Flushing, Paresthesias, and Difficulty Swallowing After a Run

John D. Cantwell, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 1 - JANUARY 98

A 45-year-old veteran runner, while on a summer vacation in Martha's Vineyard, went for his usual 5-mile jog in 80°F weather. Two minutes after completing the run, his vision blurred and he became lightheaded. He had difficulty swallowing and noted tingling in his hands and arms and generalized flushing. He felt no chest pain, but his facial and arm muscles felt "distorted."

An ambulance was summoned, and he was given oxygen while en route to the nearest emergency room. During the 10-minute ride, his hands felt better, and his muscles "seemed to loosen up" within 30 to 60 minutes of symptom onset.

His initial blood pressure in the emergency room was 148/94 mm Hg, decreasing to 130/90 mm Hg on a subsequent check. His pulse and physical examination were normal. He appeared tanned, trim, and highly fit, and he typically had no problems running 15 to 20 miles per week in hot, humid weather. He had never smoked cigarettes. His prior blood lipid measurements were: total cholesterol, 237 mg/dL; high-density lipoprotein, 44 mg/dL; low-density lipoprotein, 172 mg/dL; and triglyceride, 107 mg/dL.

Initial blood studies indicated a normal hemoglobin and white blood cell count. His blood glucose was 110 mg/dL, sodium 142 mmol/L, potassium 4.0 mmol/L, and creatine phosphokinase 156 units per liter (normal, 21 to 232). An electrocardiogram (ECG) was obtained (figure 1). Mainly because of the ECG results, he was observed overnight in the hospital, but he was discharged the next day. Several days later he presented at my clinic for a follow-up evaluation in the hope of learning the cause of his symptoms.

What does his ECG reveal? What questions might shed light on the cause of his symptoms?

Dr Cantwell practices cardiology at Cardiology of Georgia, PC, and is a clinical professor of medicine at Morehouse School of Medicine in Atlanta. He is also a member of the editorial board of The Physician and Sportsmedicine. Address correspondence to John D. Cantwell, MD, 755 Mt Vernon Hwy, Suite 530, Atlanta, GA 30328.

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