Right ventricular (RV) dilatation is a recognized morphological adaptive change induced by exercise, but also a major echocardiographic criteria for the diagnosis of inherited cardiomyopathies such as arrhythmogenic right ventricular cardiomyopathy (ARVC). Particularly in athletes, the “grey zone”, when mild phenotypes of cardiomyopathies overlap with physiological changes, poses important matter of debate.
We report a case of a 14-year-old elite karate athlete who was referred for transthoracic echocardiographic preparticipation screening and was found to have increased right ventricle dimensions. No abnormalities were identified at clinical examination. Twelve lead ECG (12-lead ECG) showed sinus rhythm (80 beats/min), QRS axis at 45 degree and duration of 120ms. Additionally, delta wave was identified in leads DI, DII, V2-V6. Transthoracic echocardiography revealed right ventricular and pulmonary artery trunk enlargement, mild tricuspid regurgitation, a mild rise in pulmonary systolic arterial pressure and moderate pulmonary regurgitation. Cardiac magnetic resonance showed enlargement of right ventricle with no identifiable abnormalities such as regional RV akinesia, dyskinesia or dyssynchronous RV. RV ejection fraction was 71%, end diastolic volume of 91 mL/m2 and end-systolic volume of 47 ml. In conclusion, morphological cardiac consequences of long-term high intensity physical activity may fall into the grey zone, and thus becoming a challenge to distinguish the physiologic remodelling from pathological one. Therefore, our patient was advised to withdraw from the competitive sport and a close follow-up was crucial.
athletes, RV dilation, WPW syndrome
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