A 32-Year-Old Man Is Evaluated for a Murmur, Which Was

A 32-year-old man is evaluated for a murmur, which was found during a preventive examination.  He has no symptoms, and his past medical history is insignificant.  The patient smokes a pack of cigarettes per day.  He has no family history of cardiovascular disease or sudden death.  Blood pressure is 132/80 mm Hg and heart rate is 68/min.  The patient's height is 178 cm.  Body mass index is 31 kg/m2.  A 2/6 ejection-type murmur is heard at the right upper sternal border.  His physical examination is otherwise unremarkable.  Transthoracic echocardiogram shows normal left atrial and left ventricular size, left ventricular ejection fraction of 60%, bicuspid aortic valve, and trivial aortic regurgitation.  There is no evidence of aortic stenosis on Doppler echocardiography.  For which of the following conditions should this patient be evaluated specifically?

A) Fibrillin gene mutation
B) Myosin gene mutation
C) Nonsustained ventricular tachycardia
D) Renal artery stenosis
E) Thoracic aortic aneurysm

Correct Answer:

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