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Electrocardiographic Abnormalities following Syncope during Warm-up in a Professional Football Player: A Case Report
Korean J Sports Med 2021;39:131-134
Published online September 1, 2021;  https://doi.org/10.5763/kjsm.2021.39.3.131
© 2021 The Korean Society of Sports Medicine.

Dae-Hee Lee, Sang-Hun Ko, Ki-Bong Park, Kyung-Joo Lee

Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
Correspondence to: Ki-Bong Park
Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, Korea
Tel: +82-52-250-7129, Fax: +82-52-235-2823
E-mail: kbpark@uuh.ulsan.kr
Received March 15, 2021; Revised May 7, 2021; Accepted May 11, 2021.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
We describe the case of a 32-year-old male professional football player experiencing syncope during a warm-up ahead of a regular professional football league match. Syncope recovered spontaneously, but an electrocardiogram test revealed T-wave inversion and upward convex ST elevation. Subsequent echocardiogram, angiography, exercise stress test, cardiac magnetic resonance imaging, and gene analysis showed no abnormalities. The athlete had no recurrence of chest pain or syncope during the treatment period of about 4 weeks, and there was no recurrence of symptoms until 6 months after returning to sports.
Keywords : Syncope, Electrocardiography, Football, Athletes
꽌 濡

뇤 愿瑜(cerebral hypoperfusion)뿉 湲곗씤븯뒗 씪떆쟻씤 쓽떇 냼떎濡 젙쓽릺뒗 떎떊(syncope) 鍮좊Ⅸ 諛쒕퀝, 吏㏃ 諛쒗쁽 湲곌컙, 옄諛쒖쟻씤 셿쟾 쉶蹂듭씠 듅吏뺤씠吏留, 슫룞 以 諛쒖깮븯뒗 떎떊 룎뿰궗瑜 쑀諛쒗븷 닔 엳뒗 떎뼇븳 떖옣吏덊솚쓽 珥덇린 利앹꽭濡 굹굹뒗 寃쎌슦媛 엳떎1. 뵲씪꽌 슫룞 以 諛쒖깮븯뒗 떎떊 떖옣留덈퉬瑜 쑀諛쒗븷 닔 엳뒗 湲곗 떖옣吏덊솚쓽 寃쎄퀬 利앹긽엫쓣 怨좊젮빐빞 븯硫2, 듅엳 寃쎌웳 슫룞 꽑닔뒗 鍮 슫룞 꽑닔 鍮꾧탳븯뿬 룎뿰궗 쐞뿕씠 2.8諛곕줈 넂湲 븣臾몄뿉 깮紐낆쓣 쐞삊븷 닔 엳뒗 湲곗 떖삁愿吏덊솚쓣 諛곗젣븯湲 쐞븳 꽭떖븳 룊媛媛 븘슂븯떎3.

옄뱾 썙諛띿뾽 怨쇱젙 以 떎떊씠 諛쒖깮븳 봽濡 異뺢뎄 꽑닔쓽 떖쟾룄 寃궗뿉꽌 T뙆 뿭쐞(T-wave inversion) 쐞濡 蹂쇰줉(upward convex)븳 ST遺꾩젅쓽 긽듅쓣 솗씤븯쑝굹, 異붽 寃궗뿉꽌 湲곗 떖옣吏덊솚쓣 솗씤븷 닔 뾾뿀떎. 씠뿉 利앸 蹂닿퀬 븿猿 슫룞 꽑닔뿉꽌 諛쒖깮븯뒗 떎떊뿉 븳 吏꾨떒 븣怨좊━利섍낵 떖쟾룄 빐꽍뿉 븳 愿젴 臾명뿄쓣 怨좎같븯떎. 蹂 뿰援щ뒗 쓽븰뿰援ъ쑄由ъ쐞썝쉶 듅씤쓣 諛쏆븘 吏꾪뻾븯떎(No. 2021-02-016).

