Image of Note: Septal Wall Subtleties in a Young Athlete

By Dermot Phelan, MD, PhD

A white male high school basketball player undergoes an ECG and echocardiogram after presenting with atypical chest pain. Although the ECG is unremarkable, he is disqualified from competitive sports because of concern for hypertrophic cardiomyopathy (HCM) after the echo reveals septal wall thickness of 1.5 cm. He has no family history of HCM.

He comes to Cleveland Clinic’s Sports Cardiology Center for a second opinion. The septal wall measurements are confirmed on echocardiogram (left image below). While up to 18 percent of African-American athletes have septal wall thickness greater than 12 mm, this finding is unusual in a white athlete. However, diastolic function and longitudinal strain are normal (see systolic strain profile at bottom of post).

He performs well on a metabolic stress test (VO2 max is 64.3 mL/kg/min), and MRI reveals no scar and a normal mitral valve apparatus. Close evaluation of the MRI reveals that the septal measurement from long-axis view was overestimated due to a tangential cut through the septum and inclusion of right ventricular trabeculation (middle image above). The true septal measurement is determined to be 11 mm (right image above). The collective findings are believed to be related to “athlete’s heart,” and the patient is allowed to return to play.

The patient’s systolic strain profile.

For more on athlete’s heart, see this companion Consult QD post .