Posted 9/18/2016 11:36 AM (GMT -6)
This isn't for me. But nevertheless I want an answer to my question.
Here is the patient:
Medical History: Infections but nothing serious
Exercise History: Muscle toning exercises 5-6 times a week but not 5-6 times in a row
Family History: Paternal grandparents died of the plague years before she was born
Genetics: No genetic diseases
SOB(shortness of breath)
High voltage but otherwise SB(Sinus Bradycardia)
High side of normal(to be expected when you have more cardiac muscle)
Can feel heartbeat all the time
Hear heartbeat often
So far it sounds like a case of Athlete's Heart with everything healthy and hypertrophy and cardiomegaly. Her hypertrophy was caused by exercise which is normal. Her strong pulse is probably due to increased stroke volume as is her bradycardia. Feeling and hearing your heartbeat is normal when your heart is strong. Even I can sometimes hear my heart beat even while resting without using a stethoscope.
But I am wondering if this is Hypertrophic Cardiomyopathy given that this patient has chest pain. I don't think someone who is healthy and has symmetric ventricular hypertrophy(characteristic of Athlete's Heart) would have chest pain due to their heart beating strongly. They might have a headache due to a strong pulse but this patient has been acclimated to this strong pulse and has no headaches.
She says that her chest pain is near her heart which is always concerning. This makes me think that maybe it is Athlete's Heart w/ Myocarditis or Hypertrophic Cardiomyopathy. Creatinine tests haven't been done and nor have any other cardiac enzyme tests.
Just from this info alone can I determine whether the chest pain is from Myocarditis of an otherwise healthy heart or Hypertrophic Cardiomyopathy?
If so which one is it?
If not, what do I need to do to determine it? Creatinine?(though with all her muscle toning, it will probably be elevated as a norm) Cardiac enzymes?(Though that could mislead me to believe it is a heart attack when there is no ischemia) X ray?(I don't know if myocarditis will affect a chest x ray of someone who already has cardiomegaly due to ventricular hypertrophy) 12 lead?(so far I have only done a rhythm strip)
If it is neither one of those(I am not sure if Myocarditis would affect a Ventricular Hypertrophy EKG or not), then what else could it be?