Our patient is a 25-year-old man with a chief complaint of two episodes of passing out in the last three weeks.
The pertinent features of his history include the following:
A heart murmur was heard at the age of ten, although no limitation of activity was advised.
He was asymptomatic until 3 weeks ago when he had an episode of syncope while running to catch a fly ball during a baseball game. Another episode occurred 2 days ago while running to catch a bus. In each case, his wife observed that he was unconscious for less than a minute and when he regained consciousness, he appeared to be entirely normal.
Further questioning revealed that in retrospect, he had previously had several minor lightheaded spells with exertion.
There is no history of rheumatic fever, cyanosis or squatting, chest pain or dyspnea, palpitations, tonic or clonic movements or focal central nervous system symptoms.
There are also no known risk factors such as a family history of heart disease or a personal history of hypertension, hyperlipidemia, diabetes or smoking.