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In Depth Diagnosis: A Case Of Exercise Associated Collapse - Page #1
 

Author: Reggie Taylor, DO, MA
Co Author #1: Brian Merrigan, MD
Co Author #2: n/a
Co Author #3: n/a
Senior Editor: Drew Duerson, MD
Editor: Leigh Romero, MD, ATC, LAT

Patient Presentation:
A 19-year-old Caucasian male active-duty service member presented to the emergency department after two exercise associated syncopal events. Patient reported loss of consciousness 1 mile into a run with no prodromal symptoms. He regained consciousness and endorsed feeling lightheaded but was able to resume his run. A few minutes later he felt his legs and upper body go weak and give out. He lost consciousness again, this time hitting the back of his head. Patient went directly to the ER following the second collapse. He denied chest pain preceding collapse, but he reported brief chest pain upon regaining consciousness that resolved without intervention.

Review of Systems: (-) Confusion, vomiting, tongue biting, jerking, shortness of breath, palpitations; (+) Blurry vision after 2nd collapse.

History:
Past medical history: Narcolepsy and ADHD.
Medications: None.
Family history: Diabetes type 2. Maternal cousin with sudden unexplained death in 20s. Two paternal cousins with sudden unexplained death in their 20s to 30s. Father with myocardial infarction in his late 40s.
Social History: He denied use of alcohol, tobacco, illicit drugs, caffeine, and supplements.

Physical Exam:
Vitals: Temperature 98.7 (rectal), Heart Rate 72, Blood Pressure 105/60, Respiratory Rate 18, SpO2 99% on room air.
General: Alert and oriented, well nourished, no acute distress.
Eyes: extraocular movements intact, pupils equal and reactive to light and accommodation, normal conjunctiva.
HENT: Normocephalic, atraumatic.
Lungs: Non-labored respiration, symmetric bilateral chest wall expansion, clear to auscultation bilaterally.
Heart: No peripheral edema, well perfused, regular rate and rhythm, no murmurs.
Skin: Warm, dry, and pink, no rashes or lesions.
Neurologic: Awake, alert, and oriented, Cranial Nerves II-XII intact, no focal deficits.

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

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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