Abstract
Introduction: Athlete’s Heart refers to the structural and functional remodeling of the heart due to intense physical activity, such as benign cardiac changes from a demanding soccer regimen. Physiological and training-related changes in athletes typically do not warrant further investigation, but some cases require additional analysis to distinguish pathology from normal variants. Evaluating an athlete’s electrocardiogram (ECG) is challenging in Black African athletes, as various physiological adaptations can overlap with conditions associated with an increased risk of sudden cardiac arrest (SCA) or sudden cardiac death (SCD). This case report series aims to provide a comprehensive overview of the clinical presentation, diagnostic challenges, and management strategies for overlapping patterns found in ECG patterns in Black African soccer players during a preseason screening. Case Presentation: This case series involves two South African male professional soccer players, aged 26 (Case A) and 23 (Case B), who presented themselves for preseason medical screening. These athletes were recruited from a research study examining the ECG profiles of black South African soccer players. Athlete A reported intermittent palpitations and throbbing abdominal pain during games, without collapsing or experiencing chest pain. Athlete B was asymptomatic, but exhibited changes consistent with the typical black athlete’s heart, as classified by the international consensus standards for ECG interpretation in black athletes. Conclusions: Although SCA on the soccer field is rare, its occurrence during play underscores its life-threatening nature and the profound impact it has on witnesses, reinforcing the need for effective preventive strategies. South African soccer players often present with moderate-to-high risk profiles for SCA and SCD, revealing distinct trends in Athlete’s Heart manifestations that diverge from established patterns in other populations. Electrocardiogram screening enhances detection of cardiovascular conditions predisposing to SCD/SCA, but these case reports highlight the need for more nuanced evaluation of cardiomyopathy in black athletes. Differentiating between physiological adaptations of black athlete’s heart and pathological changes remains challenging due to considerable overlap between benign and disease-related cardiac remodeling.