Category: Clinical Case Studies
Tags: Cardiovascular, Diagnostics, Clinical Reasoning, PANCE Case Study
SEO Focus Keyword: PANCE cardiovascular case study

Excerpt:
A 23-year-old runner collapses mid-race. This PANCE-style case explores the diagnostic reasoning behind exertional syncope — and the clues that lead to hypertrophic cardiomyopathy.

Full Article:
A 23-year-old man collapses during a marathon. He briefly regains consciousness with no seizure activity or incontinence. Physical examination reveals a brisk carotid upstroke and a systolic murmur that increases with Valsalva.

Step 1: Recognize the Red Flags
Exertional syncope in a young athlete is never normal. The differential includes structural cardiac disease (HCM, AS), arrhythmia, or heat-related collapse — but murmurs that intensify with Valsalva point strongly toward hypertrophic cardiomyopathy (HCM).

Step 2: Correlate with Exam Findings
The murmur of HCM is a harsh midsystolic sound best heard at the left sternal border. It increases with maneuvers that decrease preload (standing, Valsalva) and decreases with squatting or handgrip.

Step 3: Confirm the Diagnosis
ECG may show left ventricular hypertrophy or deep Q waves. Echocardiography confirms asymmetric septal hypertrophy and dynamic LV outflow obstruction.

Step 4: Manage and Educate
First-line management includes beta-blockers to reduce contractility and avoid sudden death risk. Advise against competitive sports. Screening is essential for first-degree relatives.

Takeaway:
This case captures the essence of PANCE reasoning: pattern recognition, physiology linkage, and prioritization of patient safety. In the exam — as in life — every murmur tells a story.