The case of an asymptomatic 21-year-old male college sprinter demonstr
ates that aortic insufficiency may go undiagnosed despite severe under
lying cardiac pathology: A murmur detected during the preparticipation
exam was the first sign. Activity modification was an important initi
al intervention. Echocardiography documented severe aortic regurgitati
on. An exercise multiple gated acquisition (MUGA) scan identified abno
rmal ejection fractions. After valve replacement, the patient's return
to competition was guided by echocardiography, exercise testing, and
input of the medical team and family.