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- W1975753931 abstract "1163 HISTORY - A 58-year old male powerlifter presented with mild chest tightness, difficulty breathing and fatique climbing one flight of stairs. He was bench pressing 450 pounds and squatting 500 pounds prior to these symptoms. He denied wheezing, pleuritic chest pain, orthopnea, PND, edema or URI symptoms. Past history of BPH, impotence, left medial meniscal tear and a recent diagnosis of hypertension and hypercholesterolemia. Medications include Flomax and Viagra. He denies any tobacco or alcohol use and denies ever using anabolic steroids or recreational drugs. PHYSICAL EXAMINATION - BP 136/98 mmHg, HR 80 bpm, Weight 221 lbs. HEENT: Unremarkable. CV: No lifts, heaves or thrills. Regular rate and rhythm with a normal sounding S1 And S2. No gallops, murmurs or rubs appreciated. Neck veins are flat in the upright position. The carotid upstrokes are even bilaterally and normal. No carotid bruits heard. Lungs are clear to auscultation bilaterally. Abdomen is soft, nontender, normal bowel sounds, no hepatosplenomegaly. Extremeties are warm and free from edema. DIFFERENTIAL DIAGNOSIS: 1. Myocardial ischemia or infarction 2. Aortic Aneurysm 3. Hypertensive Cardiomyopathy 4. Pulmonary Embolism 5. Pneumothorax TESTS AND RESULTS: Normal serum chemistries and CBC. Normal CK and Troponin. Normal homocysteine level. Total cholesterol 275, LDL 193, HDL 27. EKG:NSR. CXR shows mildly enlarged cardiac silhouette. Pt had an abnormal GXT and underwent coronary angiography which revealed 2 vessel stenosis (proximal LAD with 80% and the major diagonal artery had a mid 75% stenosis). A ventriculogram showed that the left ventricle was dilated with an ejection fraction of 41%. FINAL WORKING DIAGNOSIS: 1. Dilated Cardiomyopathy with moderate left ventricular systolic dysfunction, New York Heart Association functional class I. Etiology of cardiomyopathy either ischemic, hypertensive or idiopathic. TREATMENT AND COURSE: The patient was started on appropriate medical therapy including ACE inhibitor, beta blocker, digoxin, aspirin, lipid-lowering agent. His symptoms improved and he tolerated up-titration of his ACE inhibitor and beta blocker. We performed 12 lead EKG metabolic stress testing during bench press weight lifting finding ischemic changes when he lifted 250 pounds. It was recommended that the patient not bench press or squat over 200 pounds." @default.
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- W1975753931 date "1999-05-01" @default.
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- W1975753931 title "EXERTIONAL ANGINA AND DYSPNEA IN A POWER-LIFTER" @default.
- W1975753931 doi "https://doi.org/10.1097/00005768-199905001-01160" @default.
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