Author: Caitlyn Rerucha, MD
Co Author #1: Collin Hu, DO, FAAFP
Co Author #2: Julie Creech, DO
Co Author #3: Sean Wise, DO, CAQSM, FAAFP
Senior Editor: Warren Bodine, DO, FAMSSM
Editor: Rock Vomer, DO, DPT

Patient Presentation:
A 17 year-old African American male with a past medical history of Risk-Level 1 Kawasaki's Disease, diagnosed at age four years old, presented after he woke up in the morning with diffuse intermittent substernal chest pain which he described as " 4/10 pressure he has never felt before". The pain was, non-radiating, and non-exertional, and was not previously provoked during his routine weightlifting and football practices. Prior to presentation the patient tried an over-the-counter antacid without relief. A thorough review of systems is unremarkable including no recent illnesses, palpitations, dyspnea, or unexplained syncope.

History:
He is a lifelong multi-sport athlete excelling in football, baseball, tennis, basketball, soccer, and swimming. He is currently weight training at home four days per week with infrequent aerobic exercise during the COVID-19 pandemic. He is a junior at a competitive high school that recently transferred in on scholarship to play football linebacker. <br>Medical History, Risk Level 1 Kawasaki’s Disease diagnosed at age four <br>Surgical History, none <br>Medications or supplements, no chronic medications, took one antacid this morning <br>Drug Allergies, none <br>Family History, he reports healthy immediate family members without heart disease and a maternal grandmother with heart failure that died suddenly at age 58 presumably from a heart <br>attack without autopsy.

Physical Exam:
Height 6 feet 3 inches, 274lbs, BMI 35, blood pressure 117/65 normal for pediatric age and <br>height, 96 oxygen saturation on room air <br>General – well-appearing with a muscular body habitus, comfortable and non-toxic appearing, in <br>no acute distress <br>HEENT – unremarkable with normal jugular venous pulse (5cm) and no carotid bruits <br>Pulmonary – lung sounds clear bilaterally <br>Cardiac – S1 and S2 sounds present with normal intensity without fixed split. Normally placed <br>apical impulse. There is a new 2/6 systolic ejection murmur at the left lower sternal boarder that <br>increases from squat to stand and with Valsalva. No S3, S4, or rub appreciated. Radiofemoral <br>pulses are equal without delay. <br>Chest Wall/Abdomen – non-tender to palpation <br>Skin – unremarkable <br>Peripheral extremities – unremarkable

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