Thursday-Abstracts
Thursday-Abstracts
Thursday-Abstracts
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Official Journal of the American College of Sports Medicine<br />
PhysICaL EXaMINaTION:<br />
Height 6’ 1.5”, Weight 175 lbs, BP 114/64, HR 58<br />
General: WD, WN, NAD, A&O x 3<br />
HEENT: WNL<br />
Neck: no JVD, bruit, thyromegaly, or lymphadenopathy<br />
CV: RRR without murmur, rub or gallop - auscultated in supine and upright positions;<br />
equal peripheral pulses; normal chest wall<br />
Lungs: CTAB<br />
ABD: ND, BS(+), NT, no HSM<br />
EXT: no edema or cyanosis<br />
Skin, MSK, and Neuro: WNL<br />
2D screening echocardiogram: Moderately dilated LV, with EF 40%. No wall motion<br />
abnormalities. No LVH. Normal LVOT. Mild mitral regurgitation. Mild tricuspid<br />
regurgitation. Normal pulmonary pressure. Patent foramen ovale with left to right shunt.<br />
PhysICaL EXaMINaTION:<br />
1. Myocarditis<br />
2. Idiopathic cardiomyopathy<br />
3. Prior stimulant or anabolic steroid abuse<br />
TEsT aNd rEsuLTs:<br />
Stress echocardiogram: Physiologic hemodynamic response to exercise. HRR at 1<br />
minute 52. EF at rest 45%. Improved global LV function with exercise but does not<br />
get as hyperdynamic as expected for age, HR, and MET level achieved. No ischemic<br />
changes. Rare PAC’s. No arrhythmias.<br />
Cardiac MRI: LV dilated with diffuse hypokinesis. LVEF = 46%. RV dilated with mild<br />
diffuse hypokinesis. RVEF 51%. Trivial pericardial effusion. No myocardial edema.<br />
Diffuse myocardial fibrosis. Consistent with nonischemic cardiomyopathy.<br />
FINaL WOrKING dIaGNOsIs:<br />
Resolved myocarditis with resultant myocardial scarring<br />
TrEaTMENT aNd OuTCOMEs:<br />
Athlete is withheld from sports participation and exercise. He was placed on a low<br />
dose ACE-I. A repeat echocardiogram is scheduled for 3 months and follow up cardiac<br />
MRI is scheduled in 6 months.<br />
1774 May 30, 4:15 PM - 4:35 PM<br />
heart Murmur- Basketball<br />
Michael R. Tiso, Luis Salazar. Ohio State, Columbus, OH.<br />
(Sponsor: Thomas M. Best, FACSM)<br />
(No relationships reported)<br />
hIsTOry: A 19-year-old African American college sophomore basketball player<br />
presented for a routine pre-participation physical. He reported no previous medical<br />
conditions or injuries, syncope with exercise, or previous loss of consciousness. He<br />
stated he had never had chest pain, shortness of breath, or palpitations while playing<br />
basketball. The athlete had no family history of sudden death but reports his mother<br />
had a “heart valve problem with prior surgeries.”<br />
PhysICaL EXaMINaTION: Vitals: Blood pressure 120/80, pulse 55, respiratory<br />
rate 14, and BMI 25. The patient was a physically fit athlete in no distress. A<br />
musculoskeletal exam showed normal strength, tone, and sensation. Respirations were<br />
clear to auscultation bilaterally. Cardiac exam revealed a regular rate and rhythm with<br />
normal S1/S2 and no gallop, rub, S3, or S4. JVD was not present, he had brisk carotid<br />
upstrokes bilaterally, and peripheral pulses were 2+ throughout. A 3/6 systolic murmur<br />
was heard loudest along the left sternal border which decreased in intensity with<br />
squatting and increased for 3-5 beats upon standing.<br />
PhysICaL EXaMINaTION:<br />
1. Physiologic murmur<br />
2. Hypertrophic obstructive cardiomyopathy<br />
3. Mitral regurgitation<br />
4. Ventricular septal defect<br />
5. Aortic stenosis<br />
TEsTs aNd rEsuLTs:<br />
ECG:<br />
-Sinus bradycardia with LVH and T wave inversions in V3 - V5<br />
Echocardiogram:<br />
-Normal LV function with EF of 65%.<br />
-Intraventricular septal wall 1.1cm in diameter, left ventricular posterior wall 1.4cm.<br />
Cardiac MRI:<br />
-Concentrically hypertrophied LV with normal cavity size and EF of 65%.<br />
-RV minimally hypertrophied with prominent trabeculations.<br />
-Septal thickness 1.4cm, LV free wall thickness 1.3cm<br />
-Anatomically normal valves.<br />
FINaL / WOrKING dIaGNOsIs:<br />
Hypertrophic obstructive cardiomyopathy<br />
TrEaTMENT aNd OuTCOMEs:<br />
1. Case was discussed between cardiology and sports medicine as the posterior wall<br />
thickness was in a diagnostic indeterminate zone.<br />
2. Imaging did not meet criteria for hypertrophic cardiomyopathy; therefore athlete<br />
could not be disqualified from play.<br />
3. Recommended deconditioning for six months with follow up echocardiogram /<br />
cardiac MRI.<br />
4. Athlete decided to continue to play the season without incident.<br />
Vol. 45 No. 5 Supplement S343<br />
1775 May 30, 4:35 PM - 4:55 PM<br />
Thigh Pain--cyclist<br />
