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ECG Quiz: Collapse in a Young Runner

Matthew F. Davis, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 25 - NO. 7 - JULY 97


An 18-year-old woman who ran four times weekly and played competitive soccer was approximately 1 mile into her standard running route when she collapsed. At the scene, a bystander summoned help and began cardiopulmonary resuscitation (CPR). Emergency medical service personnel arrived and found the patient unresponsive. She had no pulse or spontaneous respirations and was generally cyanotic. CPR was continued and a rhythm strip obtained (figure 1). The patient was resuscitated and brought to a hospital emergency department.

[FIGURE 1]

On physical examination at the hospital, her blood pressure was 123/83 mm Hg, her pulse was 94, and she was breathing spontaneously. She had no significant medical history. She did not smoke, drink alcohol, or use illicit drugs. Past preparticipation exams were unremarkable, and there was no family history of early coronary artery disease, arrhythmia, or sudden death.

Further physical exam showed no evidence of trauma to the head. Her lungs were clear to auscultation and her heart rate and rhythm were normal without murmur, rub, or gallop. The neurologic exam showed intact cranial nerves and ability to move all her extremities. An electrocardiogram (ECG) was obtained (figure 2). Her complete blood count and biochemical profile were normal.

[FIGURE 2]

From what cardiac arrhythmia did this patient suffer? What further studies should be obtained?

Dr Davis is a senior resident in the department of medicine at the University of Florida in Gainesville. Address correspondence to Matthew F. Davis, MD, Senior Resident, University of Florida Department of Medicine, 5240 SW 92nd Ct, Gainesville, FL 32608; e-mail to [email protected].


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