Value of Patient-Directed Brain Magnetic Resonance Imaging Scan with a Diagnosis of Migraine

Background

The objective of this study was to determine whether a brain magnetic resonance imaging (MRI) scan in patients with a diagnosis of migraine, who insist on the performance of imaging, is of more benefit in detecting clinically significant unsuspected structural abnormalities than would be expected by chance.

Cardiopulmonary function following post-cardiac surgical mediastinitis

Eleven survivors of bacterial mediastinitis, which followed cardiac surgery through a median sternotomy approach, underwent noninvasive cardiopulmonary evaluation to determine whether clinically apparent mediastinal fibrosis had developed. Compared to preoperative values, forced vital capacity was reduced by 9.75 percent of predicted; the greatest reduction occurred in those patients with Gram-negative mediastinitis. In one patient, an abnormal jugular venous wave form and apex cardiogram were consistent with constrictive cardiac physiology, but this was not associated with an abnormal echocardiogram or impaired functional status. In this small series, no serious abnormalities in cardiopulmonary function were detected which could be attributed to prior mediastinal infection.     

Doppler tissue imaging to evaluate early myocardium damage in patients with undetermined form of Chagas' disease and normal echocardiogram

Chagas' disease can lead to severe and potentially lethal damage of cardiac function. Thus, the identification of contractile abnormalities in asymptomatic patients can be important for risk stratification in those patients. Doppler tissue imaging (DTI) is a new diagnostic modality for the study of regional and longitudinal contractility of the left ventricle. However, DTI has not been used for the assessment of Chagas' cardiopathy. The purpose of this study was to identify abnormalities related to longitudinal contractility by means of DTI in patients with an undetermined form of Chagas' disease and with normal echocardiogram and Doppler studies. Forty patients were studied, including 21 chagasic ones with normal electrocardiographic, radiologic, and echocardiographic studies, and 19 normal control individuals. All of the patients were submitted to DTI to evaluate longitudinal contractility in the various myocardial segments, including assessment of systolic and diastolic velocities and isovolumic contraction time (IVCT). Similar values were observed among the various systolic function rates in both groups, except for the IVCT along the septal wall, which was significantly higher in the chagasic group. DTI enabled the early detection of contractile abnormalities in patients with an undetermined form of Chagas' disease and with normal echocardiogram. Such abnormalities were particularly striking in the interventricular septum. The present study could be useful in risk stratification for those patients.     

Persistent Left Superior Vena Cava and Absent Right Superior Vena Cava: Not Only an Anatomic Variant

Introduction:

A 71 year old asymptomatic woman came for an echocardiogram because of a left bundle branch block. A much dilated coronary sinus (CS) with an entering large vessel was found along with a mild left ventricular systolic dysfunction. Cardiac Magnetic Resonance (CMR) showed a persistent left superior vena cava (PLSVC), and an absent right superior vena cava (ARSVC). PLSVC drained into the dilated CS. No other cardiac abnormalities were found. Any late Gadolinium enhancement was also not seen. PLSVC and ARSVC are associated with sinus node and conduction tissue maldevelopment and atrial arrhythmias, and thus clinical follow up is indicated.

Conclusion:

CMR is a useful addition to echocardiogram to search for further cardiac abnormalities, and outline the anatomy with precision in doubtful cases.     

Isolated ventricular noncompaction is associated with coronary microcirculatory dysfunction

OBJECTIVES: We sought to analyze whether a microcirculatory dysfunction might be associated with isolated ventricular noncompaction (IVNC). BACKGROUND: In IVNC, which is a cardiomyopathy thus far "unclassified" by the World Health Organization, heart failure and sudden cardiac death are common findings, but the pathophysiologic mechanisms are unknown. METHODS: In 12 patients with IVNC and 14 control subjects, quantitative evaluation of regional myocardial perfusion (myocardial blood flow [MBF]) and coronary flow reserve (CFR, hyperemic/baseline MBF) was performed using positron emission tomography and (13)N-ammonia. The left ventricular myocardium was divided into nine segments, and the two-dimensional echocardiogram in each patient with IVNC was compared with CFR in each segment. Noncompaction was defined as a two-layered structure with excessive trabeculation. RESULTS: The CFR in control subjects averaged 4.2+/-0.9, providing a cut-off value > or =2.5, but it was 2.1+/-0.8 in patients with IVNC. A perfusion scan defect was found in 14 of 24 segments with noncompaction, although no defect was found in 76 of 84 normal segments (overall agreement 83%, p < 0.0001 by the chi-square test). In 16 of 21 segments with noncompaction, a decreased CFR was found; but a decreased CFR was also found in 36 of 60 segments without noncompaction (p = NS). In 45 of the 57 segments with wall motion abnormalities, CFR was decreased, but it was preserved in 17 of the 24 segments with normal wall motion (agreement 77%, p < 0.0001). CONCLUSIONS: In patients with IVNC, a decreased CFR is not confined to noncompacted segments, but extends to most segments with wall motion abnormalities. Thus, coronary microcirculatory dysfunction is associated with IVNC.     

