
	Physical Examination	127
	12-Lead ECG	127
	Diagnostic Course	127
	Recommendations	128
	Discussion	128
	References	129
	17 A Symptomatic Judoka with Wolff-Parkinson-White Pattern	131
	Athletic History	131
	Family History	131
	Personal History	131
	Physical Examination	131
	12-Lead ECG	131
	Echocardiography	132
	Electrophysiologic Study and Ablation Procedure	132
	Clinical Course and Recommendations	133
	Discussion	133
	References	135
	18 A 35-Year-Old Competitive Cyclist with Frequent Premature Ventricular Beats	136
	Athletes History	136
	Previous Diagnostic Testing	136
	Medical History	136
	Physical Examination	137
	12-Lead ECG	137
	New Diagnostic Testing	137
	Recommendations and Treatment	141
	Clinical Course	141
	Discussion	141
	References	143
	19 An Athlete with Ischemic Pattern on Exercise ECG	144
	Family and Personal History	144
	Physical Examination	144
	12-Lead ECG	144
	Exercise Electrocardiography	144
	Echocardiography	145
	ECG Holter Monitoring	146
	Other Tests	146
	Ventriculo-Coronary Angiography	147
	Cardiac Magnetic Resonance	147
	Diagnosis and Recommendations	148
	Discussion	148
	References	149
	20 A 17-Year-Old National Cyclist with Exercise-Induced Ventricular Tachycardia	150
	Family and Personal History	150
	Medical History	150
	Physical Examination	150
	12-Lead ECG	151
	Echocardiography	151
	Blood Analysis	151
	Exercise Test: Race Simulation	152
	Holter ECG Monitoring During Bicycle Race	152
	Recommendations	154
	Additional Diagnostic Tests	154
	Electrophysiologic Study	154
	Subsequent Clinical Course	154
	Continued Follow-Up	154
	Final Recommendations	155
	Discussion	155
	References	156
	21 A 53-Year-Old Recreational Jogger with Atrial Fibrillation	157
	Family and Personal History	157
	Physical Examination	157
	12-Lead ECG	157
	Echocardiography	158
	Diagnosis and Treatment	158
	Clinical Course	158
	Discussion	159
	References	161
	22 Paroxysmal Atrial Fibrillation in a Professional Cyclist	162
	Family and Personal History	162
	Athletic History	162
	Physical Examination	162
	12-Lead ECG	162
	Echocardiography	163
	Maximal Exercise Testing with Gas Analysis	163
	Follow-Up and Other Testing	164
	Treatment and Recommendations	166
	Subsequent Follow-Up	166
	Discussion	166
	References	167
	23 A Female Soccer Player with Unusual Fatigability and Ventricular Arrhythmia	168
	Medical History	168
	Diagnostic Testing	168
	Clinical Course	170
	Recommendations and Treatment	170
	Subsequent Clinical Course	170
	Recommendations and Treatment	171
	Discussion	171
	References	172
	24 A 38-Year-Old Marathon Runner with Tricuspid Valve Regurgitation	173
	Personal Medical History	173
	Family History	173
	Type and Level of Sports Activity Performed	173
	Physical Examination	173
	Diagnostic Testing	174
	12-Lead ECG	174
	Echocardiography	174
	Treadmill - Exercise - Testing	175
	Cardiac Magnetic Resonance (CMR)	175
	ECG Holter Monitoring	176
	Laboratory Results	177
	Diagnosis and Recommendations	177
	Discussion	177
	Reference	177
	25 A Young Rower with an Unusual Left Ventricular Hypertrophy	178
	Family and Personal History	178
	Physical Examination	178
	12-Lead ECG	178
	Echocardiography	178
	Exercise Testing	179
	Detraining	180
	Clinical Course	181
	Additional Diagnostic Testing	181
	Diagnosis and Recommendations	182
	Discussion	184
	References	185
	26 An Elite Athlete with Controversial Left Ventricular Hypertrophy	186
	Medical History	186
	Physical Examination	186
	12-Lead ECG	186
	Echocardiography	186
	Clinical Course	187
	Diagnosis and Recommendations	190
	Discussion	191
	References	192
	27 A Non-compaction Cardiomyopathy or Innocent LV Trabeculation?	194
	Medical History	194
	Family and Personal History	194
	Physical Examination	194
	12-Lead ECG	194
	Exercise Testing	195
	24-h ECG Holter Monitoring	195
	Signal Averaging ECG	195
	Echocardiography	196
	Cardiac Magnetic Resonance (CMR)	197
	Diagnosis and Recommendations	197
	Discussion	198
	References	199
	28 A 31-Year-Old Male, Recreational Soccer Player with 0Low Risk0 Hypertrophic Cardiomyopathy	202
	Medical History	202
	Physical Examination	202
	12-Lead ECG	202
	Echocardiography	202
	Exercise Testing	203
	ECG Holter Monitoring	203
	Diagnosis and Recommendations	203
	Clinical Course	204
	Autopsy Findings	204
	Discussion	205
	References	206
	29 Competitive Cyclist Suffering from Myocardial Infarction, Willing to Resume Competitive Sport	207
	Family and Personal History	207
	Athletic History	207
	Medical History	207
	Reason for Cardiovascular Evaluation	209
	Physical Examination	209
	12-Lead ECG	209
	Evaluation and Risk Stratification	209
	Diagnostic Testing	209
	Recommendations	211
	Discussion	211
	References	212
	30 A 32 Year-Old Male Soccer Player with Chest Trauma	213
	Medical History	213
	Physical Examination	213
	12-Lead ECG	213
	Clinical Course	213
	Cardiac Evaluation in the CCU	213
	Additional Testing	215
	Recommendations	215
	Discussion	215
	References	215
	31 Asymptomatic Cyclist with Stenosis of Left Main Coronary Artery	217
	Medical History	217
	Physical Examination	217
	12-Lead ECG	217
	Exercise Testing	217
	Additional Testing	217
	Diagnosis and Recommendations	218
	Discussion	220
	References	221
	Appendices	222
	Index	237