Normalizing T-Wave Inversion after Exercise Stress Test (Treadmill) on a Cycling Race Athlete : A Case Report

Author : E.D.Hargiyanto
Upload Date : 19-04-2018

Background T wave inversion (TWI) is characterized by an opposite orientation of the normal T wave, therefore reported as negative instead of positive. The causes of T-wave inversions have commonly been grouped into 2 categories. Primary changes is alterations in the duration or morphology of the action potential, without concurrent changes in the orderly such as coronary ischemic events. Secondary changes result from aberrant ventricular activation in the context of normal action potential characteristics such as bundle-branch blocks.

 Methods A 31-years-old cycling race athlete who is in regional sport training center was undergo medical check up. The examinations were include physical examination, electrocardiogram, exercise stress test (treadmill) and echocardiography.

Results This athlete did not complaint about chest pain. Physical examination was revealed heart rate of 61 bpm, respiration rate of 16x per minute, and body temperature of 35,80C. Auscultation revealed no wheezing, rhonchi or murmur. Electrocardiogram showed TWI in anterolateral and inferior leads. Exercise stress test (treadmill) showed total exercise time 13:05; Max HR 125 bpm; Max BP 120/80; Maximum workload: 10.00 METS; Reason for termination: Normalizing ECG; Summary: Resting ECG: TWI. Chest pain: none. Conclusion: normalizing anterolateral and inferior TWI. Echocardiography showed within normal limit (resting)

Discussion The causes of TWI are associated with a lot of meaning such as coronary ischemic events, bundle-branch blocks, ventricular ectopic beats or physiological effect. TWI on  inferior lead, which is happened by this athlete, cannot be attributed to physiological remodeling and thus warrants further examination such as cardiac MRI. In subjects with resting T-wave abnormalities in the absence of coronary artery disease, the exercise testing can induce normalization of TWI related to the sympathetic activation. In this case, concurrent findings of J-point elevation or biphasic T waves more likely represents athlete’s heart.

KEYWORDS : T-wave inversion,treadmill test,echocardiography,athlete’s heart

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