Electrocardiogram Interpretation of the Athletic Heart:
Examples and Resources

by Elizabeth H. Dineen, DO, Heather Shenkman, MD, Gerald Bourne, MD and Victor Froelicher MD on behalf of the CA ACC Sports and Exercise Committee.

For questions, contact us at SportsCardio@caacc.org

The American College of Cardiology’s California Chapter has established a Sports Cardiology and Exercise Health Committee in response to the growing need for evidence-based, standardized, comprehensive care for athletes. The committee aims to serve as a resource for consultative cardiovascular assessment of highly active individuals as well as a home for educational tools to aid in their assessment and management.

The present document will provide a succinct overview of the interpretation of the electrocardiogram (ECG) in the athletic population by providing select resources for a more comprehensive understanding of ECG changes occurring in athletes, supported by a few examples of abnormal findings.

This document does not serve to support or refute the case for pre-participation screening with an ECG, but rather as a resource to help those providers whenever they are faced with analyzing an athlete’s ECG, including team physicians, family medicine, sports medicine, cardiology, athletic trainers and others caring for athletic individuals.

1. ECGs provided in this document with brief description. ECGs obtained from Dr. Vic Froelicher.
2. “International recommendations for ECG in the athlete” provides tables and figures that clearly delineate normal and abnormal ECG findings (Figure 1), definitions of ECG findings (Table 1) and evaluation suggested in the setting of these ECG findings (Table 2). Full article found here: http://www.onlinejacc.org/content/69/8/1057.
3. For further practice, please reference the University of Washington ECG Modules: https://uwsportscardiology.org/e-academy/ecg-modules/
4. Please find Uberoi and colleagues, “Interpretation of the Electrocardiogram of Young Athletes,” at the following link: https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.110.013078
5. Please find Parry-Williams and colleagues, “Current understanding of the electrocardiographic manifestations of the ‘athlete’s heart,’ at the following link: https://www.alliedacademies.org/articles/current-understanding-of-the-electrocardiographic-manifestations-of-theathletes-heart.pdf
6. Please find Abela and Sharma’s Abnormal ECG Findings in Athletes: Clinical Evaluation and Considerations at the following link: https://link.springer.com/article/10.1007/s11936-019-0794-4?wt_mc=socialmedia.twitter.1.SEM.ArticleAuthorIncrementalIssue

Guidelines from International Recommendations for Electrocardiographic Interpretation in Athletes

In the JACC article and the slideshow below are tables and figures that clearly delineate normal and abnormal ECG findings (Figure 1), definitions of ECG findings (Table 1) and evaluation suggested in the setting of these ECG findings (Table 2).

Copyright Source: Journal of the American College of Cardiology; Volume 69, Issue 8, February 2017. Authors: Sanjay Sharma, Jonathan A. Drezner, Aaron Baggish, Michael Papadakis, Mathew G. Wilson, Jordan M. Prutkin, Andre La Gerche, Michael J. Ackerman, Mats Borjesson, Jack C. Salerno, Irfan M. Asif, David S. Owens, Eugene H. Chung, Michael S. Emery, Victor F. Froelicher, Hein Heidbuchel, Carmen Adamuz, Chad A. Asplund, Gordon Cohen, Kimberly G. Harmon, Joseph C. Marek, Silvana Molossi, Josef Niebauer, Hank F. Pelto, Marco V. Perez, Nathan R. Riding, Tess Saarel, Christian M. Schmied, David M. Shipon, Ricardo Stein, Victoria L. Vetter, Antonio Pelliccia and Domenico Corrado
Read the JACC Article

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Examples of ECGs found in Athletes

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For questions, contact us at SportsCardio@caacc.org