Normal Variant T-Wave Changes in an Athlete with Structurally Normal Cardiac Anatomy and Function

Athletes who perform regular and intensive physical activity may undergo structural and electrical remodeling of the heart that results in electrocardiographic changes that can cause concern. Marked T‐wave inversion may represent one such physiologic change. On the other hand, T‐wave inversion could be a sign of inherited heart muscle disease or may be a normal variant. Therefore, it is imperative to determine whether abnormalities on an athlete's electrocardiography (ECG) reflect underlying cardiac disease that could place the athlete at risk for sudden cardiac death. For athletes who present with markedly abnormal ECGs, the echocardiography and cardiac magnetic resonance imaging should be considered to evaluate the potential for cardiac disease. We report the case of a high‐intensity athlete with concerning ECG changes who required additional studies to exclude cardiac disease.