Rodney S' Gonzalez, MD

1
Preparticipation Screening Volleyball

• Rodney S. Gonzalez, MD
• MAJ, MC, USA
• Primary Care Sports Medicine Fellow
• Uniformed Services University of the Health
  Science, Bethesda, MD

2
History

• 20yo college volleyball player PPE
• No complaints/concerns
• Routine PPE questionnaire was negative
• ROS
• No CP, SOB, syncope
• No h/o heart problems, joint dislocations/laxity,
  skin problems
• Wore contact lenses for myopia, no recent changes

3
History

• Family History
• Father height 79, no sig. med prob
• Mother height 71, no sig. med prob
• Sister height 75, no sig. med prob
• Sister height 76, MVP

4
Physical Examination

• Vital Signs
• Height 79, Wt 212
• BP 133/74, Pulse 92 (equal all 4 extremities)
• Routine PPE normal, except as noted

5
Physical Examination

• Oral Cavity
• High arched palate
• Cardiac Exam
• II/VI SM, best in the apex, no change with
  squatting or Valsalva
• Musculoskeletal Exam
• Arm Span 81.5 (ASH ratio of 1.03)
• No joint laxity, no arachnodactyly
• Wrist sign (or Walker sign) negative
• Thumb sign (or Steinberg sign) positive

6
EKG

• Normal Sinus Rhythm at 90
• Otherwise normal

7
ECHO

• Enlarged LV
• 5.8 cm diastolic (nl lt5.6 cm)
• 4.2 cm systolic (nl lt4.0 cm)
• Borderline Aortic Root size
• 3.7 cm (nl lt3.7 cm)
• Somewhat redundant anterior mitral valve leaflet
  borderline MVP with mild MR by Doppler

8
Optometry Exam

• Visual Acuity 20/20 OU with contacts
• Moderate myopic prescription
• OD -3.00-0.75x085
• OS -3.50-0.50x080
• Dilated fundus examination
• Healthy Retina
• No signs of any intraocular lens displacement
• No ocular manifestations of Marfans Syndrome,
  except myopia

9
Differential Diagnosis

• Marfans Syndrome
• Marfans Syndrome Variant
• Ehlers-Danlos Syndrome
• Mitral Valve Prolapse
• Normal Variant

10
Final Diagnosis

• Mitral Valve Prolapse
• Otherwise Normal Variant

11
Disposition

• Mitral Valve Prolapse
• SBE Prophylaxis (Mild MR)
• Repeat ECHO in 2 years
• Cleared for full participation

12
Marfans Screening