Author: Elan Goldwaser, DO
Co Author #1: Sharon Longo, OMS-IV
Senior Editor: Mandeep Ghuman, MD, FAMSSM
Editor: Ian McKeag, MD

Patient Presentation:
28-year-old male Caribbean Olympic Track and Field athlete who presents with sudden loss of consciousness while pacing a professional 3000m race during an indoor track and field event and was found to be pulseless.

History:
The athlete was completing approximately 2,000 meters of the 3,000-meter race when he collapsed, fell off the track, and underwent a grand-mal seizure. <a href="CaseStudyImages/CS4CS3CS2CS1SuddenCa-793.jpg" title="Case Photo #4" data-lity><b>Case Photo #4</b></a> He was found pulseless and Basic Life Support was initiated. The athlete was defibrillated at 3 minutes from collapse and achieved a return of spontaneous circulation after the first defibrillation. He was intubated and transferred across the street to a medical center for hypothermia protocol and further treatment in the cardiac intensive care unit. <a href="CaseStudyImages/CS5CS4CS3CS2CS1Sudde-793.jpg" title="Case Photo #5" data-lity><b>Case Photo #5</b></a> After 36 hours, the athlete was rewarmed and successfully extubated. <br> <br>The athlete communicated that he had no preceding medical issues and no family history of medical issues, specifically a completely negative cardiac family history. About 1 month before the event, he had a routine ECG and lab work completed at his annual primary care visit, which were both normal. He had a slight cold in the weeks leading the event, but was training without issues. This athlete denied drinking, smoking, and illicit drugs. He stated he eats a healthy diet in coordination with a local nutritionist and drinks roughly 2-3 liters of water daily.

Physical Exam:
General: Heart Rate 46, Blood Pressure 93/60, Respirations 16, Temperature 98.1, Oxygen Saturation 97%, BMI 19.6 <br>Alert and oriented x3. Speech was clear. Mobility: Ambulatory. No apparent distress <br>HEENT: Normocephalic, Atraumatic, moist mucous membranes, extra-ocular muscles intact, pupils equally round and reactive to light and accommodation, sclera anicteric <br>Neck: no jugular venous distention <br>Lungs: Clear to auscultation bilaterally without wheezing/rhonchi/rales <br>Heart: The cardiac PMI is normal. Regular rate and rhythm and no S3 was heard. Rare premature beat. Normal S1/S2. No murmurs/rubs/gallops <br>Abdomen: Normal bowel sounds without rigidity/guarding/rebound. Soft, nontender and no hepatomegaly. <br>Extremities: no edema in all extremities. No clubbing/cyanosis. No bruising/ecchymosis. <br>Musculoskeletal: no joint erythema and no effusion. <br>Skin: warm, dry and no rash or lesions. <br>Neurologic: Strength 5/5 throughout. Negative lower or upper motor neuron lesions. <br>Psychiatric: normal mood and normal affect

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