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Exertional chest pain in an intercollegiate athlete.

OBJECTIVE
To present the case of an intercollegiate soccer player who collapsed twice within a week during vigorous exercise, with radiating chest pain and dyspnea.


BACKGROUND
Episodes of chest pain or syncope in athletes are often alarming and may signal an underlying cardiac condition. Recognition and management of these athletes is vital to the reduction of sudden cardiac death in athletics.


DIFFERENTIAL DIAGNOSIS
Cardiac arrest, structural abnormality, valvular dysfunction, coronary artery disease, anomalous coronary artery, coronary vasospasm, asthma.


TREATMENT
Standard treatment in these cases requires stabilization of the athlete and identification of the cause of chest pain. An electrocardiogram, echocardiogram, and exercise electrocardiogram demonstrated asymmetric T-wave inversion but otherwise were within normal limits. After the second episode of collapse, the athlete underwent extensive noninvasive cardiopulmonary testing. The athlete did not consent to cardiac catheterization; an angiogram was not obtained.


UNIQUENESS
A diagnosis of chest pain, unknown etiology, was offered. The athlete was permitted to return to athletics with this clinical diagnosis. No condition was identified as the cause of the chest pain or abnormal ECG.


CONCLUSIONS
Further testing may have identified the cause of chest pain, but the athlete did not consent to this. Recent research indicates that some signs and symptoms previously considered benign may serve as indicators for sudden death candidates.