Quantitative thallium imaging findings in patients with normal coronary angiographic findings and in clinically normal subjects

Computer-quantified exercise thallium images in 45 clinically normal subjects (group I) and in 44 patients with chest pain and no significant coronary artery disease by angiography (group II) were compared. Group II patients were older and more frequently female, had ST-segment depression by electrocardiography, and included 8 with subcritical (0 to 49%) stenoses. When normality was defined by the range of thallium imaging values in the clinically normal subjects, and after correcting clearance for peak exercise heart rate, 20 of 44 patients (45%) in group II had "abnormal" findings. The only difference between the 20 patients with abnormal findings and the 24 with normal findings in group II was a greater frequency of subcritical (less than 50%) coronary stenoses in the abnormal group, 7 (35%) vs 1 (4%) (p less than 0.05). However, this does not explain most of the abnormalities of thallium imaging in group II. Thus, abnormal thallium findings in subjects with normal angiographic findings are frequently seen and are partially related to the presence of subcritical coronary stenoses, suggesting an underestimation of coronary obstruction. Furthermore, clinically and angiographically normal subjects may differ substantially, and both sets of normal subjects should be considered when establishing criteria for abnormality in exercise thallium imaging.     

Isolated cleft posterior mitral valve leaflet: an uncommon cause of mitral regurgitation

A 53-year-old woman with a history of hypertension was referredfor an echocardiogram by her primary care physician after anunspecified abnormal ECG. The echocardiogram showed normal leftventricular size and function; however, an isolated cleft posteriormitral valve leaflet was identified with concomitant bileafletprolapse and mild mitral regurgitation. She was subsequentlyreferred to a cardiologist for clinical evaluation. Cleft mitralvalve leaflet (CMVL) is an uncommon congenital cause of mitralregurgitation. Clefts, defined as slit-like holes or defects,are hypothesized to be a result of incomplete expression ofan endocardial cushion defect which most commonly involves theanterior mitral valve leaflet with a paediatric incidence of1:1340. Clefts affecting only the posterior mitral valve leafletare extremely rare with only four cases being reported in themedical literature. Important co-existing anomalies with eitherposterior and/or anterior CMVL include counterclockwise rotationof the papillary muscles, the presence of an accessory papillarymuscle or mitral valve leaflet, atrial septal defects, and mitralvalve prolapse. Regurgitation from CMVL can lead to importantphysiological and anatomical changes within the cardiac system.Regurgitation results from blood flow directly through the cleftitself or from malcoaptation from accessory chordae with orwithout papillary muscle distortion. Significant chronic mitralregurgitation elevates left atrial filling pressures and leadsto chamber enlargement and eccentric left ventricular hypertrophy.Early detection through two-dimensional echocardiography canprovide accurate anatomical images of the various mitral valvestructures and identify associated congenital anomalies. Earlysurgical correction is preferred before mitral regurgitationcauses unfavourable remodelling. Most mitral valve cleft defectscan easily be repaired by suturing the edges of the cleft. Ifa cleft resection leads to limited residual valve tissue, theleaflet of the mitral valve can be reconstructed using an autologouspericardial patch pre-treated with buffered glutaraldehyde.Posterior CMVL is an uncommon but clinically important causeof mitral insufficiency. Early recognition of this rare clinicalentity and possible co-existent anomalies can identify the patientswho would benefit from surgical intervention before compensatoryleft ventricular remodelling and contractile dysfunction develop.     

