Resolution of a Heart Abnormality? - Basketball

Abstract

Part I HISTROTY: This report is a follow-up to a case presented at the 1991 ACSM meeting. A previously healthy 18-year old African-Americ an Division I basketball player presented for PPE in 1990. History was negative for cardiac related symptoms and family history of sudden death. Following diagnosis, he was barred from playing collegiate basketball. PHYSICAL EXAMINATION: 1990, September. Height 6'7“, Weight 220 lbs., Pulse 90 bpm, BP 138/60. Physical exam normal except for cardiovascular exam. Auscultation: normal S1, physiologically split S2 and prominent S3 gallop over heart's apex. No murmurs or rubs. Resting ECG showed left ventricular hypertrophy with secondary repolarization changes. Loud S3 gallop prompted an echocardiogram (Echo). DIFFERENTIAL DIAGNOSIS: Athletic Heart Cardiomyopathy TESTS AND RESULTS: 1990, September: Initial Echo: Septum 16 mm, posterior free-wall (PFW) 11mm; Diastolic Ventricular Diameter (DVD) 51 mm. Septal to free wall ratio (SFWR) 1.45. No systolic anterior motion of mitral valve. Outflow tract flow velocity normal. Repeat Echo showed similar findings. 1990, December: Echo after 4 month deconditioning period: No septal thickness change, free wall regressed to 10 mm. SFWR 1.6. DVD reduced to 42–45 mm. Final Working Diagnosis: Hypertrophic Cardiomyopathy (HCM) TREATMENT AND OUTCOMES: Athlete barred from playing collegiate basketball following HCM diagnosis. Part II HISTROTY: Two years later this player was extensively evaluated at the National Institutes of Health. Previous diagnosis confirmed. However, NIH consultants believed his risk of sudden death was minimal. PHYSICAL EXAMINATION: PE unremarkable; gallop rhythm not heard after initial exam. DIFFERENTIAL DIAGNOSIS: HCM Athletic Heart Variant TESTS AND RESULTS: 1992, July: NIH Comprehensive Cardiac Evaluation. Tests were either normal or revealed no life-threatening abnormalities. FINAL WORKING DIAGNOSIS: HCM TESTS AND RESULTS: Athlete played Division I basketball and 9 yrs in the NBA with no cardiac related symptoms. Yearly cardiac evaluations demonstrated similar abnormal septal wall thickness and DVD dimensions. 2006, JUNE: ECHO: Normal Septum 8 mm, PFW 8 mm, SFWR 1.0, DVD 48 Impression: Athletic Heart variant with regression of myocardial septal hypertrophy?