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What is Which of the following ECG changes in an Asymptomatic Athlete's Heart should be considered pathological ? and explain in detail?
Ans. is 'b' i.e., Second Degree (Mobitz 2) heart block o Athletes Heart is associated with a prolonged QT interval and not a shortened QT interval.o Athletes Heart is usually associated with a prolonged QT interval because of bradycardia. When corrected for heart rate the QT interval (QT) is usually at the upper limit.Normal ECG findings in athleteso These common training-related ECG alterations are physiological adaptations to regular exercise, considered normal variants in athletes and do not require further evaluation in asymptomatic athletes.Sinus bradycardia (> 30 bpm)Sinus arrhythmiaEctopic atrial rhythmJunctional escape rhythm1deg AV block (PR interval > 200 ms)Mobitz type I (Wenckebach) 2degAV blockIncomplete RBBBIsolated QRS voltage criteria for L VH (High QRS voltage)Except: QRS voltage cirteria for L VH occurring with any non-voltage cirteria for LVH such as left atrial enlargement, left axis deviation, ST segment depression, T-wave inversion or pathological Q waves.Early repolarisation (ST elevation, J-point elevation, J-waves or terminal QRS slurring).Convex ('domed') ST segment elevation combined with T-wave inversion in leads V1-V4 in black/African athletes.Tall peaked TwavesProminent u wavesT wave flattening or inversion that normalizes with exerciseo Second Degree (Mobitz-2) heart block should be considered a pathological finding in an Athletes Electrocardiogram.y Various degrees of airioventricidar blocks have been described in endurance athletes. First Degree Blocks and Second Degree (Mobitz-1) are a common finding. However second degree (Mobitz-2) and third degree blocks are pretty1 rare and should be considered pathological'.Abnormal ECG findings in athletesAbnormal ECG findingDefinitionT-wave inversion> 1 mm in depth in two or more leads V2-V6, II and aVF, or I and VL (excludes III, aVR and VI)ST segment depression> 0.5 mm in depthin two or more leadsPathologic Q waves> 3 mm in depth or >40 ms in duration in two or more leads (exceptfor HI and AYR)Complete left bundle branch blockQRS > 120 ms, predominantly negative QRS complex in lead VI (QS or rS), and upright monophasic R wave in leads / and V6.Intraventricular conduction delayAny QRS duration > 140 msLeft axis deviation-30deg to-90degLeft atrial enlargementProlonged P wave duration of > 120 ms in leads I or II with negative protion of the P wave 31 mm in depth and3 40 ms in duration in lead VIRight ventricular hypertrophy patternR-VI+S-/V5 >10.5 mm AND right axis deviation > 120degVentricular pre-xcitationPR interval < 120 ms with a delta wave (slurred upstroke in the QRS complex) and wide QRS (>120 ms)Long QT intervalQTc > 470 MS (male)QTc >480 ms (female)QTc > 500 ms (marked QTprolonation)Short QT intervalQTc <320 msBrugada-like ECG patternHigh take-off and downsloping ST segment elevation followed by a negative T wave in >2 leads in VI-V3Profound sinus bradycardia<30 BPM or sinus pauses > 3sAtrial tachyarrhythmiasSupraventricular tachycardia, atrial-fibrillation, atrial-flutterPremature ventricular contractions> 2 PVCs per 10s tracingVentricular arrhythmiasCouplets, tripplets and non-sustained ventricular tachycardia