Author: Matthew Waldrop, MD
Co Author #1: Neil Sparks, DO
Co Author #2: Kiran Mullur, MD
Senior Editor: Justin Mark Young, MD, FAMSSM
Editor: Bjorn Irion, MD

Patient Presentation:
A 22-year-old male college basketball player presented for a pre-participation physical evaluation upon transferring to a new school.

History:
A 22-year-old male college basketball player presented for a pre-participation evaluation after transferring schools. He reported no symptoms but mentioned a routine screening at his last school revealed a "large aorta," though details and records were unavailable. He recalled negative genetic testing and was previously cleared for full participation. He did not compete last season due to a knee injury, which has since been resolved. He reported no past medical or surgical history. He denied any medications, use of herbs, supplements, caffeine, alcohol, or other drugs. He did not know of any family history of arrhythmias, congenital heart disease, or sudden cardiac death. His screening electrocardiogram was abnormal Case Photo #1 , and he was restricted from sport pending further evaluation and review of medical records. On follow-up questioning, he disclosed occasional palpitations, previously unreported due to their mild and infrequent nature.

Physical Exam:
He was 6 feet 9 inches tall and weighed 253 pounds and 9 ounces. His body mass index was 27.18 kilograms per meters squared. His heart rate was 90 beats per minute. His blood pressure was 112/63 mmHg. His respiratory rate was 12 breaths per minute. His oxygen saturation was 99 percent on room air. He appeared normal and well-developed. He was comfortable and in no acute distress. His cardiac exam was notable for a regular rate and irregular rhythm. No murmurs, rubs or gallops noted while supine, sitting, standing, or squatting. Brisk capillary refill was present and 2-plus peripheral pulses in all extremities. No JVD or carotid bruits were present. His lungs were clear to auscultation bilaterally without wheezes, rales, rhonchi, or crackles. He had normoactive bowel sounds, and his abdomen was non-tender to palpation with no masses or pulsating lesions noted. He had no strength, sensory, or range of motion deficits in any extremity. No Marfanoid stigmata were noted. No lower extremity edema was present.

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