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ECG Quiz Question

Acute Onset of Chest Pain in a Soccer Player

David S. Ross, MD; Gary Cooper, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 27 - NO. 12 - NOVEMBER 1999


A 36-year-old soccer player with retrosternal chest pain was brought to the emergency department. The patient was visiting from Egypt and did not speak English. A friend who accompanied the patient was able to give a limited history.

The athlete described acute onset of chest pain earlier that morning. The pain radiated into his neck and both arms. It also was associated with nausea, vomiting, presyncope, and diaphoresis. He had been active with an amateur soccer league in Egypt and had played soccer the day before he experienced symptoms. He denied any history of similar symptoms, recent illnesses, or trauma. Medical, surgical, and family history were unremarkable. He was taking no regular medications and denied the use of recreational drugs; however, he reported many years of tobacco use. He denied risk factors for the human immunodeficiency virus and any history of exposure to tuberculosis.

On physical exam, his blood pressure was approximately 130/90 mm Hg in both arms, pulse was 106 per minute, respiration rate was 32 per minute, and temperature was 99.4°F. He appeared to be in moderate distress and was unable to lie flat on the gurney. His lungs were clear, and auscultation of the heart detected no significant abnormality except for the tachycardia. No murmurs, rubs, or gallops were appreciated. The rest of the physical exam was normal.

His electrocardiogram (ECG) is shown in figure 1. The only significant lab abnormalities noted on admission were a white blood count (WBC) of 15,800 (75% neutrophils, 2% bands, 14% lymphocytes, 8% monocytes, 1% eosinophils), phosphorus 1.9 mg/dL, and triglycerides 241 mg/dL. Arterial blood gases on room air were: pH 7.45, Pco2 37 mm Hg, Po2 88 mm Hg; Hco3 was 26 mEq/L, and O2 saturation was 97%. A chest radiograph showed no significant abnormalities. Initial total creatine kinase was 106 U/L, and lactate dehydrogenase was 145 U/L.

[Figure 1]

Based on this information, how would you treat this patient? What would be your next step?

Dr Ross is director of the Primary Care Sports Medicine Fellowship Program at Methodist Hospitals in Dallas and the University of Texas Southwestern Medical Center in Dallas. He serves as team physician for Dallas Baptist University. Dr Cooper is an associate clinical professor in the Division of Cardiology in the Department of Medicine at the University of Florida in Gainesville. Address correspondence to David S. Ross, MD, Family Practice and Sports Medicine Center, 3500 W Wheatland Rd, Dallas, TX 75237; e-mail to [email protected].


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