Author: Cody Clinton, DO
Co Author #1: David Webner M.D
Co Author #2: Steven Collina M.D.
Co Author #3: Nate Holmes M.D.

Patient Presentation:
M.S. is a 17 year old female cross-country/track runner who presents to our Sports Medicine office 11 months after an episode of exercise-induced collapse, with complaints of exercise-induced fatigue and subsequent pre-syncope.

She states that her initial collapse occurred 100 feet from the finish line during a 5K cross-country meet. The ambient temperature during the race was 90 degrees Fahrenheit. She recalls feeling fatigue at the 2K mark, disorientation at the 4K mark, and sudden collapse without loss of consciousness just before the finish line. She was noted to be pale with cyanotic fingers and lips and tachycardia with heart rate around 200 bpm. This lasted for about 5 minutes. Her parents and coach attributed her collapse to dehydration and heat exhaustion, so she did not seek medical evaluation until 1 month after the initial event.

Since that time, she has been having continued symptoms of near collapse while in track running the 800-3200 meter events. To date, she has had an extensive negative work-up including an EKG, Holter monitor, cardiac stress test, cardiac echo, EEG, and bloodwork (CMP, CBC, TSH, lyme, lactate/pyruvate). She has been seen by a pediatrician, cardiologist, neurologist, and endocrinologist without a definitive diagnosis and has continued symptoms.

History:
ROS (during races): no palpitations, dyspnea, wheezing, chest pain,
Positive for nausea, headache, dizziness, fatigue, muscle aches in quadriceps, and blurry vision.
ROS (daily): no fevers, chills weight loss, fatigue, loss of appetitie, or cough.
Past Medical History: exercise-induced bronchoconstriction (presumed), Lyme disease(treated with 2 weeks of doxycycline).
Past Surgical History: none.
Social History: denies smoking, alcohol, or illicit drugs; no pets.
Family History: Coronary artery diseas in grandparents; asthma in brother.
Medications: Albuterol inhaler prn.

Physical Exam:
Vitals: heart rate 64, respiratory rate 16, BP 118/70, height 66 inches, weight 146 pounds.
Well-appearing female in no distress with normal physical exam.

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