A 24-Year-Old Man Experiences Syncope While Shoveling Snow

A 24-year-old man experiences syncope while shoveling snow.  He regains consciousness within 1 minute.  He has had some shortness of breath and chest pains recently, related primarily to exercise.  He denies illicit drug use.  His temperature is 37.2° C (98.9° F) , blood pressure is 126/76 mm Hg, pulse is 76/min, and respirations are 14/min.  Physical examination shows a well-built man in no apparent distress.  Lungs are clear.  A crescendo-decrescendo systolic murmur is heard along the left sternal border without carotid radiation.  Chest x-ray is normal.  Which of the following is the most likely cause of his syncopal episode?

A) Atrioventricular conduction delay
B) Interventricular septal hypertrophy
C) Aortic dissection
D) Aortic stenosis
E) Mitral valve degeneration

Correct Answer:

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