Author: Christopher Mills, DO
Co Author #1: Joseph Armen, DO

Patient Presentation:
21 year old NCAA Division 1 Caucasian male basketball player with no significant past history initially presented with a chief complaint of intermittent chest tightness and missing beats while lifting weights ten days prior.
EKG demonstrated non-specific findings and was unchanged from baseline 3 years prior. Labs including CBC, CMP and TFT's were essentially unremarkable. A transthoracic echocardiogram demonstrated an EF 50-55%, a borderline dilated left atrium and an IVSD of 1.3cm compared to 1.3cm on the LV posterior wall. A pharmacologic nuclear stress test was negative for inducible ischemia, scars or other abnormalities.
His Holter monitor results were markedly abnormal when he developed substernal chest pain, dizziness and tachycardia while performing rehab exercises after a patellar tendon debridement. He was evaluated in the athletic training room and found initially to be extremely tachycardic above 200 bpm and relatively hypotensive. A subsequent ECG demonstrated atrial fibrillation with a rate of 115 bpm. Following an additional 15 minutes of rest his vital signs normalized including his rate with an irregularly irregular rhythm auscultated. Cardiology was consulted via phone and recommended to start Aspirin once daily with follow up in two days.
Later that day he had another episode of tachycardia with chest tightness and therefore was admitted for further evaluation and management. His rate was controlled with intravenous calcium channel blockers and he spontaneously converted back into sinus rhythm overnight. He was subsequently sent home on a beta blocker and anti-arrhythmic.

History:
The athlete's past medical history was negative for cardiovascular disease. Mother has a history of paroxysmal Atrial Fibrillation.

Physical Exam:
Upon hospital discharge:
Vitals were stable with T 97.5, P 75(regular), BP 117/55, RR 20 and SpO2 98%.
Gen: AAOx3 in no acute distress.
HEENT: Pupils equal and reactive to light. Normocephalic. Normal nasal and oral mucosa.
CV: RRR, no murmurs, rubs or gallops. 2+ peripheral pulses.
Pulm: CTAB. No wheezing, rales, rhonchi
GI: Abdomen soft, non-tender x 4 quadrants, bowel sounds normal and non-distended
Neuro: Grossly intact

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