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Near Syncope And Chest Pain In A Young Female Varsity Athlete - Page #1
 

Author: Andrew Cox, MD
Co Author #1: Rachel Lampert, MD
Co Author #2: Robert Elder, MD
Co Author #3: Matthew Lynch, MD
Senior Editor: Rachel Coel, MD, PhD

Patient Presentation:
The patient is a 20 year old adopted female collegiate field hockey player with an otherwise unremarkable past medical history, taking a combined hormonal oral contraceptive pill, who presents with 3 episodes of near syncope with worsening substernal chest pain over a period of 6 months. Each episode occurred during strenuous exertion, which included combinations of aerobic conditioning (ie. shuttle runs) and Olympic lifting. Despite her associated headache, lightheadedness and dizziness, she never lost consciousness. The episodes varied in duration, lasting anywhere from 5 to 10 minutes during the initial incident to about an hour with the third incident. After the third episode, she underwent formal cardiology evaluation including an EKG and echocardiogram.

History:
Past Medical History: unremarkable <br>Past Surgical History: Left knee meniscal repair <br>Medications: combined oral contraceptive pill <br>Allergies: none <br>Family History: unknown, adopted <br>Social History: collegiate varsity athlete, sophomore. Sporadic alcohol intake, denies risky drinking, tobacco or illicit drug use.

Physical Exam:
Vitals: 115/78, HR 79, SPO2 99%, WT 54 kg, HT 5 feet, BMI 23.1 <br>GEN: well appearing female, no acute distress <br>HEENT: moist mucous membranes, no oropharyngeal lesions, anicteric sclera, no conjunctival pallor <br>CV: S1 with physiologic split S2 with inspiration, no murmur, rubs or gallops, JVP 5cm H2O, no carotid bruits <br>Pulm: clear to auscultation in all lung fields <br>Abdomen: active bowel sounds, soft, non-tender, non-distended without evidence of organomegaly <br>Skin: no obvious skin lesions <br>MSK: No musculoskeletal deformities <br>Extremities: warm, well perfused, brisk capillary refill, 2+ peripheral pulses in bilateral upper and lower extremities. No clubbing, cyanosis or edema.

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