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Calling Timeout For A Heart On A Fast Break - Page #1
 

Author: Corey Spector, DO
Co Author #1: Ben Reisz, ATC
Co Author #2: Ankit Shah, MD
Co Author #3: Korin Hudson, MD
Senior Editor: Drew Duerson, MD
Editor: Molly McDermott, DO

Patient Presentation:
A healthy-appearing 18-year-old male with no relevant past medical history presented for a sports preparticipation physical examination.

History:
An 18-year-old male NCAA Division 1 athlete presented for cardiac evaluation after experiencing episodes of shortness of breath during practice that resolved with coughing. During his pre-participation screening history, he denied significant past medical history. He was a multisport athlete in high school and denied any history of syncope, chest discomfort, dizziness, lightheadedness, or palpitations during exercise. He had no known family history of cardiovascular disease. During pre-participation screening, a stress test documented supraventricular tachycardia lasting 20 seconds at approximately 250 beats per minute post-exercise. In retrospect, the patient acknowledged having similar sensations during exercise previously, terminated by coughing, but not realizing this was abnormal.

Physical Exam:
Vital Signs: Blood Pressure 139/62 mmHg, Heart Rate 65 beats per minute, SpO2 99% on room air, Respiratory Rate 14 breaths per minute <br>General: No acute distress. <br>Neck: No jugular venous distention. <br>Cardiovascular: Regular rate and rhythm, no murmur, gallop, or rub. No pectus deformity. <br>Lungs: No respiratory distress. Lungs clear to auscultation with no wheezing or crackles. <br>Pulse check: Femoral and distal pulses were 2+ without bruit <br>Musculoskeletal: No gross deformity of extremities. Full range of motion. No swelling. <br>Skin: Warm, dry, pink <br>Neurologic: Sensation intact to light touch. No focal motor deficits.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

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