New Patient

[ender18d]

Sdiver nailed the easy #1, but I'll try to offer some additional options:

HCM is the most common etiology of sudden death in young athletes, and is consistent with the murmur. Increase index if he's African American. I bet the murmur got quieter when he squatted, or would have if the provider had tried it.

Nurse Tim is also on to something with Marfan's, which may lead to aortic dissection. Marfan's can also cause murmurs through a variety of mechanisms usually related to prolapse of valves or regurgitation.

Abnormalities of the coronary arteries are another possible structural etiology, although they don't explain the murmur quite as nicely.

Myocarditis is a possible infectious cause of sudden cardiac death by way of arrhythmia. Its always worth considering other treatable etiologies.

I'll throw long QT in as another congenital cause of SCD.

Brugada is an interesting thought, although the connection between that and exercise-induced SCD is unclear: usually Brugada kills you in your sleep.

Useful related note for medics in general:
Syncope DURING exercise is much more concerning than syncope AFTER exercise. Just a simple differentiator on whether to get your hackles up. Not saying syncope after exercise is always benign, but if it happens in the middle of exertion, you need to take it very seriously.

[swatsurgeon]

I'm happy to see this one got picked up quickly, good job. Keep the simple things in mind when you come across symptoms that add up to disaster ; it's not rocket science but there is doing good medicine and not taking signs and symptoms for granted, ie chest discomfort after a long PT, etc. any murmur an 'athlete' should be checked by an echo not some other non anatomic test.
ss

[ender18d]

Originally Posted by swatsurgeon

I'm happy to see this one got picked up quickly, good job. Keep the simple things in mind when you come across symptoms that add up to disaster ; it's not rocket science but there is doing good medicine and not taking signs and symptoms for granted, ie chest discomfort after a long PT, etc. any murmur an 'athlete' should be checked by an echo not some other non anatomic test.
ss

Appreciate your taking the time sir.

[Sdiver]

Originally Posted by swatsurgeon

I'm happy to see this one got picked up quickly, good job. Keep the simple things in mind when you come across symptoms that add up to disaster ; it's not rocket science but there is doing good medicine and not taking signs and symptoms for granted, ie chest discomfort after a long PT, etc. any murmur an 'athlete' should be checked by an echo not some other non anatomic test.
ss

Doc,
Thanks for the brain tickler. It's always appreciated when you and the others on the board throw these up.

Hypertrophic cardiomyopathy has been a study of mine since I was Dx'd with it several years ago. Had a bad case of bronchitis and had a chest x-ray done of my lungs to r/o pneumonia, the ER doc showed me the pics, (he knew me from when I was on the ambulances) and showed my enlarged heart. Last physical I had, was told I have a slight murmur on the left side (probably mitral valve), so I started doing research on this condition. So I'm always aware of not "over doing it" when working out or doing too much strenuous activity.

Here's a couple of pictures I've collected about HCM along with a cool picture of the vessels of the heart.

Thanks again SS

[Trapper John]

Originally Posted by ender18d

Sdiver nailed the easy #1, but I'll try to offer some additional options:

HCM is the most common etiology of sudden death in young athletes, and is consistent with the murmur. Increase index if he's African American. I bet the murmur got quieter when he squatted, or would have if the provider had tried it.

Nurse Tim is also on to something with Marfan's, which may lead to aortic dissection. Marfan's can also cause murmurs through a variety of mechanisms usually related to prolapse of valves or regurgitation.

Abnormalities of the coronary arteries are another possible structural etiology, although they don't explain the murmur quite as nicely.

Myocarditis is a possible infectious cause of sudden cardiac death by way of arrhythmia. Its always worth considering other treatable etiologies.

I'll throw long QT in as another congenital cause of SCD.

Brugada is an interesting thought, although the connection between that and exercise-induced SCD is unclear: usually Brugada kills you in your sleep.

Useful related note for medics in general:
Syncope DURING exercise is much more concerning than syncope AFTER exercise. Just a simple differentiator on whether to get your hackles up. Not saying syncope after exercise is always benign, but if it happens in the middle of exertion, you need to take it very seriously.

Great dDx Bro. But Scooter answered the asked question. Q: What happened? A: He died.