Distinctive ECG patterns in healthy black adults

Six ECG patterns are found more frequently in healthy black adults than in whites. These patterns are presumably benign, but also may resemble those of malignant disease. 1) Healthy black adults show higher QRS voltage, and more often meet ECG criteria for left ventricular hypertrophy (LVH). Associated repolarization abnormalities can produce ST segment elevation (STE) that resembles ST elevation MI (STEMI). 2) The pattern of benign anterior STE, seen often in males, is more common in black subjects. Similar to LVH, this pattern may falsely suggest STEMI. 3) Both early repolarization (ER) and benign inferolateral STE are more common in black patients. Although they may convey a higher risk of fatal arrhythmias or cardiac death in white populations, it does not appear that black subjects with these patterns show a similar risk. 4) The persistent juvenile T wave inversion pattern shows asymmetric T wave inversion (TWI) in V1-V4, without ST segment deviations. It is most common in black females, and is considered benign. However, this pattern can also resemble the anterior TWI of arrhythmogenic right ventricular cardiomyopathy (ARVC). 5) A pattern of anterior TWI with associated J point elevation is a common finding in the black population, especially athletes. It could suggest hypertrophic cardiomyopathy, but can be presumed to be a benign finding in black athletes, when TWI is limited to V1-V4 and preceded by J point elevation. 6) TWI in the lateral precordial leads, usually associated with end-QRS slurring or notches is seen much more often in apparently healthy black subjects than white subjects. Unlike the anterior TWI pattern, however, it cannot be presumed benign. In conclusion, awareness of these ECG patterns may help to avoid unnecessary diagnostic or therapeutic interventions, but also encourage appropriate investigations

Distinctive ECG patterns in healthy black adults

Six ECG patterns are found more frequently in healthy black adults than in whites. These patterns are presumably benign, but also may resemble those of malignant disease. 1) Healthy black adults show higher QRS voltage, and more often meet ECG criteria for left ventricular hypertrophy (LVH). Associated repolarization abnormalities can produce ST segment elevation (STE) that resembles ST elevation MI (STEMI). 2) The pattern of benign anterior STE, seen often in males, is more common in black subjects. Similar to LVH, this pattern may falsely suggest STEMI. 3) Both early repolarization (ER) and benign inferolateral STE are more common in black patients. Although they may convey a higher risk of fatal arrhythmias or cardiac death in white populations, it does not appear that black subjects with these patterns show a similar risk. 4) The persistent juvenile T wave inversion pattern shows asymmetric T wave inversion (TWI) in V1-V4, without ST segment deviations. It is most common in black females, and is considered benign. However, this pattern can also resemble the anterior TWI of arrhythmogenic right ventricular cardiomyopathy (ARVC). 5) A pattern of anterior TWI with associated J point elevation is a common finding in the black population, especially athletes. It could suggest hypertrophic cardiomyopathy, but can be presumed to be a benign finding in black athletes, when TWI is limited to V1-V4 and preceded by J point elevation. 6) TWI in the lateral precordial leads, usually associated with end-QRS slurring or notches is seen much more often in apparently healthy black subjects than white subjects. Unlike the anterior TWI pattern, however, it cannot be presumed benign. In conclusion, awareness of these ECG patterns may help to avoid unnecessary diagnostic or therapeutic interventions, but also encourage appropriate investigations

International criteria for electrocardiographic interpretation in athletes: Consensus statement.

Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly, advanced by a growing body of scientific data and investigations that both examine proposed criteria sets and establish new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington (USA), to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD

International criteria for electrocardiographic interpretation in athletes: Consensus statement

Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly, advanced by a growing body of scientific data and investigations that both examine proposed criteria sets and establish new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington (USA), to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD

THE EFFECT OF ETHNICITY AND BODY SIZE ON THE ATHLETE’S HEART AND THEIR IMPACT ON CARDIOVASCULAR PRE-PARTICIPATION SCREENING

