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A 42-Year-Old Man Comes to the Emergency Department After a Syncopal

question 183

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A 42-year-old man comes to the emergency department after a syncopal episode preceded by palpitations and lightheadedness.  The patient has no significant medical history and takes no medications.  He does not use tobacco, alcohol, or illicit drugs.  The patient is a computer programmer and spends most of his time indoors.  Vital signs are within normal limits with no orthostatic changes.  Heart and lung sounds are normal.  The liver span is increased with no tenderness.  The skin appears darkly tanned.  ECG demonstrates sinus node dysfunction, and echocardiography reveals abnormal diastolic relaxation of the left ventricle.  Which of the following is the most likely cause of this patient's condition?

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