Netherlands Heart Journal

, Volume 27, Issue 5, pp 281–281 | Cite as

A young man with exertional chest discomfort

  • L. E. Lezcano GortEmail author
  • B. Roque Rodríguez
  • M. R. Porro Fernández
Open Access
Rhythm Puzzle – Question
In this case we present a 43-year-old athletic male, nonprofessional cyclist with unremarkable medical history. He had been admitted to the emergency department because of chest discomfort, dizziness, heavy sweating and nausea after cycling 40 km in extreme heat (local temperature 41.5 degrees Celsius). Physical examination revealed a Glasgow Coma Scale score of 15, and he was haemodynamically stable. The laboratory results showed: creatine kinase 870 IU/l, creatine kinase-MB 12 IU/l, troponin T 16 ng/ml, and creatinine 1.6 mg/dl. Out-of-hospital electrocardiogram taken at first medical contact is shown in Fig. 1.
  1. 1.

    What is your diagnosis?

  2. 2.

    What is the most likely mechanism and the suggested therapy?

Fig. 1

Out-of-hospital electrocardiogram at first medical contact


You will find the answer elsewhere in this issue.

Copyright information

© The Author(s) 2019

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Authors and Affiliations

  • L. E. Lezcano Gort
    • 1
    Email author
  • B. Roque Rodríguez
    • 1
  • M. R. Porro Fernández
    • 1
  1. 1.Department of CardiologySan Pedro de Alcantara Universitary HospitalCáceresSpain

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