Retrosternal Heartburn in Division I Athlete

Abstract

HISTORY: A 20-year-old African American collegiate basketball forward presented with retrosternal “heartburn” to the athletic training staff during practice. He was given antacids which seemed to help and he went home to rest. On awakening, the retrosternal pain was persistent and increased in severity. He presented to the hospital complaining of worsening retro-sternal chest pain. The onset was sudden with squeezing sharp sensation, associated with diaphoresis. Pain was worse with sitting up; improving while lying down and with inspiration. He denied radiation, shortness of breath, palpitations, dizziness or syncope. He received aspirin and pain medication, decreasing his pain from 8/10 to 2/10. PHYSICAL EXAMINATION: Physical exam revealed the following vitals: BP 137/73, Pulse 46, Temp 96.4 F, Respiratory rate 20, Height 6’4”, weight 214 lbs, BMI 26.13, and SpO2 100%. He appeared non-toxic. No carotid bruit or JVD were appreciated on examination. His chest wall was non-tender to palpation. Auscultation: regular bradycardia without murmurs, rubs, or gallops. No Marfanoid features. The remainder of the examination was normal. DIFFERENTIAL DIAGNOSIS: 1.Angina 2.Gastroesophageal reflux 3.Drug induced chest pain 4.Pneumonia/pneumonitis/pulmonary contusion 5.Acute NSTEMI 6.Pericardial effusion TEST AND RESULTS: Chest x-ray negative for acute process Drug screen + Troponin 14.39 EKG: sinus bradycardia with early repolarization TIMI Score 2 Echocardiogram: Ejection Fraction 55-60% with 1 cm globular mass attached to the P1 scallop of the posterior leaflet of the mitral valve. This was found to be mobile on the atrial side. Cardiac catheterization: Normal Left main and RCA without stenosis. Pending labs at discharge included Anti-phospholipid anti-bodies and ANA. FINAL/WORKING DIAGNOSIS: NSTEMI secondary to mitral valve myxoma emboli TREATMENT AND OUTCOMES: 1. He was transferred from the local hospital to a Cardiac Center 2. He underwent minimally invasive cardiothoracic surgery. 3. Cardiac rehabilitation over 12 weeks; clearance for return to play Division 1 basketball. 4. Recommended cessation of tobacco use.