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Normal athlete ECG — RACP Paediatrics MCQ

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HardCardiologyNormal athlete ECGRACP Paediatrics

An asymptomatic 16-year-old endurance athlete has sinus bradycardia 44/min, early repolarisation and isolated voltage criteria for left ventricular hypertrophy. Examination and family history are normal. Which interpretation is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Interpret all three as training-related findings in this clinical context

Explanation lettering: C = shown as A · D = shown as B · A = shown as C · B = shown as D

A is correct because sinus bradycardia, early repolarisation and isolated voltage LVH are recognised physiological athletic adaptations when symptoms, examination and family history are reassuring. B confuses common voltage with structural hypertrophy; pathological repolarisation or imaging findings would alter the assessment. C overstates benign early repolarisation in this phenotype. D ignores normal increased vagal tone and chronotropic assessment. E lacks the relevant repolarisation, conduction and structural features. The international athlete-ECG criteria include Australian sports-cardiology expertise and are jurisdiction-neutral for RACP practice.

Reference: Royal Children’s Hospital Melbourne, Basic paediatric ECG interpretation: https://www.rch.org.au/clinicalguide/guideline_index/Basic_Paediatric_ECG_interpretation/; International criteria for ECG interpretation in athletes: https://pubmed.ncbi.nlm.nih.gov/28258178/