1.the rhythm is sinus with soft findings suggestive of enhanced vagal tone including the minor, but noticeable, variation in P-P interval (for example first P-P compared to 4th or 5th P-P). In addition the PR interval is at upper normal limit (about 200ms). Put together, these findings are ‘soft suggestions’ that the patient has enhanced vagal tone, that is not uncommonly seen in athletic patients like himself, and may have nothing to do with his syncope.
2.there is increase voltages with marked repolarization changes, most prominently in the form of steeply, inverted, T waves and also diffuse ST elevations. Also, QT is a bit short.
3. Lead V1 looks abnormal with R>S and some fractionations of QRS.
Whether these changes mean anything or just incidental findings seen in an “athletic heart” it’s hard to tell. Definitely the patient needs an echocardiogram as well as an MRI if available.
In regard to the syncope that he had in the shower, which is a bit classical for vasovagal syncope, we need more clinical history for further delineation to determine next step, which likely include some monitoring for arrhythmia surveillance given his abnormal EKG.
So, simply "athletic heart"..(increased mass and bradycardia/vagal effect in context of systematic training). I bet that his syncope is simply vaovagal and has nothing to do with his EKG changes. Thanks for sharing @Mohsin Salih
Several observations can be made on this EKG.
1.the rhythm is sinus with soft findings suggestive of enhanced vagal tone including the minor, but noticeable, variation in P-P interval (for example first P-P compared to 4th or 5th P-P). In addition the PR interval is at upper normal limit (about 200ms). Put together, these findings are ‘soft suggestions’ that the patient has enhanced vagal tone, that is not uncommonly seen in athletic patients like himself, and may have nothing to do with his syncope.
2.there is increase voltages with marked repolarization changes, most prominently in the form of steeply, inverted, T waves and also diffuse ST elevations. Also, QT is a bit short.
3. Lead V1 looks abnormal with R>S and some fractionations of QRS.
Whether these changes mean anything or just incidental findings seen in an “athletic heart” it’s hard to tell. Definitely the patient needs an echocardiogram as well as an MRI if available.
In regard to the syncope that he had in the shower, which is a bit classical for vasovagal syncope, we need more clinical history for further delineation to determine next step, which likely include some monitoring for arrhythmia surveillance given his abnormal EKG.
Initially I thought he may have HOCM, because ECG has high voltage
however his echo showed mild increase LV wall thickness and CMR normal
So, simply "athletic heart"..(increased mass and bradycardia/vagal effect in context of systematic training). I bet that his syncope is simply vaovagal and has nothing to do with his EKG changes. Thanks for sharing @Mohsin Salih