Author: Landon Mueller, MD
Co Author #1: Christian Glaser, DO
Co Author #2: Korin Hudson, MD
Senior Editor: Margaret Gibson, MD, FAMSSM
Editor: Matthew LeBaron, DO

Patient Presentation:
Adult female tennis player who presented to the medical tent with a chief complaint of “heartburn” during a match.

History:
The patient is an otherwise healthy high level female adult athlete, who presented to the medical tent during a tennis tournament. The patient developed symptoms of what she described as “heartburn” while playing a match and requested to be seen by medical personnel during a changeover for her symptoms. During the evaluation she also stated she “could not get enough air” with inspiration. She denied any significant prior medical history, was not on oral contraceptives, but did report flying for 10 hours prior to the tournament. Upon further questioning, she did not think her symptoms were limiting her effort or athletic performance and was subsequently given an antacid medication and finished her match with acute complication. After the match she presented to the medical tent again for repeat evaluation and reported that the heart burn sensation had improved, but that she still felt dyspneic. The athlete’s vital signs and physical examination were without abnormality and she appeared stable clinically and was discharged with discussion of red-flag symptoms and need for close follow-up.
Later that night she developed increasing dyspnea and was directed to the emergency room for further evaluation.

Physical Exam:
Examination after the match and in the emergency department was notable for normal vital signs: The patient was afebrile, BP 110/74, HR 80, RR of 14 and pulse ox 99% without supplemental oxygen. Cardiac auscultation: regular rate & rhythm with no murmurs/rubs/gallops. Distal extremity perfusion was intact.
Pulmonary exam: no respiratory distress, patient able to speak in full sentences, no wheezes, crackles, or rales were auscultated.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.