Is It Wolff-Parkinson-White or Not - FBS College Football Player: 1042: June 1 9:50 AM - 10:10 AM : Medicine & Science in Sports & Exercise

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A-27 Clinical Case Slide - Cardiovascular I: JUNE 1, 2011 9: 30 AM - 11: 30 AM: ROOM: 503

Is It Wolff-Parkinson-White or Not - FBS College Football Player


June 1 9:50 AM - 10:10 AM

Green, John S. FACSM; Martin, Steven E.; Lambert, Brad; Oliver, Jon; McCammon, Kaite; Guitierrez, Ricardo; Dobdon, Justin; Gill, Kory L.; Crouse, Stephen F. FACSM

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Medicine & Science in Sports & Exercise 43(5):p 166-167, May 2011. | DOI: 10.1249/01.MSS.0000400438.61433.a6
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HISTORY: A 19 year old African American male underwent a PHYSICAL EXAMINATION for football participation at a FBS school. He is 189.2 cm tall, weighs 117.2 kilograms. He has a history of exercise induced asthma and his medications include ProAir, an albuterol sulfate based beta-2 agonist and Delsum, a cough suppressant containing dextromethorphan. No observable symptomology was noted.

PHYSICAL EXAM: PHYSICAL EXAMINATION revealed a resting blood pressure of 128/88 and a standing pre-exercise pressure of 130/90. A 12-lead ECG was obtained from the subject. Examination of the ECG yielded a heart rate of 75, no discernable rhythm disturbances, an axis of approximately 70 degrees, a PR-interval of exactly.12 seconds, A QRS interval of.11 seconds, a QT interval of.40 seconds, no signs of left or right atrial enlargement, voltage criteria for left ventricular hypertrophy (Sv3 +Rv5=53mv), and no signs of ischemia or infarction. However, a small delta wave was present. This, in conjunction with a PRI of.12 seconds, cast suspicion on the presence of Wolff-Parkinson-White syndrome.

DIFFERENTIAL DIAGNOSIS: 1. Normal ECG variant 2. Unconventional pre-excitation syndrome

TESTS AND RESULTS: The patient was referred to an electrophysiologist who subjected the patient to an adenosine challenge test. No antegrade accessory pathways were discovered and it was concluded that no pre-excitation was present. The patient subsequently underwent symptom limited maximal graded exercise testing. He achieved a peak heart rate of 204, a peak blood pressure of 206/86 and a maximum oxygen consumption of 30 ml/kg body weight/minute. No ECG abnormalities were noted during testing.


TREATMENT AND OUTCOMES: The patient was ordered to continue on his usual medications and no additional treatments were ordered.

© 2011 American College of Sports Medicine