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J Athl Train. 1997 Jan-Mar; 32(1): 59–62.
PMCID: PMC1319238

Exertional Chest Pain in an Intercollegiate Athlete



To present the case of an intercollegiate soccer player who collapsed twice within a week during vigorous exercise, with radiating chest pain and dyspnea.


Episodes of chest pain or syncope in athletes are often alarming and may signal an underlying cardiac condition. Recognition and management of these athletes is vital to the reduction of sudden cardiac death in athletics.

Differential Diagnosis:

Cardiac arrest, structural abnormality, valvular dysfunction, coronary artery disease, anomalous coronary artery, coronary vasospasm, asthma.


Standard treatment in these cases requires stabilization of the athlete and identification of the cause of chest pain. An electrocardiogram, echocardiogram, and exercise electrocardiogram demonstrated asymmetric T-wave inversion but otherwise were within normal limits. After the second episode of collapse, the athlete underwent extensive noninvasive cardiopulmonary testing. The athlete did not consent to cardiac catheterization; an angiogram was not obtained.


A diagnosis of chest pain, unknown etiology, was offered. The athlete was permitted to return to athletics with this clinical diagnosis. No condition was identified as the cause of the chest pain or abnormal ECG.


Further testing may have identified the cause of chest pain, but the athlete did not consent to this. Recent research indicates that some signs and symptoms previously considered benign may serve as indicators for sudden death candidates.

Full text

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Horton R. Science of sudden cardiac death. Lancet. 1994 Apr 23;343(8904):1029–1030. [PubMed]
  • Liberthson RR. Sudden death from cardiac causes in children and young adults. N Engl J Med. 1996 Apr 18;334(16):1039–1044. [PubMed]
  • Nearing BD, Huang AH, Verrier RL. Dynamic tracking of cardiac vulnerability by complex demodulation of the T wave. Science. 1991 Apr 19;252(5004):437–440. [PubMed]
  • Magarian GJ, Mazur DJ. The hyperventilation challenge test. Another means of identifying coronary vasospasm in patients with angina-like chest pain. Chest. 1991 Jan;99(1):199–204. [PubMed]

Articles from Journal of Athletic Training are provided here courtesy of National Athletic Trainers Association