利 濡

봽濡 異뺢뎄 꽑닔씤 32꽭 궓옄 솚옄媛 궡썝 1씪 쟾 젙洹 由ш렇 꽑諛 異쒖쟾쓣 븵몢怨 떆뻾븳 썙諛띿뾽(젣옄由 쎇湲) 以묒뿉 諛쒖깮븳 떎떊쓣 二쇱냼濡 궡썝븯떎. 利앹긽 諛쒖깮 떦떆 샇씉怨ㅻ 諛 빟 5珥덇컙쓽 쓽떇 냼떎씠 룞諛섎릺뿀쑝硫, 쓳湲 썑넚 썑 寃쎄린옣 씤洹 蹂묒썝뿉꽌 떆뻾븳 떖쟾룄긽 V1–V5 쑀룄뿉꽌 T뙆 뿭쐞媛 愿李곕릺뿀怨(Fig. 1), 뇤 쟾궛솕떒痢듭쁺긽寃궗뿉꽌 듅씠 냼寃ъ 愿李곕릺吏 븡븯떎. 씠썑 쓨넻씠굹 쓽떇 냼떎 벑쓽 利앹긽씠 뾾뼱 닕냼 蹂듦瑜 寃곗젙븯怨 젙諛 寃궗瑜 쐞빐 긽湲 蹂묒썝쓣 諛⑸Ц븯湲곕줈 븯떎.

Fig. 1. Initial 12-leads electrocardiogram showing T-inversion in V leads.

蹂몄썝뿉꽌 떆뻾븳 臾몄쭊긽 궡썝 1媛쒖썡 쟾뿉룄 媛묒옉뒪윭슫 샇씉 怨ㅻ씠 엳뿀떎怨 븯쑝굹, 궡썝 떦떆뿉뒗 쓨넻, 샇씉 怨ㅻ, 뼱吏윭 벑쓽 利앹긽 뾾뿀怨, 떖삁愿怨 삉뒗 뇤삁愿怨 媛議깅젰룄 뾾뿀떎. 솢젰 吏뺥썑뒗 닔異뺢린 삁븬 122 mm Hg, 씠셿湲 삁븬 65 mm Hg, 遺꾨떦 떖諛뺤닔 63쉶, 遺꾨떦 샇씉닔 18쉶, 궛냼룷솕룄 100%, 泥댁삩 36.4룄濡 븞젙 냼寃ъ쓣 蹂댁떎. 삁븸 寃궗긽 移쇰ⅷ, 젚궛 깉닔냼슚냼(lactate dehydrogenase), 겕젅븘떞 씤궛솢꽦슚냼(creatine phosphokinase) 닔移섍 넂 寃 씠쇅뿉 씠긽 냼寃ъ 뾾뿀떎(Table 1). 蹂몄썝뿉꽌 떆뻾븳 떖쟾룄뒗 룞 꽌留, 룞꽦 遺젙留κ낵 V2–V6 쑀룄뿉꽌 쐞濡 蹂쇰줉븳 ST 遺꾩젅쓽 긽듅 냼寃ъ쓣 蹂댁떎(Fig. 2). 슫룞 以 諛쒖깮븳 떎떊, 怨좎뭡瑜⑦삁利, 쐞濡 蹂쇰줉븳 ST 遺꾩젅 긽듅쓽 떖쟾룄 씠긽 냼寃ъ쓣 諛뷀깢쑝濡 湲됱꽦 愿긽룞留 利앺썑援 삉뒗 Wellens 利앺썑援, 怨좎뭡瑜⑦삁利앹쑝濡 씤븳 ST 遺꾩젅 긽듅 媛뒫꽦쓣 쓽떖븯쑝硫, 湲곗 떖옣吏덊솚쓽 議댁옱 뿬遺瑜 븣븘蹂닿린 쐞빐 D’Ascenzi 벑2씠 諛쒗몴븳 吏꾨떒 븣怨좊━利섏뿉 뵲씪 2李 寃궗瑜 떆뻾븯떎. 떖옣 珥덉쓬뙆寃궗뒗 醫뚯떖諛 鍮꾨 씠쇅뿉 듅씠 냼寃ъ쓣 蹂댁씠吏 븡븯쑝硫, 愿긽룞留 議곗쁺닠 젙긽 냼寃ъ쓣 蹂댁怨 삁愿 뿰異 쑀諛 寃궗긽 媛뒾 넻利 諛쒖깮, 떖쟾룄 蹂솕, 떖삁愿 議곗쁺닠 蹂솕 紐⑤몢 愿李곕릺吏 븡븯떎. 옄쑉떊寃쎄퀎 寃궗긽 湲곕┰寃쎌궗寃궗, 떖샇씉寃궗 諛 諛쒖궡諛(Valsalva) 닔湲곕 떆뻾븷 븣 듅씠 利앹긽씠 諛쒖깮븯吏 븡븘 以묒텛 떊寃쎄퀎 씠긽 뾾뒗 寃껋쑝濡 뙋떒븯떎. 24떆媛 솢룞 떖쟾룄 寃궗, 슫룞遺븯寃궗, 떖옣 옄湲곌났紐낆쁺긽寃궗뿉꽌룄 듅씠 냼寃ъ쓣 蹂댁씠吏 븡븯떎. 理쒖쥌쟻쑝濡 遺젙留μ쭏솚 쑀쟾옄 寃궗瑜 떆뻾븯쑝硫, 遺꾩꽍 寃곌낵 CACNA1C 蹂씠, c.5408G>A, p.(Arg1803Gin)媛 솗씤릺뿀쑝굹, 遺덊솗떎븳 쓽誘몄쓽 蹂씠 踰붿<뿉 룷븿릺뼱 엫긽쟻 愿젴꽦 궙떎怨 빐꽍븯떎.

