Cyclist With Generalized Weakness - Page #1

Author: Bradley Bley, DO
Co Author #1: Katherine M. Riggert, D.O. University of Massachusetts
Co Author #2: J. Herbert Stevenson, M.D. University of Massachusetts
Editor: Daniel Parker, MD, MPH

Patient Presentation:
A 48 year old male competitive cyclist presented to the medical tent after completing a 28 mile race complaining of generalized weakness and inability to catch his breath that began during his warm-up.
He describes feelings of “heaviness” in his arms and legs whenever his heart rate(HR) would go above 140 beats per minute(as measured on his HR monitor). He was able to complete the race by keeping his HR below this level.
He notes that he experienced similar symptoms associated with chest discomfort about one week prior while training for the race. The symptoms resolved shortly after stopping exercise and did not return the rest of the week while exercising.
Currently, he complains of mild left-sided chest discomfort without radiation to the neck, jaw, back or arm. He denies palpitations, wheezing, lightheadedness, nausea, vomiting, or recent illness.

Past medical history is non-contributory.
Current Medications: MVI, B12, Folic Acid, Melatonin
He is a former smoker: 15 pack years; quit in 1989.
Family history is significant for premature coronary artery disease in his father.

Physical Exam:
Vital signs: HR: low 100’s, Blood pressure (BP): initial – 152/70, Respiratory rate (RR): 24; repeat 5mins later: HR: 82, BP: 110/62, RR: 18
General: athletic male in moderate distress with right fist clenched and pressed against left chest, restless
Cardiovascular: Tachycardic in low 100’s, regular rhythm, Normal S1, S2, No S3 or S4, No murmurs,rubs, or gallops, pulses 2+, no carotid bruits. No tenderness to palpation of anterior chest wall.
Lungs: Clear to auscultation bilaterally, No wheezes, rales, or rhonchi
Abdomen: soft, non-tender, non-distended, bowel sounds - normal
Extremities: warm and well-perfused, diaphoretic
Neurologic: 5/5 strength throughout

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