P2.208: Acting on a Mother’s Intuition: Diagnosing A Hidden Cardiac Risk in a Young Athlete

Introduction: Introduction
Chest pain is common in pediatric patients, with 99% of cases being non-cardiac [2]. Nevertheless, patients with concerning symptoms require activity restriction and referral to a pediatric cardiologist. We present a unique case of a patient with chest pain in which prompt recognition facilitated careful screening, close follow-up and shared decision-making, leading to the best possible outcome.

Case Description: Case Description
An 11-year-old male with a history of headaches presented to the pediatrician for follow-up. During the visit, he mentioned experiencing shortness of breath and chest tightness while playing basketball. His coach was concerned he needed better conditioning. The pain occurred during running but not sprinting, resolved with rest and he denied palpitations or syncope. He was diagnosed with exercised-induced bronchospasm and was prescribed an albuterol inhaler. At follow-up, he lost weight and denied chest pain, but his mother remained concerned due to rising reports of sudden cardiac death cases in basketball players and a family history of atrial septal defect. On subsequent prompting he admitted to experiencing sharp chest pain during exercise, radiating to his back. He did not share this before because he wanted to play basketball. He was placed on activity restrictions and referred to cardiology. He was found to have an anomalous right coronary artery originating from the left sinus with an interarterial course on echocardiogram and confirmed on computed tomography angiography. He underwent surgical correction seven months later and was cleared for exercise fifteen months after his initial referral.

Discussion: Discussion
Anomalous aortic origin of a coronary artery is a significant risk factor for sudden cardiac death, particularly when arising from the opposite sinus of Valsalva and coursing between the great arteries [1]. Clinical symptoms are found in approximately 50% of children prior to sudden cardiac death, and typical symptoms of exertional chest pain, palpitations and syncope are rare before early adolescence [1]. Our patient's case highlighted a diagnostic challenge. His chest pain occurred with moderate exercise but not with sprinting and he initially denied symptoms at follow-up. However, by listening to the mother’s concerns and fostering a trusting environment, the care team uncovered his true symptoms. This led to timely referral and appropriate intervention.

Conclusion: Conclusion
Physicians should carefully consider patient and family concerns, as they play a vital role in early diagnosis and intervention. This is particularly crucial for patients with anomalous coronary arteries who may present with nonspecific symptoms of chest pain as they require interdisciplinary care with cardiologists and surgeons to prevent risk of sudden cardiac death. Patient provider relationships in primary care settings that build trust over time can serve as a foundation for addressing patient concerns with empathy and attention.