Table 1 . Blood chemistry and electrolyte of patient on admission

VariableNormal rangeCurrent case
White blood cell (K/μL)4.00−10.004.87
Hemoglobin (g/dL)14.0−18.017.6
Albumin (g/dL)3.5−5.04.9
Blood urea nitrogen (mg/dL)8.0−20.012.6
Creatinine (mg/dL)0.6−1.50.85
Potassium (mM/L)3.5−5.36.8
LDH (IU/L)106−230555
CK (IU/L)0−190263
CK-MB (ng/mL)0.0−3.61.80
Troponin T (ng/mL)0.0−0.10.009

LDH: lactate dehydrogenase, CK: creatine phosphokinase, CK-MB: CK MB fraction.



Fig. 2. Electrocardiogram showing sinus bradycardia, sinus arrhythmia, and upward convex ST elevation in V2–V5 leads.

긽湲 꽑닔뒗 利앹긽 諛쒖깮 썑 4二쇱감源뚯 利앹긽 옱諛쒖씠 뾾뼱 슫룞 蹂듦븯쑝硫, 利앹긽 諛쒖깮 썑 6媛쒖썡씠 吏궃 쁽옱源뚯 利앹긽 옱諛 뾾씠 寃쎄낵 愿李 以묒씠떎.

怨 李

떎떊씠 諛쒖깮븳 슫룞 꽑닔瑜 吏꾨즺븷 븣 媛옣 以묒슂븳 寃껋, 利앹긽쓽 썝씤쓣 諛앺궡怨 슫룞 꽑닔媛 빐떦 슫룞쓣 怨꾩냽븷 닔 엳뒗吏瑜 寃곗젙븯뒗 寃껋씠떎. 슫룞 썑 쓽떇 냼떎 삁븬 湲곗쟾뿉 쓽븳 諛쒖깮쓣 쓽떖븯寃 븯吏留, 슫룞 以 諛쒖깮븯뒗 떎떊 遺遺 遺젙留 湲곗쟾뿉 湲곗씤븳떎怨 븣젮졇 엳뼱 슫룞 以 諛쒖깮븳 떎떊뿉 븳 룊媛뒗 돺吏 븡떎怨 븷 닔 엳떎4.

