Author: Michael Dakkak, DO
Senior Editor: Yaowen Hu, MD, MBA
Editor: Bernadette Pendergraph, MD
Editor: Joseph Chorley, MD

Patient Presentation:
A 19-year-old NCAA Division I freshman female basketball player with no past medical history presented to the training room with intermittent chest tightness, exertional dyspnea, and fatigue for the last 4 months.

History:
Her symptoms over the last 2 weeks had been progressive with increased frequency and intensity to the point where she began experiencing chest tightness and dyspnea within 5 minutes of starting physical activity. Symptoms were relieved with rest. She had no previous history of similar instances, cardiac symptoms, or dyspneic complaints. She was born and raised in Africa but moved to the USA at age 14 where she competed in basketball with no reported issues. She reports no history of trauma, illness, sick contacts, fevers, chills, orthopnea, cough, wheezing, edema, syncope, dizziness, melena, hematochezia, or hematuria.
She admits to fatigue and palpitations. She denies using tobacco, alcohol, or illicit drugs. She is not sexually active. She reports regular monthly menses lasting 5 days and uses 3 pads per day.
Family history is significant for a grandmother with diabetes mellitus.

Physical Exam:
BP: 115/59, Pulse 54, Temp 98.2, RR: 16, SpO2 99%
General: No acute distress
Chest: Normal symmetry, tenderness to palpation along the left 4th and 5th ribs, no retractions
Cardiac: Regular rate and rhythm, normal S1/S2, no murmur
Pulmonary: Clear to auscultation bilaterally
Abdomen: Soft, non-tender, normoactive bowel sounds, no palpable hepatosplenomegaly
Extremities: No clubbing, cyanosis, or edema
Neurological: No gross or motor sensory deficits, CN 2-12 intact

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