A 22-year-old college wrestler comes for a sports physical examination. He tells you that he often feels excessively short of breath during practice and even has had chest pain that resolves with rest. He reports experiencing a syncopal episode 3 months ago while running a marathon. While taking the family history he tells you that his father died of ‘earlier-than-normal age’ sudden death. Later, you send the patient for an echocardiogram, which reveals a hypertrophic heart, a thickened interventricular septum and a functional left ventricular outflow obstruction durings systole. Which of the following would you expect as you auscultate his heart?