D’Ascenzi 벑2 슫룞 꽑닔뿉꽌 諛쒖깮븳 떎떊뿉 븳 吏꾨떒 븣怨좊━利섏쓣 냼媛쒗븳 諛 엳떎. 떖쟾룄瑜 룷븿븳 珥덇린 룊媛뿉꽌 怨좎쐞뿕援곗쑝濡 遺꾨쪟맂 꽑닔뱾 떖옣 珥덉쓬뙆, 24떆媛 솢룞 떖쟾룄寃궗 벑쓽 2李 寃궗媛 븘슂븯硫, 異붽 寃궗뿉꽌 듅씠 냼寃ъ씠 뾾뜑씪룄 떎떊씠 諛섎났쟻쑝濡 諛쒖깮븯뒗 寃쎌슦씪硫 湲곕┰寃쎌궗寃궗굹 씠떇삎 궗嫄 湲곕줉湲(implantable loop recorder) 벑쓽 異붽 寃궗瑜 沅뚭퀬븯怨 엳떎. 씠踰 利앸뒗 샇씉怨ㅻ쓽 怨쇨굅젰, 슫룞 以 諛쒖깮븳 떎떊, 떖쟾룄 씠긽 벑쓽 냼寃ъ씠 엳뿀湲곗뿉 2李 寃궗瑜 떆뻾븯쑝硫, 吏㏃ 떆媛 룞븞 寃⑸젹븳 떊泥 솢룞씠 슂援щ릺뒗 異뺢뎄 醫낅ぉ쓽 듅吏뺤쓣 怨좊젮븯뿬 떖옣 옄湲곌났紐낆쁺긽寃궗 遺젙留 吏덊솚 쑀쟾옄 寃궗源뚯 떆뻾븯떎.

떖옣 옄쑉떊寃쎄퀎媛 슫룞 솚寃쎌뿉 깮由ъ쟻쑝濡 쟻쓳븿쑝濡쒖뜥 깮湲곕뒗 깮由ъ쟻씤 떖쟾룄 蹂솕뒗 썕젴맂 슫룞 꽑닔뿉꽌 쓷븯寃 愿李곕릺吏留, 湲곗 떖옣吏덊솚쓣 븫떆븷 닔 엳뒗 떖쟾룄 蹂솕 냼寃ъ쓣 깮由ъ쟻씤 떖쟾룄 蹂솕 諛섎뱶떆 援щ퀎빐빞 븯湲 븣臾몄뿉 슫룞 꽑닔쓽 떖쟾룄 寃곌낵瑜 젙솗븯寃 뙋룆븯뒗 寃껋 留ㅼ슦 以묒슂븯떎. 씠踰 利앸뒗 珥덇린 移쇰ⅷ 닔移섍 6.8 nM/L濡 넂븯뒗뜲, 怨좎뭡瑜⑦삁利앹 듅吏뺤쟻씤 떖쟾룄 씠긽쓣 쑀諛쒗븷 닔 엳떎. 룺씠 醫곴퀬 移쟻쑝濡 넂 T뙆, QRS complex쓽 widening 벑쓽 듅吏뺤쟻씤 떖쟾룄 씠긽쓣 쑀諛쒗븷 닔 엳쑝硫, 닔移섍 異붽 긽듅븯뒗 寃쎌슦뿉뒗 P뙆쓽 amplitude媛 媛먯냼븯뿬 蹂댁씠吏 븡寃 맂떎. 뱶臾쇨쾶뒗 떖洹쇨꼍깋쓣 紐⑤갑븯뒗 ST 遺꾩젅 긽듅(‘pseudoinfarction’ pattern)룄 굹굹뒗 寃껋쑝濡 븣젮졇 엳떎5.

