Question of the Week # 203

203) A 16 year old boy presents for pre-participation examination prior to athletic training in his college campus. He denies any history of dizziness or palpitations or shortness of breath upon exertion. He denies any syncopal episodes. He denies any family history of Sudden Cardiac Death.  Physical examination reveals a systolic murmur that increases with valsalva maneuver.  Electrocardiogram reveals changes consistent with lEft ventricular hypertrophy. An echocardiogram reveals asymmetric septal hypertrophy and Systolic Anterior Motion (SAM) of the Anterior Mitral Leaflet. The findings are discussed with patient and he intends to participate in athletics because he does not have any symptoms. Which of the following is the most appropriate next step?

A) Clear the patient for athletic training

B) Start Beta Blocker Therapy

C) Exercise Stress Test

D) Cardiac catheterization

E) Implantable Cardioverter-Defibrillator

6 Responses

  1. b

  2. C to se if need ICD, before athletic training

  3. Exercise stress test
    If there is decrease blood pr during exercise, ICD next.

  4. C:)

  5. He needs exercise stress test (reduce BP in exercise) and holter monitoring (non sustain or sustained VT)= high risk and indications for ICD.

  6. e, BASED ON 204:)

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