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