0741 HISTORY: A 17-year-old freshman college soccer player began complaining of chest pain and shortness of breath during drills at an afternoon practice. The pain was pleuritic, did not radiate, and was not associated with nausea, vomiting or diaphoresis. He also complained of some lightheadedness and chills. Two days prior he had noted nasal congestion, dry cough, and wheezing. He had throat tightness and coughing before taking the field. There was no significant past medical or surgical history. In addition, he denied a family history of coronary artery disease or dysrythmia. His social history was negative for tobacco, alcohol, or drug use. He had no known allergies, and was not taking any medications. He was brought to the student health office, where he noted that his precordial pressure had eased, but he still felt lightheaded and cold. He did not note any change in symptoms with positional shift. PHYSICAL EXAMINATION: Vital Signs were as follows: T = 36.9 C (98.4 F), BP = 131/73, HR = 82 and regular, RR = 18, 02 saturation = 99% on RA. Examination revealed an erythematous throat, with boggy nares. No tonsillar swelling was noted. He had bilateral expiratory wheezes left greater than right, without crackles. No heave was detected at the point of maximal impulse, and the remainder of the cardiovascular exam did not demonstrate decreased heart sounds, murmurs, or rubs. No S3 or S4 was present. No chest pain was elicited on palpation of the costochondral region. He was admitted to the hospital for observation and laboratory testing. DIFFERENTIAL DIAGNOSIS: Myocardial Infarction Bronchopneumonia Asthma exacerbation Viral syndrome Pericarditis Myocarditis Endocarditis TESTS AND RESULTS: Peak flows: pre, one, and five minutes post albuterol nebulizer treatment were 400, 500, and 530 respectively. EKG: NSR with ST elevation in the precordial and inferior leads, with PR depression. CXR: No infiltrates or cardiomegaly FINAL/WORKING DIAGNOSIS: Viral Pericarditis TREATMENT AND OUTCOMES: Motrin 800 mg PO TID; Chest discomfort resolved within 48 hours entirely. Subsequent ECHO showed only physiologic fluid in the pericardium; No evidence of endocarditis or myocarditis; Slight increased LV cavity and normal LVEF. Cardiolyte exercise stress test revealed normal response to exercise 48 hours after diagnosis. Athlete resumed activity 2 weeks after being pain free, without complications.