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- W4387054511 abstract "HISTORY: An 18-year-old college cross country runner presented to sports medicine clinic with intermittent episodes of chest pain for several years. Chest pain is sharp, “feels like muscle spasm,” is located under the left pectoral muscle, and lasts a few minutes. Chest pain is intermittent, occurs several times per year, and has only ever occurred at rest. Last spring, he suffered dizziness with nausea and vomiting immediately after a few of his races. This has not occurred in recent races and never in the middle of a race or with other training. Although low risk, referral to cardiology was placed given concern for cardiac related chest pain. PHYSICAL EXAMINATION: NSRR, normal S1/S2, no S3 or S4. Point of maximal impulse nondisplaced. Valsalva maneuver in a forward flexed position without change. No murmurs or rubs. Normal breath sounds without wheezes, rhonchi or rales. No peripheral edema or rashes. DIFFERENTIAL DIAGNOSIS: Myocarditis, Pericarditis, Hypertrophic cardiomyopathy, Anomalous origin of coronary artery, Non-cardiac chest pain TEST AND RESULTS: ECG: NSR, no hypertrophy, QT prolongation or arrhythmia ECHO: Normal biventricular size and systolic function, suggestion of anomalous origin of the right coronary artery from the left coronary cusp vs high/leftward origin of the RCA from the right cusp CTA of Coronary Arteries: Anomalous RCA with a high origin at the sinotubular junction above the left coronary cusp, inter-arterial course between the aorta and RVOT, 11 mm long intramural segment, acute take-off angle and a slit-like orifice. Exercise stress test: No cardiac ischemia, arrhythmia or ectopy. Stress ECHO: Normal biventricular size and systolic function, no wall abnormalities. MRI Cardiac w dobutamine stress w/wo contrast: No evidence of myocardial ischemia, no late gadolinium enhancement. FINAL/WORKING DIAGNOSIS: Anomalous Right Coronary Artery arising above the sinotubular junction above the left coronary cusp. TREATMENT AND OUTCOMES: Cleared for resumed competitive running from a cardiac perspective given the lack of malignant cardiac symptoms and normal stress testing placing the athlete at low risk. Sports psychology to aid adjustment to new diagnosis. Adequate hydration and diet prior to running to avoid potential cardiac symptoms. Follow up 1 year for repeat ECG and exercise stress test." @default.
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- W4387054511 date "2023-09-01" @default.
- W4387054511 modified "2023-09-27" @default.
- W4387054511 title "Cardiac Injury- Cross Country" @default.
- W4387054511 doi "https://doi.org/10.1249/01.mss.0000985696.03950.47" @default.
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