Exercise-Associated Hyponatremia and the Varon-Ayus Syndrome

Endurance sports such as marathon running are increasingly popular, attracting both professional and recreational athletes. While most participants recognize that these events can result in health hazards, few consider death a likely outcome. Exercise associated hyponatremia can be a consequence for which fatal outcomes may occur. In some it is mild and without symptoms. However, in others it is of such severity that respiratory failure secondary to pulmonary edema, and possibly death may result. This article reviews new information regarding predisposing factors, treatment, and outcomes associated with exercise induced hyponatremia and the Varon-Ayus syndrome (hyponatremia, pulmonary edema and cerebral edema associated to marathon running).


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An Unusual Chest Pain

A 67-year-old gentleman with a prior history of coronary artery disease and a four-vessel coronary artery bypass graft five years prior to admission, presented to the hospital complaining of a 12-day history of midsternal chest pain. A chest radiograph performed 18 months prior to this presentation revealed a normal cardiovascular silhouette and normal mediastinum. Upon presentation, a new chest radiograph revealed a wide mediastinum. A computed tomography done emergently revealed an aortic thrombus starting at superior mediastinum and large (6 cm) pseudoaneurysm in anterior mediastinum. An emergency angiogram revealed that the pseudoaneurysm to be emerging 2 cm below the innominate takeoff in the ascending aorta, which corresponded exactly to the prior CABG cannulation site. The patient underwent successful repair.


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