gms | German Medical Science

Objective: The medical practice is a series of clinical decisions.Not even a good practice basing on up to date guidances and instruments and investigation leads to the best clinical judgement. Respecting the patient but forgetting the sportsman even the right clinical decisiond could break sport carriers.

27 years old african origin professional basketball player suffered calf strain during training and forced 2 days break.

During the next session he has reported weakness, dizziness and collapsed without losing consciousness. After appropiate water intake he has become asymptomatic and left for home. The following day at lunchtime he has had the same attack and the ambulance has brouht him to the Neurologic Departement of the University Hospital.

Material/Methods: Negative neuroligal symtoms ans signs. Normal lab results. Brain CT scan w/o defect. ECG: sinus rhythm, marked negative T-waves in II, III, aVF and V4-6, tall peaked T- waves in V2-3. The was transferred to the Emergency and Accident Departement because of possible cardiac background.

Emergency and Accident Department: repeated normal lab results, no further changes on ECG. Echocardiography-concentric left ventricular hypertrophy otherwise unremarkable. The patient was admitted to the Department of Medicine for overnight observaton.

Department of Medicine: repeated normal lab results, the patient was tranferred to the Department of Cardiology.

Department of Cardiology. Abdominal ultrasound: renal cyst, otherwise unremarable. Normal glucose tolarance-test. ECG: sinus rhytm, PR 225 ms, QRS 90 ms, normal R- axis, transition zone at V2-3., deep negative T waves in II, III, aVF and V4-6. Prominent ventricular strain. The clinical decision was complete prohibition from sports.

Echocardiography: suspected cardiomyopathy, ventricular wall tickness exceeds the normal upper limit. The clinical decision was complete prohibition from sports.

MRI: CMP was excluded

A cardiologist consultation: pacemaker implantation was suggested based up on the telemetric and echocardiographic results. The conclusion was still complete prohibition from sports.

The specialists in Sport Medicine reviewed the case and the medical literature decided letting the patient continouing his sport carrier without need of further intervention.

Results: In consequence of this decision the sportsman has been playing in his front-rank club succesfully. His symptoms have not repeated with following the suggested diet.

Conclusion: A high risk clinical decision considering the special circumstances of the sportsman even it differs from accepted clinical protocolls can give back an entire sporting carrier.