Exertional Syncope In A Collegiate Basketball Player - Page #1

Author: Ryan LaSota, MD
Co Author #1: Mark L. Stovak, M.D. University of Kansas School of Medicine - Wichita Sports Medicine Fellowship at Via Christi Hospitals Wichita, KS
Co Author #2: Michael J. Ackerman, M.D., Ph.D. Mayo Clinic Division of Pediatric Cardiology and Cardiovascular Disease Director of Long QT Syndrome/Genetic Heart Rhythm Clinic Professor of Medicine, Pediatrics, and Pharmacology Rochester, MN

Patient Presentation:
An 18-year-old African-American male NCAA Division I basketball player presented after collapsing during a pre-season basketball practice. He had just completed a one-on-one drill and was walking back to half-court when he developed dizziness followed by witnessed loss of consciousness and collapse. Seizure-like activity was witnessed by coaching staff and teammates. Certified athletic trainers (ATC) caring for other athletes in on-site training room were notified of the situation and responded immediately with an automated external defibrillator (AED). Initial evaluation by ATC staff revealed no palpable pulse, so chest compressions and ventilations were initiated. AED was applied. Initial rhythm analysis revealed ventricular fibrillation Case Photo #3 . The patient received one shock which resulted in return of normal sinus rhythm and return of consciousness. Elapsed time from patient collapse to defibrillation was approximately 2 minutes. He was subsequently transferred to the hospital via EMS for further evaluation and treatment.

The patient denied any prior history concerning for cardiac disease. He specifically denied history of exertional syncope, excessive or unexplained fatigue with exertion, chest pain/discomfort or palpitations with exertion, heart murmur, or hypertension.

Family history was also negative for sudden cardiac death (SCD) or premature death prior to age 50 due to heart disease, heart disease causing disability prior to age 50, or history of genetic conditions that would predispose the patient to SCD such as hypertrophic or dilated cardiomyopathy, inheritable channelopathy (such as Long QT Syndrome, Brugada Syndrome, etc.), Marfan’s Syndrome, or other clinically important arrhythmia. Following the patient’s event, his maternal grandfather did admit to a “seizure” that required defibrillation “around age 50”, however, there were no medical records of this event and this information was not known to the patient.

Physical Exam:
Initial physical exam performed during patient’s hospitalization revealed the following:
Initial Vitals (taken in the Emergency Room):
- Height – 73 inches (185 cm)
- Weight – 81 kg
- BMI – 24
- Blood pressure (seated) – 134/59 (improved to 106/60 on repeat examinations)
- Pulse – 75 – patient initially pulseless in the field
General: well nourished, well developed African-American male in no acute distress
Cardiac: regular rate and rhythm. No murmurs noted in seated or left lateral decubitus positions or with Valsalva. Radial and femoral pulses full and symmetric bilaterally.
Lungs: clear to auscultation bilaterally
No physical signs of Marfan's syndrome
Initial PPE prior to collegiate athletic participation was normal

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