Author: Jack Chen, MD
Co Author #1: Tyler Slayman, MD
Senior Editor: Margaret Gibson, MD, FAMSSM

Patient Presentation:
15-year-old female runner presents with 6 months of exertional chest pain. She was diagnosed with COVID in November 2020 and had mild symptoms. Despite difficulty, she ran during active COVID infection. She initially presented to her primary care provider in December 2020 for exertional chest pain and dyspnea with running. Electrocardiogram (EKG), Transthoracic Echocardiogram (TTE) and Chest Xray (CXR) obtained were normal. She was cleared to gradually return to running. Prior to diagnosis of COVID, she ran 30 miles per week at 8-minute per mile pace. Eight months post COVID infection, she was only able to run 10 to 20 miles per week at 11-minute per mile pace. She was limited by exertional chest pain, dyspnea and chest tightness on deep inspiration that persisted for hours after running.

History:
Past medical history of anxiety and tibial stress fracture. No history of asthma. She runs year-round with one week off after her competition season. No other sports participation.

Physical Exam:
BP 127/60 Pulse 73 Ht 157.5cm (5 feet 2 inches) Wt 49.9kg (110 lb) BMI 20.12 kg/m
General: Well appearing and well developed. No acute distress.
Cardiovascular: Regular rate and rhythm. No murmurs, rubs or gallops. Normal S1 and S2.
Pulmonary: Clear to auscultation bilaterally without wheezes, ronchi or rales. Pulmonary effort is normal. No respiratory distress. No accessory muscle use.
Abdomen: soft, nontender, BS+, no organomegaly
Extremities: Pink and well perfused. No cyanosis or clubbing
Pulses: 2+ radial and equal bilaterally
Musculoskeletal: No erythematous or swollen joints. No tenderness or edema of lower extremities.
Neuro: Normal gait

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