The Echocardiographic Assessment of Dyssynchrony: Insights from a Consecutive Series of General Cardiology Patients with Normal LVEF and Narrow QRS

Background: Prior studies have described the potential benefit of using echocardiographic rather than ECG techniques to help select the subgroup of heart failure patients that are most likely to benefit from cardiac resynchronization therapy (CRT). Currently, the most commonly used echocardiographic techniques to assess dyssynchrony include discrepancies in radial motion derived from M-mode and in longitudinal motion derived from tissue Doppler; however, there are little data available on the range of these measurements in the general cardiology population. Methods and Results: A consecutive series of patients referred for a stress echocardiogram were screened for normal LV systolic function and normal QRS width. Fifty-one patients met inclusion criteria and underwent dyssynchrony measurements in addition to their baseline echo. Previously proposed cutoff values were applied. We observed 17% of study subjects were above the reported normal values for radial dyssynchrony and 41% were above the reported normal values for longitudinal dyssynchrony. However, when both criteria were required to be abnormal only 4% were classified as dyssynchronous. Conclusions: Echocardiographic indices in general cardiology patients appear most accurate when radial and longitudinal parameters are used in combination. While the ideal cutoff values remain to be determined, this combination may optimize patient selection for CRT response.     

Long-Term Value of Stress Echocardiography in the Triage of Patients with Atypical Chest Pain Presenting to the Emergency Department

The purpose of this study was to assess the use of stress echocardiography in the triage of patients presenting to the emergency department with atypical chest pain. We hypothesized that a negative stress echocardiogram would identify patients with a very low risk for future cardiac events, thus reducing the requirement for unnecessary hospitalizations. Stress testing was performed in 105 patients presenting with atypical chest pain, no prior history of coronary artery disease, a nondiagnostic electrocardiogram (ECG), negative serial creatine phosphokinase level at 0 and 4 hours, and baseline normal echocardiagrams. Cardiac stress was invoked using an exercise protocol in 75 (71%) patients and intravenous dobutamine in 30 (29%) patients, with ECG and echocardiography results analyzed separately. Cardiac events (myocardial infarction, coronary revascularization, and cardiac death) were noted in 7 (7%) patients with a mean follow-up of 2.8 ± 1.3 years. Univariate analysis identified five predictors of future cardiac events, but only stress-induced wall motion abnormalities were found to be predictive with multivariate analysis. Kaplan-Meier estimate of cumulative event-free survival for cardiac events at 3 years was 99% for a negative stress echocardiogram (no stress-induced wall motion abnormalities) compared with 95% for stress ECG (< 1-mm ST segment depression). The event-free rate of a positive stress echocardiogram and stress ECG was 25% and 63%, respectively. We conclude that stress echocardiography can be performed safely in patients presenting with atypical chest pain. A negative stress echocardiogram carries an excellent 3-year prognosis and thus identifies patients who may forgo hospital admission and further cardiovascular workup.     

Hepatobiliary laboratory abnormalities among patients with chronic or persistent immune thrombocytopenia (ITP)

Therapies for immune thrombocytopenia (ITP) may be associated with abnormal hepatobiliary laboratory (HBL) values, but the epidemiology of these abnormalities is unknown in the ITP population. The study aim was to provide prevalence and incidence rates, as well as risk factors for abnormal HBL values among a cohort of patients with chronic or persistent primary ITP. Health insurance claims data from 3,244 patients with chronic or persistent ITP was examined to estimate the prevalence of abnormal HBL values: elevated levels of Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), total bilirubin, and Alkaline Phosphatase (ALP). Incidence of abnormal HBL values was estimated in a sub cohort of 2557 (79%) patients without evidence of comorbidities related to secondary thrombocytopenia, liver disease, or abnormal HBL values during the 12-month baseline period. The baseline prevalence of ALT and AST > 3x the upper limit of normal (ULN) was 4.6 and 3.7%, respectively. The baseline prevalence of total bilirubin and ALP >1.5x ULN was 4.2 and 3.2%, respectively. The incidence rate of new HBL abnormalities (HBLA) was 1.24/1,000 person-years (95% CI: 0.52-2.56) for ALT>3x ULN and 0.41/1,000 person-years (95% CI: 0.08-1.32) for AST>3x ULN. HBLAs were significantly associated with male gender, liver disease, diabetes, congestive heart failure, lupus, hematological cancers, and HIV infection. In conclusion, the prevalence of HBLA, specifically ALT>3x ULN, among the ITP population is relatively high compared with atrial fibrillation, though within the confidence interval for that estimate. HBLAs were significantly associated with male gender, liver disease, and several other comorbidities, thus, distinguishing drug-induced liver injury in this population is clinically challenging.     

