What findings are considered non‑physiological?

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Last updated: October 24, 2026 • View editorial policy

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Nalaze koji se smatraju nefiziološkim

Nefiziološki nalazi na EKG-u kod sportista uključuju ST-T repolarizacione abnormalnosti, patološke Q-talase, levostranu devijaciju osovine, intraventrikularni blok, ventrikularne preekscitacije, produžen ili skraćen QT interval i Brugada-like repolarizacione promene – ovi nalazi zahtevaju dodatnu evaluaciju jer mogu ukazivati na strukturne bolesti srca koje povećavaju rizik od iznenadne srčane smrti. 1

Klasifikacija EKG promena kod sportista

Prema vodičima Evropskog kardiološkog društva, EKG promene kod sportista se dele u dve grupe 1:

Grupa 1: Fiziološke promene (česte, >80% sportista)

  • Sinusna bradikardija (<60 otkucaja/min)
  • Sinusna aritmija
  • AV blok prvog stepena
  • Rana repolarizacija
  • Čisto voltažni kriterijumi za hipertrofiju leve komore (samo povećanje QRS amplitude bez drugih promena)

Ove promene odražavaju adaptaciju autonomnog nervnog sistema (povećan vagalni tonus) i strukturno remodeliranje srca kao odgovor na trening.

Grupa 2: Nefiziološke promene (<5% sportista)

Ključni nefiziološki nalazi koji zahtevaju dodatnu evaluaciju:

  • ST-T repolarizacione abnormalnosti – inverzija T-talasa ili depresija ST-segmenta
  • Patološki Q-talasi
  • Levostranu devijaciju osovine srca
  • Intraventrikularni blokovi provodnog sistema
  • Ventrikularna preekscitacija (WPW obrazac)
  • Produžen QT interval
  • Skraćen QT interval
  • Brugada-like repolarizacione promene

1

Klinički pristup

Kada su prisutni nefiziološki nalazi:

  1. Obavezna dodatna evaluacija – ehokardiografija, Holter monitoring, test opterećenja, eventualno MRI srca
  2. Isključiti nasledne kardiomiopatije i bolesti jonskih kanala
  3. Privremena diskvalifikacija od takmičarskog sporta dok se ne postavi dijagnoza

Važne kliničke zamke:

  • Čak i fiziološki nalazi mogu biti klinički relevantni ako postoji pozitivna porodična anamneza, simptomi (sinkopa, vrtoglavica, bol u grudima) ili abnormalni fizikalni nalaz
  • Duboka bradikardija (<30 otkucaja/min) ili pauze >2 sekunde tokom budnosti zahtevaju isključivanje disfunkcije sinusnog čvora, čak i kod sportista 1
  • Rasne razlike: crni sportisti češće pokazuju veće voltaže i ranu repolarizaciju, što je i dalje fiziološko 1
  • Polne razlike: žene sportistkinje obično imaju normalne ili skoro normalne EKG-e 1

Greška u razlikovanju fizioloških od patoloških promena može imati ozbiljne posledice – ili nepotrebnu diskvalifikaciju zdravih sportista ili propuštanje potencijalno smrtonosnih stanja 1.

References

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