A 17-Year-Old Boy Is Evaluated Due to Left-Sided Chest Discomfort

A 17-year-old boy is evaluated due to left-sided chest discomfort for the past week.  It is exacerbated by left arm movement and deep inspiration.  The patient plays competitive soccer for his high school and has been practicing almost daily.  His mother is worried that he has a heart condition because his maternal uncle died from a "massive heart attack" at age 35.  Blood pressure is 125/80 mm Hg, pulse is 56/min, and respirations are 15/min.  BMI is 27 kg/m².  The patient is well built with increased skeletal muscle mass.  There is no jugular venous distension.  Physical examination is unremarkable.  ECG demonstrates sinus bradycardia with T-wave inversion in lead V₁.  Echocardiography reveals slightly enlarged left ventricular cavity size, mild left ventricular wall thickening, and no left atrial enlargement.  What is the most likely cause of this patient's cardiac findings?

A) Athlete's heart
B) Cardiac amyloidosis
C) Fabry disease
D) Hypertrophic cardiomyopathy
E) Masked hypertension

Correct Answer:

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