ECG Quiz: Chest Pain in a College Football Player
John D. Cantwell, MD; Drew V. Miller, MDTHE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 8 - AUGUST 96
A 21-year-old college athlete was seen on the first day of football practice because of an acute onset of severe chest pain. The pain was noted during conditioning drills before any body contact had begun. The sharp, intermittent, left inframammary pain was aggravated by twisting or turning. The pain did not radiate and was not associated with shortness of breath, palpitations, nausea, or vomiting.
The patient's medical history was negative except for childhood asthma. He did not smoke or use alcohol. There was no history of recent chest trauma and no family history of heart disease. He typically ran 2 miles a day and lifted weights for 2 hours three times a week.
On physical examination his blood pressure was 128/74 mm Hg, his pulse 54 per minute and regular, and his temperature normal. His neck exam was negative. There was tenderness to moderate pressure on the left anterior chest area. The patient's pain was aggravated by sitting up and bending forward, and he also had discomfort with coughing and deep inspiration. The cardiac exam was negative for cardiac murmur, gallop, or rub. His complete blood count was normal at 5,500/mm3 with a normal differential. A chest x-ray showed clear lung fields and a normal-sized heart. His electrocardiogram (ECG) is shown in figure 1a.
The team orthopedist saw the patient 6 days after the onset of symptoms and ordered a bone scan, then a computed tomography (CT) scan (figure 1b).
Dr Cantwell is director of preventive medicine and cardiac rehabilitation at Georgia Baptist Medical Center and clinical professor of medicine at Morehouse School of Medicine in Atlanta. He is a member of the editorial board of The Physician and Sportsmedicine and was chief medical officer of the 1996 Summer Olympic Games. Dr Miller is a team orthopedist at the Georgia Institute of Technology in Atlanta and director of orthopedics for the 1996 Olympic Village Polyclinic. Address correspondence to John D. Cantwell, MD, 340 Boulevard NE, Suite 200, Box 413, Atlanta, GA 30312.