Shortness Of Breath- Track, Cross Country.

HISTORY: A 19 year-old female division 1 NCAA cross country athlete presented for campus pre-participation physicals during the summer of her sophomore year 2020. She reported subjective chest tightness and exercise intolerance. Patient reported symptoms consistent with a COVID-19 viral infection in February 2020 including her initial symptoms were cough, congestion, fevers, and myalgias. She subsequently developed significant dyspnea on exertion, and was unable to tolerate even minimal exertion. Patient reported initial symptoms lasted for 2 weeks, and was seen by her PCP in March 2020. She was then tested for COVID-19 IgG antibodies, which were positive. She continued to have exertional dyspnea that progressed to night time cough. Patient has a medical history of anxiety and mild intermittent asthma, requiring her albuterol inhaler once a month. At onset of symptoms, she began using her albuterol more frequently, and progressed to daily inhaled corticosteroid. Due to her continued symptoms, further medical testing was ordered. PHYSICAL EXAMINATION: Patient was resting comfortably. Heart regular rate and rhythm without murmur. Lungs clear to auscultation bilaterally. Pulses 2/4 in upper and lower extremities. DIFFERENTIAL DIAGNOSIS: 1. Progression of mild intermittent asthma 2. Cardiomyopathy3. Deconditioning TEST AND RESULTS: EKG: - NSR at 64 BPM Chest XR: -No acute findings, mild hyperinflation Labs:-Troponin <0.01, Hgb 13.0 Pulmonary Function Testing:-Normal without signs of obstruction or restriction Transthoracic echocardiogram: - Normal atrium and ventricles. Normal left ventricular function Cardiopulmonary Exercise Testing: - Low VO2 max, depressed maximum heart rate, EKG with new inferior wall changes Cardiac MRI: - Normal cardiac anatomy, normal ventricular function, no evidence of scar of infiltration. FINAL WORKING DIAGNOSIS: - Post COVID-19 syndrome TREATMENT AND OUTCOMES: 1. Received clearance for return to athletic participation after full cardiac workup. 2. Symptoms due to cardiopulmonary deconditioning secondary to viral syndrome. 3. Gradual increase in exercise as tolerated. 4. Patient's symptoms slowly improving [ABSTRACT FROM AUTHOR]