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Dr. Andrew Rynne

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Having chest pain and diagnosed with muscular strain. Echo test indicated mild aortic regurgitation. What could it be?

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Dr. Deepak Kishore Kaltari

General Surgeon

Practicing since :2002

Answered : 3191 Questions

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Posted on Tue, 26 Nov 2013 in Hypertension and Heart Disease
Question: Hi, who would I speak to regarding an elite 15 year old athlete? My son is an elite 15 year old soccer player who trains 18 - 20 hours per week. He is currently on trial with a professional team in england. 3 weeks ago we took him to emerg with chest pain. Because his xrays, blood and ecg were "pristine" he was diagnosed with a muscular strain. He was sent home, told to rest and take Aleve which he did. Seemed fully recovered. 5 days later the same symptoms occurred. The ER doctor wondered if perhaps it was Pericarditis because Aidan was presenting a fever this time, and his siblings were sick with a flu. Tests were redone, and a shadow on his lung was apparently dismissed as not material. Because of the diagnosis he was referred to a paeditric consultant in the area who re-ran all the tests. thios time pneumonia was present. He was given anti biotics for the pneumonia and told to rest while taking them. In order to release him to train the doctor, in light of the previous diagnosis in ER recommended that we rule out everything (she was sure of the pneumonia being the cause of the problem) before releasing him to train, given the level he trains at. He had a 24 hour holter test and an echo done. The paediatric cardiologist who did the echo indicated the echo shoed a very mild aortic regurgitation. He said Aidan had a fully developed tricuspid aortic valve, but for some reason there was small regurgitation which he presumed was caused by a strep infection as a child. He has released aidan, pending his full recovery from the pneumonia (2 weeks) to go back to training and playing soccer at an elite level which given his diagnosis, from what i can learn online, is indicated. However, he has suggested that aidan not lift more than 5 kilos to train going forward. Now i am no "stage parent" and aidans health comes first, but that is a problematic decision for a young man with a professional dream. Aidan trains with a renowned trainer (who deals with professional hockey and soccer players) whos first speculative question was "aidan has been training anaerobically for 4 years, with a heavy load, the chest pain which moved from front to side was assumed to be from the pneumonia, and no sign of this ever showed up in his training results?" He wondered if the course of treatment was a broadly accepted course applicable to the general population and not an elite, highly trained athlete. I have since learned that my father in law has the exact same condition and his cardiologist has told him he has probably had it his whole life. He is 76, was in the air Force until 35, a boxer and rugby player, and lifted weights and did strenuous yard work his whole life. Until he was 65 nhe ran between 5 and 10 K daily, did isometric and weight exercises daily and only stopped doing that because of an achilles tendon issue. He still walks 5 K daily and plays golf 3 times a week in season. his condition (mild aortic regurgitation) was discovered because, at 75, he had developed a blood pressure issue. What should we do? Weights are an integral part of training an elite athlete. Does his grandfathers situation change his ability to train with resistance? If not...he stops. I just want to know before i confirm that his path to his dream just met a detour. Your thoughts?
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Answered by Dr. Deepak Kishore Kaltari 10 hours later
Brief Answer: He can lead a Normal life and fulfil his dreams Detailed Answer: Namaste Welcome to Healthcare-Magic Greetings of the day Dear Learwoddy, Presence of mild aortic regurgitation with a good ejection fraction should not be a constrained for any aerobic exercise. As per the description the etiology is more likely a sequelae of Rheumatic heart disease, which can be confirmed by ASLO titre. It's due to cross reactivity of antigen between the streptococcus bacteria which causes respiratory infection and and the cardiac tissue. It's basically a immune mediated damage. One has to be careful of any respiratory infection as it may worsen the cardiac status, every respiratory infection should be thoroughly be treated with appropriate antibiotic. Also I suggest you to get a follow up Echocardiography every 6months,just to know if it is progressing. Rarely does the disease progress after the patient is 20years of age. I would also suggest you to discuss with your Physician for need of Penicillin prophylaxis every 21 days in order to prevent further progress of Rheumatic Heart disease. In my opinion, at present it should not be a hindrance to achieving his goals. Wishing him a successful life. May his dreams come true. Take care Regards Dr Deepak Kishore Consultant Pediatric Surgeon
Above answer was peer-reviewed by : Dr. Shanthi.E
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Follow up: Dr. Deepak Kishore Kaltari 5 hours later
A couple of things come to mind. First, he completed his antibiotics a week ago. The day after he completed the AB's an exam indicated the pneumonia was almost completely gone. A week later he feels great and wants to train and play. 1) can he train and play yet? Is there a period where he should not be training following pneumonia?. It is now 2.5 weeks since diagnosis, and he remained home from school for almost two weeks. He feels great. 2) will he be able to do resistance training (weights, isometrics) going forward? or is that not recommended?
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Answered by Dr. Deepak Kishore Kaltari 1 hour later
Brief Answer: Can resume exercise Detailed Answer: Namaste. Greetings of the day He can definitely start training if he physically feels fit and fine. That should not be a problem. Let him start on slow gradual resumption is advisable. Let him wait to start for the isometrics. First he should get to the full potential. Have a wonderful day. Take care Regards Dr Deepak Kishore Consultant Pediatric Surgeon
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Deepak Kishore Kaltari 4 hours later
I recently sent you a query but cannot seem to confirm it went through . It was in response to your reply sent to me 3 hours ago, beginning "Greetings of the day". Please let me know if your received it. cheers, Will
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Answered by Dr. Deepak Kishore Kaltari 23 minutes later
Brief Answer: Can resume his exercise Detailed Answer: Namaste Greetings He can definitely start training as he already started feeling good. There is no specific time duration following pneumonia that he should not be training. Training can definitely be resumed following pneumonia once there is clinical improvement in symptoms and feeling of well being. Coming to your second query, yes he can definitely start with resistance training like weight lifting after getting accustomed to his routine exercise. It should not be hindrance to his exercise schedule. I am sorry that the previous reply did not get through you. Apologies for that. I hope I have answered your query. In case you have any other query Kindly get back to me. Regards Take care Dr Deepak
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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