Preparticipation Screening Detects Cardiac Disease In An Asymptomatic Preadolescent Athlete - Page #1

Author: Jeremy Coleman, MD
Co Author #1: Dr. James B. Robinson
Editor: Rebecca Carl, MD, FAMSSM

Patient Presentation:
A 13-year-old African-American male was evaluated during a large, station-based Preparticipation Physical Evaluation (PPE). He reported a history of occasional high blood pressure readings and a family history of hypertension. He is a talented, high-intensity athlete and otherwise healthy. He was asymptomatic and specifically denied chest pain (CP), shortness of breath (SOB), palpitations, lightheadedness, or syncope.

The patient reported a family history of cardiovascular disease (grandparents) and hypertension (both parents), but denied a family history of structural cardiac abnormalities or premature sudden cardiac death.
He also mentioned a personal history of occasional high blood pressure readings. During a later chart review, BPs ranging from 146-166/62-76 were noted over the preceding 2 years.
Despite this, he denied all other medical conditions, medicine use aside from an occasional OTC NSAID/Tylenol, the use of alcohol, illicit drugs, steroids, or tobacco, AND prior restrictions on sports participation.

Physical Exam:
The patient was afebrile (T 98). Although he was large for his age, with both height (6 feet 0 inch) and weight (172 lbs) being greater than the 99th percentiles for age, he was a healthy weight per BMI (22).
Pulse (60) and RR (14) were WNL, but blood pressure (140/76) was noticeably elevated especially when compared to age-related normative values. Case Photo #1
Generally, the patient was well-appearing and devoid of any obvious dysmorphic features.
His cardiac exam did reveal a grade 3/6 crescendo-decrescendo systolic murmur heard best at the left upper sternal border. Murmur increased with Valsalva maneuver. Lungs, Abdomen, Genitourinary, and extremity exams were unremarkable.

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