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ECG Quiz: Palpitations and Fatigue in a Football Player

Cortland P. Bassett, PA-C, MAE, ATC; Raymond J. Barile, MS, ATC; Michael A. Goodfriend, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 3 - MARCH 96


An 18-year-old college football linebacker reported to the training room physician's office in early September complaining of an irregular heartbeat and lightheadedness while weightlifting. He also noted mild fever and chills and rapid fatigability during practice. He said that he had had a skin eruption several weeks earlier. He denied chest pain or pressure, near syncope or syncope, shortness of breath, or history of palpitations.

Physical examination revealed a blood pressure of 160/60 mm Hg with Korotkoff sounds of varying intensity, and a very irregular pulse of 44 to 52 per minute. A giant A wave was detected in the jugular venous pulse, as well as a variable first heart sound. A mild aortic-insufficiency murmur was also present. Carotid and peripheral pulses were normal. Temperature was 100°F (38°C), and his lungs were clear. He had no rash, skin lesions, or palpable lymphadenopathy. Figure 1 shows his initial resting electrocardiogram (ECG).

[FIGURE 1]

What's your diagnosis?

Mr Bassett is a physician's assistant at Cornell University in Ithaca, New York, and a fellow of the American Academy of Physician Assistants. Mr Barile is head athletic trainer for the St Louis Blues of the National Hockey League and a member of the National Athletic Trainers' Association. Dr Goodfriend is a cardiologist in private practice in Ithaca. Address letters to Cortland P. Bassett, PA-C, MAE, ATC, Gannett Health Center, Cornell University, 10 Central Ave, Ithaca, NY 14853-3101; e-mail to [email protected]


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