Echocardiography in Athletes: the Ever-Evolving Assessment of Physiology Versus Pathology

Figures

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  Fig. 1. The 2D echocardiogram image in panel A obtained in the parasternal long axis view shows the basal anteroseptal wall segment. The red line demonstrates an overmeasurement of the basal septal wall thickness by including the crista supraventricularis. The green line is correct measurement of the basal septal wall. In the short axis view seen in panel B, the distinction between the left ventricle and right ventricle is clearer and marked by the blue dashed line. The crista supraventricularis is outlined in yellow. Panel C demonstrates how the use of biplane can assist with confirming findings on standard parasternal long and short axis, Panel D is an image taken from cardiac MRI showing the crista supraventricularis outlined in yellow

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  Fig. 2. The cardiac testing of an 18-year-old male athlete shows concerning findings suspicious for apical hypertrophic cardiomyopathy. The maximal wall thickness does not meet the generally accepted diagnostic criteria of 15mm however would meet criteria for relative apical HCM. Panel A is the abnormal ECG with diffuse T wave inversions. Panel B is an apical four chamber, left ventricle focused echocardiogram showing lack of apical tapering. Panel C show abnormal regional strain in the septal wall and apex. Panel D is a contrast enhance echocardiogram image obtained in the apical two chamber view showing the end systolic cavity and near obliteration of the apex. Panel E is the corresponding cardiac MRI showing borderline hypertrophy of the basal septal wall and increased wall thickness of the apex

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  Fig. 3. The echocardiogram images were obtained in the parasternal short axis view utilizing 2D color compare. The image on the left is that of the right coronary artery and its origin from the right coronary sinus. The image on the right displays an anomalous right coronary artery which takes an inter-arterial course and originates from the lest coronary sinus