TSH, CBC, CMP, and magnesium level were normal.
ECG: 63 bpm, normal axis, undeterminable rhythm, with nonspecific ST elevation; "consider lateral injury or acute infarct." Case Photo #1
The athlete was withheld from competition and referred to Cardiology and
Cardiac Electrophysiology, which produced the following test results:
Echocardiogram: Normal LV size with overall mildly depressed ventricular function with EF of 46%. Mild concentric LV hypertrophy. Mildly enlarged left atrium and borderline enlarged right atrium.
Holter Monitor: NSR at baseline with very frequent monomorphic PVCs throughout daytime hours; some couplets and bigeminy noted; no symptoms reported. Maximum heart rate 113, minimum heart rate 37. PAC total 17. PVC total 19,621. Longest run of SVT was 5 beats. No VT.
Cardiac MRI: Diagnostic criteria for ARVD not met. No evidence for right ventricular akinesia, dyskinesia, or aneurysm. No evidence for delayed enhancement or myocardial scarring. Slightly reduced left ventricular function with EF of 45%. This is felt to be not secondary to patient's conditioning as an elite athlete. Right ventricular EF of 44%. Heart rate of 34.
Exercise Treadmill Test: Asymptomatic PVCs that reduced with exercise.
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