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(Pearl provided by Dr. Semhar Tewelde)
Physiological LV hypertrophy in trained athletes is defined by an isolated increase in QRS amplitude, normal axis, normal atrial and ventricular activations patterns, and normal ST-segment T-wave replorization; athletes of African/Caribbean descent have prominent cardiovascular remodeling leading to pronounced voltage criteria for LV hypertrophy and BER
Despite the presence of voltage criteria for LVH, pure QRS voltage criteria for LVH in an asymptomatic athlete without family hx of cardiovascular diseases or SCD, and lack of non-voltage ECG criteria does not warrant systematic evaluation with echocardiography.
In other words, young patients, especially men, especially those of African/Caribbean descent, will be expected to have large voltage QRS complexes and sometimes abnormal repolarization, and this is not necessarily a pathologic finding.
References
Corrado D, Pelliccia A, Heidbuchel H, et al. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. European heart journal. Jan 2010; 31(2):243-259