A 24-Year-Old Man Is Evaluated Due to an Episode of Syncope

A 24-year-old man is evaluated due to an episode of syncope.  He was jogging when he felt light-headed and passed out, but he did not sustain a head injury.  The patient has had 2 similar episodes of light-headedness while jogging over the last year, but this was the first time he passed out.  He considers himself in good health and has no other medical conditions.  The patient does not use tobacco, alcohol, or recreational drugs.  His father died suddenly at age 30.  Vital signs are within normal limits.  On physical examination, the patient has a harsh systolic murmur.  The lungs are clear to auscultation.  There is no peripheral edema.  Transthoracic echocardiography shows asymmetric interventricular septal hypertrophy.  This patient's symptoms are most likely explained by left ventricular outflow obstruction created by which of the following structures?

A) Aortic valve cusp and interventricular septum
B) Aortic valve cusp and papillary muscle
C) Aortic valve cusps
D) Ascending aorta and interventricular septum
E) Mitral valve leaflet and interventricular septum

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