Our patient is a 16-year-old young man who was referred for medical evaluation after he passed out one week ago.
The pertinent features of his history include the following: a heart murmur was heard at the age of twelve, although no limitation of activity was advised. During the past year, he has had several episodes of dyspnea and chest discomfort with exertion. The discomfort is characterized as a chest pressure sensation that resolves with rest. He felt these symptoms indicated that he was out of shape and that further motivated him to try harder. An episode of syncope occurred one week ago during wrestling practice. His coaches observed that he was unconscious for less than a minute and that when he regained consciousness, he appeared to be entirely normal. On further questioning, he admits to also experiencing several lightheaded spells with exertion during the past year.
There is no history of rheumatic fever, cyanosis or squatting, palpitations, tonic or clonic movements or focal central nervous system symptoms.
A review of his risk factors revealed the following: there is a family history of sudden death. His mother died suddently at age forty of an unknown cause. There is no known personal history of coronary artery disease, hypertension, hyperlipidemia, diabetes, smoking or illicit drug use.