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Correct diagnosis will not only prevent the use of medications destined to fail but will occasionally uncover potentially life-threatening disease. Herein we present a case of a young athlete with EID who was initially misdiagnosed and treated empirically for EIB, which led to delayed diagnosis of a life-threatening disease. CASE DESCRIPTION An 18-year-old woman presented to an outpatient cardiology clinic for evaluation of exertional dyspnea worsening over the past 1.5 years. Her medical history was significant for the diagnosis of exercise-induced [http://www.selleckchem.com/products/byl719.html learn more] asthma treated with as-needed short-acting bronchodilators. Her only other medication was an oral contraceptive (desogestrel-ethinyl estradiol 0.15�C30 mg�Cmcg). She did not use tobacco, alcohol, or recreational or performance-enhancing drugs. She was an active athlete participating in varsity basketball, volleyball, and track. Approximately 1.5 years prior to presentation, she developed sudden worsening dyspnea with minimal exertion and associated presyncope. Symptoms were provoked by 5 minutes of aerobic exertion and relieved with [http://www.selleckchem.com/products/SB-431542.html Smad inhibitor] and pulmonary exams were normal. Her abdomen was soft, nontender, nondistended, and without masses or organomegaly. There was no peripheral edema; peripheral pulses [http://en.wikipedia.org/wiki/ADAMTS12 ADAMTS12] were full and equal bilaterally. Further, there was no calf tenderness, and Homman's sign was absent. Initial laboratory data revealed normal serum electrolytes, blood counts, and renal and liver function. Quantitative D-dimer was 0.42 ug FEU/mL (normal