Dyspnea on Exertion - Basketball

Abstract

HISTORY: 19 year-old Freshman D-I men's basketball player presented complaining of dyspnea on exertion during preseason conditioning. He says that within 10-15 minutes of running he begins to feel very short of breath. He says he cannot keep up with his teammates. He has never had symptoms like this before. He denies fever, cough, wheezing, chest pain, no stridor, recent illness, syncope, dizziness, edema, palpitations. Upon resting, his symptoms resolved within minutes. He has a past medical history significant for congenital pectus excavatum. PHYSICAL EXAMINATION: Vital signs stable. Pulse Ox 96% RA. Peak flow average was 495. He is a tall, thin male with no Marfanoid features, but he does have a significant pectus excavatum deformity. He has no spinal deformity, no scoliosis, negative thumb sign, negative wrist sign, normal arm span, no arachnodactyly. Heart rate regular rate and rhythm; there is no murmur. Normal distal pulses palpable and no lower extremity edema. Lungs are clear with no wheezing and good air movement. DIFFERENTIAL DIAGNOSIS: Exercise Induced Bronchospasm Decreased Exercise Tolerance Pulmonary Hypertension Anemia Valvular Disease Myocarditis Cardiomyopathy Arrhythmia TEST AND RESULTS: Further history revealed Cardiopulmonary Stress Testing was done one year prior because of similar complaints. Findings consisted of decreased VO2 max, below the expected range for his capacity. Spirometry suggested possible increased airway resistance but no reversibility with bronchodilators. FEV1/FVC was normal. EKG was normal at rest and with stress testing. He was not able to compensate for the expected metabolic acidosis seen with exercise by increasing his minute ventilation during exercise. FINAL WORKING DIAGNOSIS: Congenital Pectus Excavatum leading to decreased Aerobic Capacity and Exercise Tolerance TREATMENT AND OUTCOMES: It was felt that there would likely not be any significant changes in these results in one year's time. An intensive aerobic exercise training program has been recommended to improve his VO2 max along with consideration to repeat Cardiopulmonary Stress Testing if symptoms persist.