Case: 28 year old Afro-American athlete is admitted to ICU directly from his physician office where EKG was done as part of a regular annual physical exam. Patient has no complaints, feel healthy and has no cardiac history in the family. EKGs from physician office and ICU shows "dome-shaped ST elevation with T wave inversions" (biphasic T waves) in leads V1 to V4. EKG pattern in all other leads is normal. Your diagnosis?
Answer: Afro-American athlete repolarization variant
10-15 percent of African-American athletes have a pattern of dome-shaped ST elevation with T wave inversions, sometimes appearing as biphasic T waves in leads V1 to V4. This EKG variation is a normal pattern if an athlete has no symptoms, otherwise normal physical exam or has no family history. Said that this is limited to leads V1 to V4. If abnormalities are noted in other leads, they should be investigated.
1. Papadakis M, Carre F, Kervio G, et al. The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African/Afro-Caribbean origin. Eur Heart J 2011; 32:2304.
2. Sheikh N, Papadakis M, Ghani S, et al. Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes. Circulation 2014; 129:1637.