Validity of electrocardiographic indices of left ventricular hypertrophy in athletes

The Authors have evaluated the reliability of the most important electrocardiographic criteria for left ventricular hypertrophy in a group of 95 athletes. An ECG and a M- and B-mode echocardiogram have been performed in each subject; the criteria by Sokolow and Lyon, by Cornell, by Gubner, by Romhilt and Estes and by Casale have been employed to evaluate left ventricular hypertrophy. Left ventricular mass has been evaluated by the echocardiogram according to Devereux and coll. The electrocardiographic method by Casale and coll., proposed only for a few years, is based on the valuation of R wave and on the study of ventricular repolarization depending on sex and age. By this method, still now not much used in the study of athletes, a good correlation with the echocardiographic data was expected, in relation to the young age of the population. The athletes have been divided into three groups, practising aerobic sports, aerobic-anaerobic sports and power sports, according to the physiologic classification of the sports activities of Dal Monte. Using the chi-squared test, for the whole population and separately for the three groups, no significant statistical correlation has been observed. In conclusion, the results demonstrate that not only the "classic" criteria, but also the most recent ECG criteria of left ventricular hypertrophy are not reliable in evaluating left ventricular hypertrophy in trained athletes, leaving the final assessment of the real state of the cardiac chambers to echocardiography.     

Normal values of the electrocardiogram for ages 16–90 years

IntroductionTo establish an up-to-date and comprehensive set of normal values for the clinically current measurements in the adult ECG, covering all ages for both sexes.MethodsThe study population included 13,354 individuals, taken from four population studies in The Netherlands, ranging in age from 16 to 90 years (55% men) and cardiologically healthy by commonly accepted criteria. Standard 12-lead ECGs were available for all participants. The ECGs were processed by a well-validated computer program. Normal limits were taken as the 2nd and 98th percentiles of the measurement distribution per age group.ResultsOur study corroborates many findings of previous studies, but also provides more differentiated results, in particular for the older age groups. Age trends were apparent for the QTc interval, QRS axis, and indices of left ventricular hypertrophy. Amplitudes in the left precordial leads showed a substantial increase in the older age groups for women, but not for men. Sex-dependent differences were apparent for most ECG parameters. All results are available on the Website www.normalecg.org, both in tabular and in graphical format.ConclusionsWe determined age- and sex-dependent normal values of the adult ECG. Our study distinguishes itself from other studies by the large size of the study population, comprising both sexes, the broad range of ages, and the exhaustive set of measurements. Our results emphasize that most diagnostic ECG criteria should be age- and sex-specific.     

Coarctation of the aorta in prenatal life: an echocardiographic, anatomical, and functional study.

In a prospective echocardiographic study of over 2000 pregnancies, 24 fetuses were found to have dilatation of the right ventricle and pulmonary artery when these structures were compared with those of the left heart. In 18 of these cases the diagnosis of coarctation or interruption of the aorta was correctly inferred from these findings. On direct echocardiographic examination of the aortic arch, arch hypoplasia or interruption of the aortic arch was recognisable prenatally in 10 of these 18 cases, most readily between 20-30 weeks' gestation. In 11 of 12 cases of aortic arch anomaly studied by Doppler echocardiography, a reduction in blood flow in the ascending aorta was demonstrated. The intracardiac appearances were suggestive of coarctation but the Doppler findings were within normal limits in two further cases which later proved to be normal. A diaphragmatic hernia was found in four fetuses and the intracardiac echocardiography and Doppler findings were the same as those found in fetuses with aortic coarctation. Five cases of coarctation were overlooked on the prenatal echocardiogram but these were found at follow up of the infants. Thus coarctation of the aorta can be diagnosed prenatally, although the condition may be missed or incorrectly predicted by the criteria examined in the present study. Reduced aortic blood flow is a demonstrable feature of aortic arch abnormalities but it is found in other conditions that are not associated with coarctation.     

Is Electrocardiography Still Useful in the Diagnosis of Cardiac Chamber Hypertrophy and Dilatation?