鍮꾪듅씠쟻 ST 遺꾩젅怨 T뙆 씠긽(non-specific ST-segment and T-wave abnormalities, NSSTTA) 냼寃ш낵쓽 援щ퀎씠 以묒슂븳뜲, NSSTTA뒗 ST junction depression쓽 젙룄, ST-segment쓽 紐⑥뼇, T-wave쓽 紐⑥뼇 벑뿉 뵲씪 媛곴컖쓽 Minnesota code濡 젙쓽맂떎6. 씠踰 利앸쓽 떖쟾룄 寃곌낵 以 븯굹씤 T뙆 뿭쐞뒗 쑀쟾꽦 떖洹쇱쭏솚쓽 理쒖큹 諛 쑀씪븳 吏뺥썑씪 닔 엳쑝硫, 듅엳 떖옣쓽 援ъ“쟻 蹂솕媛 媛먯릺湲 쟾뿉 꽑뻾븷 닔 엳떎怨 븣젮졇 엳떎7. 떖쟾룄긽 듅吏뺤쟻씤 T뙆瑜 蹂댁씠뒗 Wellens 利앺썑援곗 紐, 꽦, 뼱源⑤줈 諛⑹궗븯뒗 쟾삎쟻씤 쓨넻쓣 蹂댁씠뒗뜲, 쓳湲됱떎 궡썝 떆뿉뒗 넻利앹씠 궗씪吏뒗 듅吏뺤쓣 媛吏꾨떎. 吏꾨떒 湲곗쑝濡 V2–V3 쑀룄뿉꽌 源딆 T뙆 뿭쐞 삉뒗 씠긽(biphasic) T뙆 뜑遺덉뼱 벑쟾(isoelectric) 삉뒗 1 mm 誘몃쭔쓽 ST 遺꾩젅 긽듅쓣 룷븿븳떎8. 2媛 씠긽쓽 뿰냽맂 쟾諛 쑀룄(V1–V4)뿉꽌 T뙆 뿭쐞媛 愿李곕릺뒗 寃껋쓣 ‘anterior T-wave inversion’쑝濡 젙쓽븳 Malhotra 벑9 洹쒕え 肄뷀샇듃 뿰援ъ뿉꽌 anterior T-wave inversion 鍮 슫룞 꽑닔蹂대떎 슫룞 꽑닔뿉꽌 뜑 쓷븯寃 愿李곕릺뿀쑝硫, T뙆 뿭쐞쓽 77%媛 V1–V2 쑀룄뿉꽌 二쇰줈 愿李곕릺뿀떎怨 蹂닿퀬븯떎. Bianco 벑10 2媛 씠긽쓽 씤젒븳 쓨遺 쑀룄뿉꽌 1 mm 씠긽쓽 ST 遺꾩젅 긽듅씠 愿李곕릺뒗 寃껋쓣 議곌린 옱遺꾧레(early repolarization)쑝濡 젙쓽븯쓣 븣, 슫룞 꽑닔援곗뿉꽌 議곌린 옱遺꾧레 빟 89%뿉꽌 솗씤릺뿀쑝硫 씠뒗 議곌뎔蹂대떎 쑀쓽븯寃 留롮븯떎怨 蹂닿퀬븯떎. 븯吏留, Brugada 利앺썑援곗뿉꽌 愿李곕릺뒗 寃껉낵 쑀궗븳 upward toward the top 紐⑥뼇쓽 ST 遺꾩젅 긽듅쓣 蹂댁씠뒗 議곌린 옱遺꾧레 슫룞 꽑닔쓽 8.6%뿉꽌留 愿李곕릺뿀떎怨 蹂닿퀬븯떎.

옄뱾 썙諛띿뾽 以 떎떊씠 諛쒖깮븳 봽濡 異뺢뎄 꽑닔쓽 떖쟾룄 寃궗뿉꽌 T뙆 뿭쐞 쐞濡 蹂쇰줉븳 ST 遺꾩젅 긽듅 냼寃ъ쓣 솗씤븯뿬 湲됱꽦 愿긽룞留 利앺썑援곌낵 Wellens 利앺썑援곗쓣 諛곗젣븯湲 쐞븯뿬 愿긽룞留 議곗쁺닠쓣 떆뻾븯떎. 愿긽룞留 議곗쁺닠뿉꽌 씠긽 냼寃ъ씠 愿李곕릺吏 븡븘 떎떊쓣 빞湲고븷 닔 엳뒗 Brugada 利앺썑援 諛 湲고 湲곗 떖옣吏덊솚쓣 諛곗젣븯湲 쐞븯뿬 異붽 寃궗瑜 떆뻾븯쑝굹 湲곗 떖옣吏덊솚쓣 솗씤븷 닔 뾾뿀떎. 떎떊씠 諛쒖깮븳 슫룞 꽑닔瑜 吏꾩같븿뿉 엳뼱 蹂묐젰 泥痍⑥ 떖쟾룄寃궗瑜 넻븳 쐞뿕룄 룊媛媛 븘슂븯硫, 슫룞 꽑닔쓽 깮由ъ쟻 떖쟾룄 냼寃ш낵 援ъ“쟻 떖吏덊솚쓣 쓽誘명븯뒗 떖쟾룄 蹂솕 냼寃ъ뿉 빐 젙솗엳 媛먮퀎븯湲 쐞븳 끂젰씠 븘슂븯떎怨 깮媛곷맂떎.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Author Contributions

Conceptualization: DHL, KBP. Data curation: SHK, KJL. Formal analysis: DHL, KBP. Methodology: SHK, KBP. Writing–original draft: DHL, SHK. Writing–review & editing: KBP, KJL.

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