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Keywords

Diagnostic testing and physical examination: non-musculoskeletal conditions; interprofessional practice; secondary schools patient population

Abstract

A 17-year-old high school female cross-country runner and basketball player presented with syncope following long-endurance exercise. The syncope episodes started when the patient was 13 years old during a basketball game. After the first episode, the patient fainted every time she crossed the finish line of a cross-country meet. Her symptoms included increased heart rate, shortness of breath, and paresthesia in her hands and legs during exercise. The patient also experienced some dizziness when quickly sitting or standing during activities of daily living. The patient was first misdiagnosed with exercise induced asthma and prescribed a rescue inhaler to take prior to competition races, however the syncope episodes persisted. A referral was made to a cardiologist who performed the Q sweat response (QSR) and tilt table tests. The test results, and clinical symptoms were consistent with a diagnosis of Postural Orthostatic Tachycardia Syndrome (POTS). Metoprolol was prescribed to slow her heart rate and fludrocortisone to increase blood volume. The patient took these medications daily and also took an extra half-a-tablet of metoprolol before exercising in hot conditions. The patient’s syncope following long endurance races was managed by a coach who would catch the patient after she crossed the finish line, lay her down and elevate her legs until she regained consciousness. Once consciousness was regained, her heart rate and oxygen were monitored using a pulse oximeter. POTS is a unique condition that can be managed with strong communication between healthcare professionals. Proper management allows for continued competition with some modifications made by the athlete and close monitoring by the athletic trainer. It is important for athletic trainers to be educated on the signs and symptoms of POTS and understand that it can affect each athlete differently.

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