The echocardiogram undoubtedly is part of the cardiologist's armamentarium in the diagnosis and elucidation of cardiac abnormalities, but the ECG still continues to be the most frequently recorded noninvasive test in medicine. For many patients, particularly those who have newly diagnosed hypertension, a 12-lead ECG recording may be the only test that is required as a baseline measure. For those who have possible heart failure, an ECG and B-type natriuretic peptide measurement may be sufficient to obviate the need for an echocardiogram. Electrocardiography and echocardiography will continue to live side-by-side for the foreseeable future.     

The relationship between blood pressure, pulse pressure and right ventricular function following an atrial switch procedure for complete transposition of the great arteries

BACKGROUND: The pressure overload may be responsible for the failure of the systemic ventricle. No study so far has evaluated the association between arterial blood pressure values and right ventricular function in adults with atrially corrected complete transposition. METHODS: This was a retrospective analysis. The studied population consisted of 60 patients with complete transposition, 11.5+/-2.7 years after atrial switch procedure, divided into subgroups according to the severity of systemic ventricular dysfunction (right ventricular ejection fraction < or = 0.40 vs. > 0.40), and the severity of perfusion abnormalities in the radionuclide study (absent or mild vs. moderate-to-severe). RESULTS: All patients had blood pressure values (systolic 109.1+/-11.7 mm Hg and diastolic 72.3+/-9.7 mm Hg) within the normal range. Systolic blood pressure values correlated inversely with right ventricular ejection fraction (r = -0.450; p < 0.001). Compared to patients with systolic blood pressure below median values, patients with "elevated" blood pressure had lower right ventricular ejection fraction (32.6+/-6.3 vs. 38.9.+/-7.2; p < or = 0.002) and more significant perfusion abnormalities (1.5+/-1.0 vs. 2.9+/-1.5; p < or = 0.001). In a multivariate backward logistic regression model age at surgery and at the time of the study, systolic blood pressure at rest predicted impaired right ventricular ejection fraction (p < 0.02). Greater pulse pressure at peak exercise female sex were associated with greater more severe perfusion abnormalities (p < 0.01). Conclusions: There is a significant correlation between blood pressure values and indices of right ventricular dysfunction in patients who underwent an atrial switch procedure for complete transposition. Blood pressure values might be considered as a surrogate end point in these patients.     

Pulmonary function tests

The clinical significance of pulmonary function tests (including blood gas analysis) lies in their sensitivity for detecting PCP. PCP has most consistently been found to cause abnormalities in the DLCO and the exercise arterial blood gas; both are highly sensitive for the presence of Pneumocystis infection. These tests are more sensitive for the detection of PCP than are the resting arterial blood gas and chest x-ray. Therefore, measuring these values can be especially helpful in evaluating HIV-infected individuals who have pulmonary symptoms but whose resting arterial blood gas and/or chest radiograph are normal. The advantage of performing the exercise test over measuring the DLCO is that the exercise test is simple. It can be done without pulmonary function equipment and without a technologist. Furthermore, since many AIDS patients with non-PCP pulmonary disorders maintain "normal" exercise tests despite abnormal DLCO, it can be useful in evaluating patients for PCP who have known underlying lung disease with progressive symptoms. Measurement of lung volumes and spirometry lacks both sensitivity and specificity for detecting pulmonary disease in general and PCP in particular. Spirometry is helpful in detecting airways obstruction, which is not an uncommon finding in AIDS patients. The etiology, clinical significance, and treatment of obstructive ventilatory defects in the AIDS population remains unclear.     

Rational ordering of electrolytes in the emergency department

STUDY OBJECTIVE: To validate the predictive abilities of a retrospectively developed set of clinical criteria for detecting clinically significant electrolyte abnormalities, using a different patient population. DESIGN: Cross-sectional study. SETTING: The emergency department of a busy public hospital. TYPE OF PARTICIPANTS: Nine hundred eighty-two patients on whom the emergency physician ordered serum electrolytes. INTERVENTIONS: The predictive properties of ten clinical criteria were evaluated; these included poor oral intake, vomiting, chronic hypertension, taking a diuretic, recent seizure, muscle weakness, age of 65 years or more, alcoholism, abnormal mental status, and recent history of electrolyte abnormality. MEASUREMENTS AND MAIN RESULTS: Seven hundred thirty patients (74.3%) had one or more electrolytes outside of the laboratory normal range, but only 143 (14.6%) had clinically significant electrolyte abnormalities. The clinical criteria predicted 135 of the clinically significant electrolyte abnormalities (sensitivity, 94.4%). When the eight "false-negative" cases were reviewed, none of the electrolyte abnormalities affected patient outcome. Implementation of the criteria would have avoided unnecessary testing in 233 patients (23.7%). CONCLUSION: Although no set of clinical criteria can eliminate the need for clinical judgment, use of a set of clinical criteria could substantially decrease electrolyte ordering without compromising patient care.     

