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An asymptomatic teenager clears preparticipation evaluation. When enough is enough?
  1. Haroldo Aleixo1,
  2. Marconi Gomes da Silva1,
  3. Eduardo Back Sternick1,2
  1. 1 Post Graduation Strictu senso, Faculdade Ciências Médicas, Belo Horizonte, Minas Gerais, Brazil
  2. 2 Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil
  1. Correspondence to Dr Eduardo Back Sternick, Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima 34000-000, Brazil; eduardosternick{at}

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Clinical introduction

Sudden cardiac death occurring in young athletes is a devastating event and prompted a worldwide debate regarding optimal cost-effective schemes for preventing this from happening.1 Preparticipation screening may include an ECG and an echocardiogram (English Football Association).

An asymptomatic 13-year-old boy underwent preparticipation screening before enrolling in football training. He had no family history of sudden death, a normal physical examination and 12-lead ECG (figure 1A) showing sinus rhythm, QTc=0.44 s, J wave presenting as a notch of 0.1 mV in inferolateral leads with a +/−T wave. He was considered fit and joined the junior football team.

Four years later, an ECG (figure 1B) showed a different pattern, with profound negative T waves in inferolateral leads, downslope of the ST segment of …

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