Observations on the “juvenile pattern” of adult Negro males

doi:10.1016/0002-9343(55)90223-0

The American Journal of Medicine

Volume 18, Issue 3, March 1955, Pages 428-437

https://doi.org/10.1016/0002-9343(55)90223-0 Get rights and content

Abstract

1.
1. The unipolar electrocardiograms of 681 consecutive admissions to the Veterans Administration Hospital, Madison, Wisconsin, were studied for the incidence of the “juvenile pattern.” Of the total of 131 adult Negro males, fourteen (10.8 per cent) were found to show persistent or transient T wave inversion patterns in the unipolar leads V₁ through V₆. All fourteen patients were thought to have normal cardiovascular systems, with no clinical evidence of pericarditis. Cases 3, 7 and 9 were noted to have normal pericardiums at time of thoractomy.
2.
2. The “juvenile pattern” was consistently normalized by the oral administration of 10 gm. of potassium bicarbonate-citrate mixture and by the intravenous administration of 20–30 mg. of pro-banthīne. Hyperventilation consistently exaggerated the T wave inversion pattern, an effect which could be abolished by the administration of pro-banthīne.
3.
3. The “juvenile pattern” is believed to represent an expression of hypervagotonia and is considered to be a normal variant of the adult Negro.
4.
4. One must be cautious in the interpretation of these transient electrocardiogram changes in the adult Negro if one wishes to avoid erroneous diagnoses of “subepicardial myocarditis,” “myocardial ischemia” and “subacute pericarditis,” and the risk of promoting serious iatrogenic heart disease.

