Anonymized Patient Cases & M&M Conferences
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The Cross-Country Collapse
High school varsity runner collapses at Mile 2 in 82°F heat
Chief Complaint: Sudden syncope (fainting) during varsity 5K cross-country practice
HPI: Collapsed roughly 2 miles into an afternoon run in 82°F heat. Teammates report Marcus complained of sudden 'chest fluttering' and lightheadedness 30 seconds before stumbling and losing consciousness for ~45 seconds. No seizure activity. Regained full alertness without confusion.
Diagnostic Orders & Findings:
Novices pick this due to the 82°F running context, but heat exhaustion does not produce a harsh systolic murmur that loudens upon standing.
Gold standard for hypertrophic cardiomyopathy. Diagnostic of dynamic left ventricular outflow obstruction.
Rules out exercise-induced bronchospasm or collapsed lung, but fails to explain syncope with family history of sudden young death.
Syncope with immediate recovery to baseline without post-ictal confusion rarely warrants emergency head CT in a young athlete.
Marcus has genetically driven asymmetric thickening of his ventricular septum. During intense physical exertion and reduced venous return (standing/squatting transition), the narrowed outflow tract obstructs blood leaving the heart, triggering cerebral hypoperfusion and ventricular arrhythmias. Marcus is restricted from competitive sprinting and referred for ICD evaluation.