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Out Of Rhythm: Unexpected Electrocardiogram Findings In A Healthy Elite Athlete - Page #1
 

Author: William Schaefer, MD
Co Author #1: Adam Eggert, DO
Co Author #2: Zachary Timmerman, DO
Co Author #3: Michael Fitzgerald, DO
Senior Editor: Justin Mark Young, MD, FAMSSM
Editor: Kent Do, MD, DPT

Patient Presentation:
A 32-year-old male professional basketball player presented for a routine pre-participation physical examination. A screening electrocardiogram (ECG) obtained during the evaluation demonstrated profound bradycardia with complete atrioventricular (AV) block despite the absence of cardiac symptoms.

History:
The athlete reported no significant past medical history. During routine cardiac screening, he noted that previous pre-participation examinations had consistently documented a slow resting heart rate. He vaguely recalled being told he had an abnormal heart rhythm as a child, although subsequent evaluations had reportedly been normal.
He denied exertional chest pain, dyspnea, palpitations, lightheadedness, presyncope, or syncope. He remained fully active at the professional level without exercise limitation. Family history was negative for hypertrophic cardiomyopathy, sudden cardiac death, inherited arrhythmogenic disorders, or premature cardiovascular disease. The remainder of his medical, surgical, and social history was unremarkable.

Physical Exam:
Vital Signs: Pulse 32 bpm; Blood Pressure 122/80 mmHg; SpO₂ 96%; Temperature 36.9°C

General: Alert, oriented, well-appearing male in no acute distress.
Appearance: No Marfan stigmata.
Cardiovascular: Profound bradycardia with an irregular rhythm. No murmurs appreciated in the seated, standing, or supine positions. Radial pulses were symmetric bilaterally.
Pulmonary: Non-labored respirations. Lungs clear to auscultation bilaterally.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

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