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.
FINAL /WORKING DIAGNOSIS: Normal ECG variant
TREATMENT AND OUTCOMES: The patient was ordered to continue on his usual medications and no additional treatments were ordered.
