ST domed Elevation – an Atypical Variant of Early Repolarization in the White Athlete after the COVID-19 Pandemic. A Case Report.

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Piotr Kosiorek Dorota Waloch Juliusz Kosel Renata Brycka-Safrończyk


Background: Interpreting the electrocardiography (ECG) recording in young athletes is challenging for the sports doctor. Changes in intraventricular conduction and early ventricular repolarization observed during sports training are not always confirmed in the literature. We test healthy people and look for irregularities in their ECG records. The study aims to draw attention to ST-Elevation (STE) as a variant of the White Athlete's heart norm, with a frequency lower than an inverted T wave (TWI), but also as an effect of early repolarization of the ventricles in young athletes. Is it physiology?

Case report: 14-year-old football player, examined for five years at a sports clinic, cardiology checked every year. Changes like symptomatic adult ECGs with STE and myocardial necrosis were suspected during our observation. Echocardiography, stress test good. A simple response to exercise is to adapt the athlete's heart by ischemia, preconditioning for the heart muscle, and a reversible remodelling that disappears after the sports period. We focus on changes in ECG, which are observed in athletes under 14 years of age, while most of the ECG classifications in an athlete were described above 16 years of age.

Conclusion: the variant observed in our White Athlete is an example of several similar repolarization changes in ECG not yet classified as physiological or resulting from intensive training.

Keywords: ST-Elevation, early repolarization, ECG criteria, athletes

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KOSIOREK, Piotr et al. ST domed Elevation – an Atypical Variant of Early Repolarization in the White Athlete after the COVID-19 Pandemic. A Case Report.. Medical Research Archives, [S.l.], v. 11, n. 3, mar. 2023. ISSN 2375-1924. Available at: <>. Date accessed: 20 apr. 2024. doi:
Case Reports


1. Harmon KG, Zigman M, Drezner JA. The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: a systematic review/meta-analysis. J Electrocardiol. 2015;48(3):329-38.
2. Riding NR, Sheikh N, Adamuz C, Watt V, Farooq A, Whyte GP, et al. Comparison of three current sets of electrocardiographic interpretation criteria for use in screening athletes. Heart. 2015;101(5):384-90.
3. Drezner JA, Ackerman MJ, Anderson J, Ashley E, Asplund CA, Baggish AL, et al. Electrocardiographic interpretation in athletes: the 'Seattle criteria'. Br J Sports Med. 2013;47(3):122-4.
4. Sheikh N, Sharma S. Refining electrocardiography interpretation criteria in elite athletes: redefining the limits of normal. Eur Heart J. 2014;35(44):3078-80.
5. Cardiac Risk in the Young. CRY publishes and distributes medical information written by leading cardiologists for the general public CRY funds specialist referral, screening and cardiac pathology services at leading UK hospitals. Aug 27, 2022, United Kingdom 2022.
6. Winkelmann ZK, Crossway AK. Optimal Screening Methods to Detect Cardiac Disorders in Athletes: An Evidence-Based Review. J Athl Train. 2017;52(12):1168-70.
7. Kukla P, Jastrzebski M, Kuch M, Kurdzielewicz W. [Dynamic changes of repolarization pattern associated with deep breathing and exercise in a young athlete: the sign "athletes heart" or concealed heart disease?]. Kardiol Pol. 2012;70(8):853-5.
8. Braksator W, Mamcarz A. [ECG in a competitive athlete]. Kardiol Pol. 2012;70(8):856.
9. Brosnan M, La Gerche A, Kalman J, Lo W, Fallon K, MacIsaac A, et al. The Seattle Criteria increase the specificity of preparticipation ECG screening among elite athletes. Br J Sports Med. 2014;48(15):1144-50.
10. Sieira J, Brugada P. The definition of the Brugada syndrome. Eur Heart J. 2017;38(40):3029-34.
11. Brugada R, Campuzano O, Sarquella-Brugada G, Brugada P, Brugada J, Hong K. Brugada Syndrome. In: Adam MP, Everman DB, Mirzaa GM, Pagon RA, Wallace SE, Bean LJH, et al., editors. Gene Reviews((R)). Seattle (WA)1993.
12. Mozes A, Homoud M, Link M, Weinstock J, Garlitski A, Estes NA, 3rd. Screening for sudden death in the athlete. Cardiovasc Pathol. 2010;19(6):340-2.
13. Macfarlane PW, Clark EN. ECG measurements in end QRS notching and slurring. J Electrocardiol. 2013;46(5):385-9.
14. de Zwaan C, Bar FW, Janssen JH, Cheriex EC, Dassen WR, Brugada P, et al. Angiographic and clinical characteristics of patients with unstable angina showing an ECG pattern indicating critical narrowing of the proximal LAD coronary artery. Am Heart J. 1989;117(3):657-65.
15. Orzalkiewicz Z, Polak G, Przybyl R, Ukleja-Adamowicz M, Hoffman A. [Wellens's syndrome the ominous T-waves]. Kardiol Pol. 2005;63(6):656-61; discussion 62.
16. Satish OS, Srivastav KS. Early Repolarisation Changes in ECG: Are they Benign or Malignant? J Assoc Physicians India. 2016;64(7):51-4.
17. Davis AJ, Semsarian C, Orchard JW, La Gerche A, Orchard JJ. The Impact of Ethnicity on Athlete ECG Interpretation: A Systematic Review. J Cardiovasc Dev Dis. 2022;9(6).
18. Smith SW. http://hqmeded-ecgblogspotcom/2016/10/lad-occlusion-or-early -repolarization.html [Internet]. Smith SW, date: Aug 27, 2022; editor 2022.
19. Kukla P, Jastrzebski M. Haissaguerre syndrome a new clinical entity in the spectrum of primary electrical diseases? Kardiol Pol. 2009;67(2):178-84; discussion 85-9.
20. Baranowski R, Wojciechowski D, Kozlowski D, Kukla P, Kurpesa M, Lelakowski J, et al. [Electrocardiographic criteria for diagnosis of the heart chamber enlargement, necrosis and repolarisation abnormalities including acute coronary syndromes. Experts' group statement of the Working Group on Noninvasive Electrocardiology and Telemedicine of]. Kardiol Pol. 2016;74(8):812-9.
21. de Winter RJ, Verouden NJ, Wellens HJ, Wilde AA, Interventional Cardiology Group of the Academic Medical C. A new ECG sign of proximal LAD occlusion. N Engl J Med. 2008;359(19):2071-3.
22. Sethi KK, Sethi K, Chutani SK. Early repolarisation and J wave syndromes. Indian Heart J. 2014;66(4):443-52.
23. Claessen F, Peeters HAP, Sorgdrager BJ, van Veldhoven PLJ. Early repolarisation among athletes. BMJ Open Sport Exerc Med. 2020;6(1):e000694.
24. Maury P, Authenac C, Rollin A, Dulac Y, Mondoly P, Cardin C, et al. Prevalence of early repolarisation pattern in children. Int J Cardiol. 2017;243:505-10.
25. Ilodibia TF, Odia JO. Evaluation of the Seattle and International Criteria in elite Nigerian athletes. J Electrocardiol. 2021;68:14-23.
26. Ji CC, Chen XM, Cheng YJ, Liu LJ, Tang K, Zhu WQ, et al. The Role of Holter Monitoring in the Diagnosis of Early Repolarisation Pattern. Heart Lung Circ. 2018;27(12):1421-7.
27. Katritsis DG, Gersh BJ, Camm AJ. Early Repolarisation Syndrome. New Concepts. Arrhythm Electrophysiol Rev. 2015;4(3):169-71.