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A 37-year-old man came to the emergency department because of several days of intermittent chest pain. An electrocardiogram (ECG) showed sinus rhythm, left atrial and left ventricular enlargement, and an early repolarization pattern. A second ECG recorded 10 minutes later was strikingly different, with ST-segment elevation and large upright T waves in the anterior precordial leads, interpreted as evidence of an ST-segment elevation myocardial infarction, and the cardiac catheterization team was activated. Closer inspection of the ECG, however, disclosed that the changes were because of intermittent ventricular pre-excitation of the Wolff-Parkinson-White type, and no electrocardiographic, echocardiographic, or serum markers of myocardial infarction were found.
"persistent juvenile" T-wave pattern may not be persistent: Case series and literature review
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Citation Excerpt :
Grusin noted a pattern of precordial TWI with associated “evolving” ST-segment deviations, and stated that it would be “tempting to speculate that the electrocardiogram of the African may be of a juvenile type in the developmental sense” (35). Wasserburger found that 11% of healthy adult AA males manifested what he described as a “juvenile pattern,” defined as “frank inversion of the T waves in the right and mid-precordial leads” (36). Gottschalk and Craige also found that a “persistence of the juvenile T-wave pattern” was more common in AA subjects than in white subjects (37).
T-wave inversions (TWI) can signify serious pathology, but may also represent a benign variant. One such variant has been termed the “persistent juvenile” T-wave pattern (PJTWP). It is characterized by TWI in the right precordium, and has been understood to represent an arrested stage of the normal electrocardiographic evolution from childhood.
A series of four African-American (AA) women, ages 20 to 43 years, presented to the Emergency Department, and were found to have right precordial TWI that was absent on prior electrocardiograms. The diagnostic evaluation did not reveal acute cardiopulmonary causes for these new TWIs.
The “persistent” juvenile pattern may not be actually persistent in the individual patient. In an appropriate patient, such as a young AA woman, where acute cardiopulmonary disease has been reasonably ruled out, the finding of new right precordial TWI should not preclude the diagnosis of PJTWP.
Prevalence and significance of isolated T wave inversion in 1755 consecutive American collegiate athletes
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We evaluated the prevalence of isolated T-wave inversions (TWI) in American athletes using contemporary ECG criteria. Ethnic and gender disparities including the association of isolated TWI with underlying abnormal cardiac structure are evaluated.
From 2004 to 2014, 1755 collegiate athletes at a single American university underwent prospective collection of medical history, physical examination, 12-lead ECG, and 2-dimensional echocardiography. ECG analysis was performed to evaluate for isolated TWI as per contemporary ECG criteria.
The overall prevalence of isolated TWI is 1.3%. Ethnic and gender disparities are not observed in American athletes (black vs. white: 1.7% vs. 1.1%; p=0.41) (women vs. men: 1.5% vs. 1.1; p=0.52). No association was found with underlying cardiomyopathy.
A lower prevalence of isolated TWI in American athletes than previously reported. Isolated TWI was not associated with an abnormal echocardiogram. No ethnic or gender disparity is seen in American college athletes.
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Current guidelines for preparticipation screening of competitive athletes in the US include a comprehensive history and physical examination. The objective of this study was to determine the incremental value of electrocardiography and echocardiography added to a screening program consisting of history and physical examination in college athletes.
Competitive collegiate athletes at a single university underwent prospective collection of medical history, physical examination, 12-lead electrocardiography, and 2-dimensional echocardiography. Electrocardiograms (ECGs) were classified as normal, mildly abnormal, or distinctly abnormal according to previously published criteria. Eligibility for competition was determined using criteria from the 36^th Bethesda Conference on Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities.
In 964 consecutive athletes, ECGs were classified as abnormal in 334 (35%), of which 95 (10%) were distinctly abnormal. Distinct ECG abnormalities were more common in men than women (15% vs 6%, P < .001) as well as black compared with white athletes (18% vs 8%, P < .001). Echocardiographic and electrocardiographic findings initially resulted in exclusion of 9 athletes from competition, including 1 for long QT syndrome and 1 for aortic root dilatation; 7 athletes with Wolff-Parkinson-White patterns were ultimately cleared for participation. (Four received further evaluation and treatment, and 3 were determined to not need treatment.) After multivariable adjustment, black race was a statistically significant predictor of distinctly abnormal ECGs (relative risk 1.82, 95% confidence interval, 1.22-2.73; P = .01).
Distinctly abnormal ECGs were found in 10% of athletes and were most common in black men. Noninvasive screening using both electrocardiography and echocardiography resulted in identification of 9 athletes with important cardiovascular conditions, 2 of whom were excluded from competition. These findings offer a framework for performing preparticipation screening for competitive collegiate athletes.
Relation of Race to Electrocardiographic Patterns in Elite American Football Players
2008, Journal of the American College of Cardiology
Citation Excerpt :
These findings are consistent with historical assertions that ECG patterns might differ between healthy black and white subjects. In the early 1950s, J-point and ST-segment elevation in the right precordial leads was regarded as characteristic of young black male individuals without heart disease (10–12). More recently, several studies have demonstrated a higher prevalence of ECG abnormalities in young black men (13) or athletes (14) without systemic hypertension or cardiac disease.
The purpose of this study was to establish an electrocardiographic (ECG) profile in a biracial population of highly-trained American football players.
Intense physical training can induce cardiac structural and functional changes (“athlete's heart”), including 12-lead ECG alterations. That race might play a role in determining ECG patterns has been suggested, although not studied in a large athletic population comparing black and white athletes.
Electrocardiographic analysis of 1,959 elite male athletes attending the National Football League Invitational Camp from 2000 to 2005 was performed. Subjects were classified by race and player position and judged free of structural heart disease.
Abnormal ECG patterns were present in 480 (25%) athletes and were significantly more common among black players (n = 396; 30%) compared with white players (n = 78; 13%) or other races (n = 6; 15%) (p < 0.0001). Distinctly abnormal ECG patterns, suggestive of cardiac disease, were also more common in blacks (n = 76; 6%) than whites (n = 11; 2%) (p = 0.0005). In multivariable analysis, black race was an independent predictor of abnormal ECGs (risk ratio [RR] 2.03, 95% confidence interval [CI] 1.56 to 2.64, p < 0.0001), including patterns judged distinctly abnormal (RR 2.59, 95% CI 1.18 to 5.67, p = 0.02). Abnormal ECGs were also related to player position: most frequent in wide receivers (n = 91; 35%) and least common in quarterbacks (n = 16; 14%) and place kickers (n = 8; 11%). Echocardiograms, obtained in 203 athletes (10%), did not show structural cardiac abnormalities.
Electrocardiographic abnormalities were 2-fold more common in black than in white highly-trained male American football players, with race an independent determinant of ECG pattern. These findings have important implications for pre-participation cardiovascular screening of athletes with ECGs.

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¹: From the Department of Medicine, Cardiology Section, Veterans Administration Hospital, and Department of Medicine, University of Wisconsin School of Medicine, Madison, Wis.

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Clinical studyObservations on the “juvenile pattern” of adult Negro males

Abstract

Am. Heart J.

Am. Heart J.

Am. Heart J.

Am. Heart J.

Am. J. Physiol.

Am. Heart J.

Am. Heart J.

M. Clin. North America

Am. Heart J.

The direction of the precordial T waves in 321 normal infants and children

Am. J. M. Sc.

Juvenile electrocardiograms

Am. J. Med.

Clinical study
Observations on the “juvenile pattern” of adult Negro males