In response to the augmented haemodynamic load placed upon the heart by intense and prolonged exercise, various forms of physiological remodelling are elicited. The resultant cardiac structural, functional and electrical adaptations are coined the athlete’s heart. Due to the nature of the remodelling, in some cases these adaptations may however overlap with the diagnostic criteria for varying pathological conditions, often related to sudden cardiac death. Several variables are associated with the athlete’s heart including age, sex, sport, body size, and ethnicity. Ethnicity is of particular importance as athletes of an African/Afro-Caribbean ethnicity demonstrate a greater prevalence of abnormal changes suggestive of pathology. There is however paucity in the literature of the athlete’s heart among other ethnicities. For this reason Study 1 investigated the impact of Arabic ethnicity upon the structure, function and electrophysiology of the heart in male athletes. Study 1 identified that while Arabic athletes had larger hearts than Arabic controls, they had significantly smaller hearts than their Black and Caucasian athletic counterparts. While Black athletes had a significantly greater prevalence of training unrelated/abnormal ECG findings, Arabic and Caucasian both had similar levels of training unrelated/abnormal findings, suggesting the European Society of Cardiology guidelines for ECG interpretation in athletes are applicable for the ethnicity.Study 2 investigated another important facet of the athlete’s heart, which is body size. Study 2 identified that while there was a progressive relationship between body size and cardiac dimensions, the previously identified upper limits of cardiac structural remodelling were applicable even among those with a body surface area (BSA) over 2.3m2. Among the cohort of athletes with a BSA >2.3m2, Black athletes demonstrated significantly greater wall thickness’ than Caucasian and Arabic athletes.The second aspect to the thesis highlighted how the findings of Study 1 and 2 impact upon pre-participation screening. While debate still exists around the most effective methodology to screen for pathological cardiac conditions, several organisations mandate the use of the echocardiography alongside the resting 12-Lead ECG. Study 3 established that should echocardiography be limited to use as a follow up investigation, significant cost benefits could be elicited (47% reduction). The premise of this significant cost reduction was that no pathological case was identified by echocardiography in isolation. While still found to be useful in confirming pathology, significantly, in our study the investigation failed to identify two cases of hypertrophic cardiomyopathy.Study 4 investigated the implications of adopting modified ECG interpretation guidelines in light of the criticism that ECG screening should be avoided due to a high false positive rate. Utilising an ethnically diverse cohort, Study 4 demonstrated that using the ‘Refined’ criteria reduced the false positive rate from 22% when using the 2010 ESC guidelines to 5%. Importantly both criteria achieved 100% sensitivity, highlighting the importance of the ECG in cardiovascular screening

Maritime expressions:a corpus based exploration of maritime metaphors

This study uses a purpose-built corpus to explore the linguistic legacy of Britain’s maritime history found in the form of hundreds of specialised ‘Maritime Expressions’ (MEs), such as TAKEN ABACK, ANCHOR and ALOOF, that permeate modern English. Selecting just those expressions commencing with ’A’, it analyses 61 MEs in detail and describes the processes by which these technical expressions, from a highly specialised occupational discourse community, have made their way into modern English. The Maritime Text Corpus (MTC) comprises 8.8 million words, encompassing a range of text types and registers, selected to provide a cross-section of ‘maritime’ writing. It is analysed using WordSmith analytical software (Scott, 2010), with the 100 million-word British National Corpus (BNC) as a reference corpus. Using the MTC, a list of keywords of specific salience within the maritime discourse has been compiled and, using frequency data, concordances and collocations, these MEs are described in detail and their use and form in the MTC and the BNC is compared. The study examines the transformation from ME to figurative use in the general discourse, in terms of form and metaphoricity. MEs are classified according to their metaphorical strength and their transference from maritime usage into new registers and domains such as those of business, politics, sports and reportage etc. A revised model of metaphoricity is developed and a new category of figurative expression, the ‘resonator’, is proposed. Additionally, developing the work of Lakov and Johnson, Kovesces and others on Conceptual Metaphor Theory (CMT), a number of Maritime Conceptual Metaphors are identified and their cultural significance is discussed