{'fraction_non_alphanumeric': 0.026306174643770552, 'fraction_numerical': 0.011691633175009134, 'mean_word_length': 4.7521008403361344, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Severe Aortic Stenosis in a Professional Football Player

In the middle of a professional football training camp, a 27-year-old, newly acquired lineman presented for preparticipation clearance, already dressed in his football equipment. His medical questionnaire noted a cardiac abnormality “present since birth.” He reported that he had played professionally for several years, and the medical team never had restricted his activity before. He functioned at a high level and was a league all-star the previous year. The last time he had undergone cardiac investigations was 2 seasons earlier, and he was told that “everything was fine.” Specifically, he had no symptoms of chest pain, shortness of breath, palpitations, dizziness, or syncope. He was not, nor ever had been, on medication. He was not sure of the exact type of cardiac abnormality present. “It’s no big deal, doc” was the summation of the cardiac history. On examination, he was a large man weighing 300 pounds. His blood pressure was 120/90 mm Hg, and his heart rate was regular at 75 beats per minute. There was no jugular venous dilatation. His chest was clear, and S1 and S2 were normal. A grade 4/6 systolic ejection murmur was heard that followed a systolic ejection click, and a diastolic murmur of aortic regurgitation was evident. A systolic thrill was present on palpation of the aortic area. He was immediately removed from participation and referred to a cardiologist for investigation of the murmur. Interestingly, at the time of the cardiology consultation, more history was forthcoming and revealed that before his professional football career he had been denied participation at an American football evaluation camp put on by National Football League teams. Then, curiously enough, he went on to play professional football in Canada for a number of years. His electrocardiogram was normal. An echocardiogram showed aortic valve disease with moderately severe aortic stenosis and mild to moderate aortic insufficiency. The peak systolic gradient across the aortic valve was 99 mm Hg, and the mean gradient was estimated at 62 mm Hg. The calculated aortic valve area was 1.1 cm. The left ventricle was mildly dilated (44 mm in systole, 57 mm in diastole, 11 mm septum and posterior wall), with an ejection fraction of 60%. On the basis of this examination and a consultation with a cardiothoracic surgeon who decided on a nonoperative course, he was recommended to never play professional football again nor engage in any other competitive sport due to the high risk of sudden death. He announced his retirement later that same week. He remained well for 2 years, became lost to follow-up, and subsequently suffered a sudden death. No autopsy was available.