Brian C. Liem, Mark A. Harrast. University of Washington,<br />
Seattle, WA. (Sponsor: Stanley Herring, FACSM)<br />
(No relationships reported)<br />
hIsTOry: A 49 year old competitive cyclist presented with progressively worsening<br />
10 year history of right anterior thigh pain with exercise. She experienced a severe<br />
cramping sensation that would start in the anterior thigh and travel into the posterior<br />
thigh and calf with cycling and after several minutes. During more aggressive time<br />
trials or faster sprints her symptoms could present just after 30 seconds. She noted that<br />
when her heart rate reached 155 bpm symptoms would worsen and her leg would “shut<br />
down.” By slowing down and resting her pain improved. She had not been able to race<br />
at the level she wanted to for the prior 2 years specifically due to this right leg pain.<br />
She denied pain or weakness with regular ambulation.<br />
PhysICaL EXaMINaTION:<br />
Normal gait. Normal lumbar and hip range of motion without reproduction of<br />
symptoms. No tenderness to palpation over the groin or anterior thigh. Strength is<br />
5/5 lower extremities bilaterally, sensation is normal and reflexes are symmetric.<br />
Negative dural tension signs. FABER and FADIR maneuvers negative. Normal pedal<br />
and popliteal pulses. Femoral pulses intact in supine but with hip flexion right femoral<br />
pulse diminishes.<br />
PhysICaL EXaMINaTION:<br />
1. Hip Pathology<br />
2. Lumbar radiculopathy<br />
3. Vascular claudication<br />
4. Femoral neuropathy<br />
TEsT aNd rEsuLTs:<br />
1. Pelvis and Right femur X-rays: Normal. No fracture or osteoarthritis<br />
2. Right Ankle Brachial Indexes: 1.29 pre-exercise, 0.38 post exercise<br />
3. Duplex Doppler: Post exercise external iliac artery velocity 231 cm/sec, 50-99%<br />
stenosis.<br />
4. CT angiogram: No stenosis. Minimal narrowing right external iliac artery<br />
FINaL WOrKING dIaGNOsIs:<br />
Right External Iliac Artery Endofibrosis<br />
TrEaTMENT aNd OuTCOMEs:<br />
1. Given her desire to return to high level competition, referred patient for consultation<br />
with vascular surgery.<br />
2. Underwent saphenous vein patch angioplasty.<br />
3. Returned to cycling competition.<br />
1776 May 30, 4:55 PM - 5:15 PM<br />
Concerns Of The heart In a Professional Football hopeful<br />
Leonie Prao 1 , Andrew Tucker 2 . 1 Union Memorial Hospital and<br />
University of Maryland Medical Center, Baltimore, MD. 2 Union<br />
Memorial Hospital, Baltimore, MD.<br />
(No relationships reported)<br />
hIsTOry: 22 year old AA male presents for a professional football free agent<br />
PPE . He denies any current complaints, but admits to history of a heart murmur.<br />
Awareness of his heart murmur resulted from a syncopal episode at the age of 16.<br />
While standing during a wedding, he felt dizzy, and fainted. This syncopal episode<br />
was thought to be vasovagal or neurocardiogenic in origin. Pediatric cardiology<br />
evaluation and echocardiogram in May of 2008 revealed mild MV prolapse and trivial,<br />
hemodynamically insignificant MV regurgitation. He was cleared to participate in<br />
college football and has had no cardiac symptoms throughout college. He currently<br />
denies any chest pain, palpitations, easy fatigability, or peripheral edema.<br />
PhysICaL EXaMINaTION:<br />
The player was noted to have normal blood pressure and heart rate. Cardiac<br />
examination revealed a 3/6 holosystolic murmur with a mid-systolic click, best heard<br />
at the base, but able to be heard at the apex and bilateral sternal borders. Murmur<br />
increased with squatting. Normal S1, S2. No diastolic murmurs. No JVD. No<br />
peripheral edema, 2+ distal pulses bilaterally. Pulmonary exam normal.<br />
PhysICaL EXaMINaTION:<br />
1) Persistent/Worsening Mitral Valve Prolapse/Regurgitation<br />
2) Mitral/Aortic Stenosis<br />
3) Atrial Myxoma<br />
4) HOCM<br />
TEsT aNd rEsuLTs:<br />
EKG: Sinus bradycardia, HR 56, LVH, normal QRS<br />
aP/Lateral CXr-- mild cardiomegaly, rounded cardiac appearance<br />
TTE-Normal LV function w/ estimated LV EF 60%. No obvious segmental wall<br />
motion abnormalities. Mild tricuspid regurgitation. Pulmonary artery pressure<br />
48mmHg consistent with pulmonary hypertension. 3+(Moderate) mitral regurgitation.<br />
Prominent prolapse of the posterior mitral valve. Normal intra-atrial and intraventricular<br />
septum.<br />
FINaL WOrKING dIaGNOsIs:<br />
Persistent/Progressive Mitral Valve Prolapse/Regurgitation<br />
<strong>Abstracts</strong> were prepared by the authors and printed as submitted.<br />
<strong>Thursday</strong>, May 30, 2013