A 32-Year-Old Man Is Evaluated for Syncope

question 1042

Multiple Choice

A 32-year-old man is evaluated for syncope.  The patient passed out once briefly when playing basketball and experienced no post-syncopal symptoms.  Over the last year, he has tired easily and becomes short of breath when climbing 3-4 flights of stairs.  The patient takes lansoprazole for acid reflux.  In the past, a physician had told him that his blood pressure is "borderline."  The patient smokes half a pack of cigarettes a day.  His paternal uncle died suddenly at age 30.  Blood pressure is 152/90 mm Hg and pulse is 90/min.  A 2/6 midsystolic murmur is heard at the left sternal border and accentuates on standing.  Lungs are clear to auscultation.  Echocardiography shows left atrial enlargement, interventricular septal thickness of 2 cm (normal <1.1 cm) , and posterior left ventricular wall thickness of 0.9 cm (normal <1.1 cm) .  Left ventricular ejection fraction is 75%.  There is systolic anterior motion of the mitral valve.  At rest, peak instantaneous left ventricular outflow gradient is 30 mm Hg and increases to 45 mm Hg with Valsalva.  Which of the following is the most appropriate next step in management of this patient?

• A)Alcohol septal ablation
• B)Hypertension control with lisinopril
• C)Implantable cardioverter-defibrillator
• D)Intensive weight loss program
• E)Tilt table testing

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Definitions:

Immunizations Neglected

Refers to situations where necessary vaccinations are not administered, leaving individuals and communities at higher risk for infectious diseases.

Incomplete

Not finished; lacking some parts or elements.

Neglect

Failing to provide necessary care, assistance, or attention, often resulting in harm or risk of harm.

Holds Hands in Fist

A description often used in medical assessments to denote an individual's involuntary hand position, which could signify neurological or developmental issues.