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. Case Photo #4 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. Case Photo #5 After 36 hours, the athlete was rewarmed and successfully extubated.

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
Alert and oriented x3. Speech was clear. Mobility: Ambulatory. No apparent distress
HEENT: Normocephalic, Atraumatic, moist mucous membranes, extra-ocular muscles intact, pupils equally round and reactive to light and accommodation, sclera anicteric
Neck: no jugular venous distention
Lungs: Clear to auscultation bilaterally without wheezing/rhonchi/rales
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
Abdomen: Normal bowel sounds without rigidity/guarding/rebound. Soft, nontender and no hepatomegaly.
Extremities: no edema in all extremities. No clubbing/cyanosis. No bruising/ecchymosis.
Musculoskeletal: no joint erythema and no effusion.
Skin: warm, dry and no rash or lesions.
Neurologic: Strength 5/5 throughout. Negative lower or upper motor neuron lesions.
Psychiatric: normal mood and normal affect

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