A 48-year-old man presents to the hospital after passing out during a basketball game with his friends. He was running toward the basket when he “blacked out.” He does not remember how long he was out, but he does remember waking up. On examination, his vitals are normal. Cardiac examination reveals a 3/6 midsystolic crescendo–decrescendo murmur heard best over the right upper sternal border, which radiates to the carotid arteries. The rest of the examination, including a neurologic examination, is normal. An ECG suggests left ventricular hypertrophy. Which of the following symptoms carries the worst prognosis in this condition?Ask StudybuddyGroup of answer choicesPalpitationsDyspnea from pulmonary edemaSyncopeAngina

A 20-year-old man comes to the physician for evaluation of a murmur that was discovered on a routine physical examination. The patient has no discomfort and has not had chest pain, palpitations, dyspnea, exercise intolerance, or syncope. He has no history of chronic illness. He is a college basketball player and exercises regularly. He takes no medications. He says he sometimes smokes marijuana and drinks alcoholic beverages socially on the weekends. His uncle died while playing soccer at age 26 years. Pulse is 65/min, respirations are 12/min, and blood pressure is 117/77 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Physical examination shows clear breath sounds, no jugular venous distention, and no lower extremity edema. Cardiac auscultation discloses a faint systolic murmur heard along the lower left sternal border with the patient in the supine position. Upon standing, a grade 3/6 systolic, crescendo-decrescendo murmur is heard in the same location. Which of the following is most likely contributing to the presence of this patient's cardiac murmur?A. Abnormal opening between the left and right ventriclesB. Calcification of the aortic valveC. Dilation of the tricuspid valve annulusD. Prolapse of the mitral valve leafletE. Systolic anterior motion of the mitral valve

A 22-year-old volleyball player comes to your clinic after a syncopal episode during a game. She is in good health and has no other medical problems. Her family is healthy, although she has an uncle that died for unknown reasons at the age of 32. On examination, there is a 2/6 systolic ejection murmur at the left sternal border that becomes louder during a Valsalva maneuver. Which of the following is the most appropriate next step in management?

A 38-year-old immigrant woman comes to the Emergency Department with right-sided weakness and slurring of her speech. Initial imaging and studies are obtained, and she is found to have suffered an ischemic stroke and is treated appropriately. When you go to examine her, she has an irregularly irregular pulse, and on cardiac examination she has an early diastolic high-pitched opening snap at the apex followed by a low-pitched diastolic rumbling murmur. Upon further discussion with the family, they indicate that she does not have any chronic medical problems and has not been to the doctor since she was a baby. She had frequent throat infections as a child, but these always resolved without treatment. She takes no medications and does not smoke or drink alcohol. The mechanism by which this condition developed is most similar to which of the following other conditions?Ask StudybuddyGroup of answer choicesGraves diseaseCystic fibrosisGuillain–Barré syndromeSarcoidosisInfective endocarditis

A 78-year-old male with a history of aortic stenosis with a mechanical aortic valve, hypertension, and type 2 diabetes presents to office for evaluation. He is doing well, except for some palpitations over the past few months. He does not have associated shortness of breath, syncope, or a history of falls. On physical examination, you note an irregularly irregular heart rhythm and a mechanical S2. Examination is otherwise normal. You obtain an ECG, which confirms the irregularly irregular arrhythmia. The patient has no history of bleeding and Hgb is normal. What is the recommended medication for prevention of thromboembolic events?Ask StudybuddyGroup of answer choicesWarfarinAspirinClopidogrelDabigatranApixaban

A 24-year-old woman comes to the office due to pressure-like, substernal chest pain that occurs when she exercises.  The patient began noticing the pain approximately 6 months ago when she started to exercise to lose weight.  Prior to that, her lifestyle was largely sedentary.  She has no associated nausea, vomiting, diaphoresis, dyspnea, palpitations, or syncope.  The patient has no significant past medical history but was told as a child that she has a "murmur."  She has no significant family history of heart disease.  Blood pressure is 130/70 mm Hg on the right and 105/55 mm Hg on the left, and pulse is 72/min and regular.  BMI is 29 kg/m2.  A palpable thrill is present in the suprasternal notch.  There is a loud midsystolic murmur best heard at the first right intercostal space.  The lungs are clear to auscultation.  What is the most likely cause of this patient's chest pain?