294.2 🩺 國考版

294.2.1 高頻考點

294.2.1.1 Athletic Heart Adaptations

  • Endurance: eccentric LVH + LV dilation
  • Strength: concentric LVH
  • Bradycardia, 1° AV block, Wenckebach
  • ECG voltage LVH alone (no clinical significance)
  • Detraining reverses changes

294.2.1.2 SCD in Athletes

  • < 35 yo: HCM (US) / anomalous coronary (Italy) / ARVC / LQT / Brugada / WPW / myocarditis / commotio cordis / Marfan dissection

  • 35 yo: CAD primary

294.2.1.3 Pre-Participation Screening

  • Italian: mandatory ECG (↓ SCD ~ 90%)
  • US AHA: history + physical (ECG selectively)
  • ESC / IOC: ECG recommended

294.2.1.4 Athletic ECG Variants (Normal)

  • Sinus bradycardia
  • 1° AV block
  • Wenckebach
  • IRBBB or CRBBB (with normal QRS)
  • Voltage LVH alone
  • Early repolarization

294.2.1.5 Athletic ECG Findings to Investigate

  • T-wave inversion in lateral or inferolateral leads
  • Pathologic Q
  • Complete LBBB
  • ST depression
  • Mobitz II or higher AVB
  • Long QTc (> 460 men, > 470 women)
  • Brugada pattern
  • WPW pre-excitation
  • Epsilon waves (ARVC)

294.2.1.6 HCM in Athletes — 2024 Updates

  • LIVE-HCM (2023): moderate exercise safe
  • ICD ≠ automatic disqualification
  • Multidisciplinary decision-making

294.2.1.7 COVID-19 + Athletes

  • 3-7 days rest if mild
  • Cardiac symptoms or moderate-severe → CMR
  • Myocarditis confirmed: 3-6 month exercise restriction
  • Lake Louise CMR criteria

294.2.1.8 Commotio Cordis

  • Blunt chest impact during vulnerable T wave period
  • Triggers VF
  • AED + CPR life-saving

294.2.1.9 LQT1 and Sports

  • LQT1: exercise-induced, especially swimming
  • LQT2: startle
  • LQT3: sleep
  • β-blocker treatment

294.2.2 易混淆比范

Feature Physiologic (Athletic Heart) HCM
LV wall thickness < 13 mm usually ≥ 15 mm
LV cavity size Normal-↑ (endurance) Normal-↓
Diastolic function Normal Abnormal
Family hx of HCM/SCD No Often yes
Genetic testing Negative Sarcomere mutation
Detraining response Reverse No
Symptoms None Often dyspnea, syncope, chest pain

294.2.3 Special Topics

294.2.3.1 Damar Hamlin (NFL 2023)

  • Suspected commotio cordis
  • Survived due to early CPR + AED
  • Increased public awareness

294.2.3.2 Christian Eriksen (Euros 2021)

  • Cardiac arrest during match
  • Survived; later implanted ICD
  • Returned to professional soccer

294.2.3.3 Italian Model Long-Term

  • 25-year follow-up: SCD ↓ from 4 to 0.4 per 100,000 athlete-years
  • Cost-effectiveness debated
  • US recently more open to ECG inclusion