Echocardiographic features of progressive systemic sclerosis (PSS). Correlation with hemodynamic and postmortem studies.

Echocardiographic abnormalities were noted in 37 (69 per cent) of 54 patients with progressive systemic sclerosis (PSS). Thirty-one of the 54 patients also underwent right heart catheterization. Eight of the 11 patients who died underwent postmortem examination. Pericardial effusion was noted in 22 subjects (41 per cent), although it was suspected on clinical grounds in only seven. Echocardiography appeared to be an excellent tool for evaluating and quantitating pericardial effusions. The presence of a small pericardial effusion (<50 ml) did not affect prognosis, but the presence of a large effusion (>200 ml) was associated with a poor prognosis. The finding on echocardiogram of right ventricular dilatation, left atrial dilatation, asymmetrical septal hypertrophy, paradoxic motion of the interventricular septum or signs of pulmonary hypertension were seen predominantly or exclusively in patients who had pulmonary artery hypertension at cardiac catheterization. Pericardial effusions and abnormal mitral valve diastolic slope on echocardiogram did not correlate with pulmonary hypertension.The present study confirms clinically the frequent involvement of myocardium and pericardium that has been reported in autopsy series. At the same time, however, it suggests that the usefulness of the echocardiogram in clinical practice may really be limited to evaluating pericardial effusion and cardiomegaly, and to substantiating pulmonary artery hypertension in a safe, noninvasive manner.     

Preoperative screening: value of previous tests

OBJECTIVE: To determine the frequency of tests done in the year before elective surgery that might substitute for preoperative screening tests and to determine the frequency of test results that change from a normal value to a value likely to alter perioperative management. DESIGN: Retrospective cohort analysis of computerized laboratory data (complete blood count, sodium, potassium, and creatinine levels, prothrombin time, and partial thromboplastin time). SETTING: Urban tertiary care Veterans Affairs Hospital. PATIENTS: Consecutive sample of 1109 patients who had elective surgery in 1988. MEASUREMENTS AND MAIN RESULTS: At admission, 7549 preoperative tests were done, 47% of which duplicated tests performed in the previous year. Of 3096 previous results that were normal as defined by hospital reference range and done closest to the time of but before admission (median interval, 2 months), 13 (0.4%; 95% CI, 0.2% to 0.7%), repeat values were outside a range considered acceptable for surgery. Most of the abnormalities were predictable from the patient's history, and most were not noted in the medical record. Of 461 previous tests that were abnormal, 78 (17%; CI, 13% to 20%) repeat values at admission were outside a range considered acceptable for surgery (P less than 0.001, frequency of clinically important abnormalities of patients with normal previous results with those with abnormal previous results). CONCLUSIONS: Physicians evaluating patients preoperatively could safely substitute the previous test results analyzed in this study for preoperative screening tests if the previous tests are normal and no obvious indication for retesting is present.     

Dynamic changes of repolarization pattern associated with deep breathing and exercise in a young athlete: the sign "athletes heart" or concealed heart disease?

We described ECG of a 22-year-old healthy man, professional basketball player, who has been training since he was 14. Physical examination was normal. In ECG the following abnormalities of repolarisation were observed: biphasic, positivenegative T waves in leads V3-V6. This changes normalised during deep breathing test. The echocardiogram revealed normal size of the heart's chambers, left ventricular walls hypertrophy - septum and posterior wall: 14 mm, normal mitral inflow - E/A = 1.1, normal ejection fraction (68%). The exercise test (ExT, 20 METS) was without symptoms. During ExT normalisation of repolarisation abnormalities was observed. From 6(th) minute of the recovery phase the repolarisation abnormalities were observed again. In unselected population of young athletes abnormal ECG is observed in 4.8-11.8% of athletes. Negative T waves in precordial leads are observed 2.3% of the young athletes and in 2.7% young, professional athletes. The repolarisation abnormalities described in our patient belong to electrocardiographic spectrum of the early repolarisation pattern mainly seen in black, young athletes.