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Article Title

Division 1 Freshman Basketball Player with Palpitations

Abstract

R. Davis and M. McElroy, Geisinger Medical Center, Danville, PA

CASE HISTORY: 19 yom freshman point guard presents to Training room after feeling racing heart/palpitations. Had 2 episodes both at rest, 1 happened during finals 6 weeks ago lasted 10 seconds and passed. Did not have any associated chest pain with the events. Denies any exertional chest discomfort, denies syncope or lightheadedness. Sister had “hole in her heart” and had surgery after she had a small stroke. He was anxious and thought he may have a similar problem.

PHYSICAL EXAM:

Constitutional: WDWN, HEENT: NCAT EOMI, PERRL, Neck: Supple, CV: RRR, no mrg, Chest: CTA bilaterally. No wheezes rales or rhonchi, Abdomen: Soft, non-tender non-distended. NABS x 4, Extremities: No swelling or edema noted in bilateral LE, Skin: Warm, dry, Neuro: alert and oriented x 3, CN II-XII grossly intact

DIFFERENTIAL DIAGNOSIS: PAC’s, SVT, PVC’s, ARVD, PFO, HCM,Thyroid abnormalities, Electrolyte abnormality, Anemia, Infection, Drug Abuse TESTS AND RESULTS:

CBC, BMP, TSH: WNL

EKG: Rate 52, PR interval 162ms, QRS duration 96ms, QT 414. Rightward Axis

CXR: Unremarkable for any acute cardiopulmonary process

TTE: EF 60-64% Atrial Septal Aneurysm, Large Patent Foraman Ovale. Right to Left shunt noted through PFO. LV and RV dimensions normal no evidence of hypertrophy.

TEE: PFO measuring 11mm, Atrial Septal Aneurysm not present. PFO hemodynamically insignificant, limbus of IAS tissues between PFO and central fibrous body 8 mm length. No R-L shunt seen, believed 2DE appearance due to high cardiac output and contrast may not have been appreciated on TEE Views.

FINAL/WORKING DIAGONSIS: Patent Foramen Ovale

TREATMENT AND OUTCOMES: An Interventional Cardiologist evaluated him and decision was made with patient to continue playing basketball with no restrictions. In his case no evidence exists to close the PFO, no signs or symptoms of stroke. Even though his sister had neurologic sxs, PFO risk is still extremely low to suggest closing. Returned to basketball with-in 3 weeks.

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