A 68-year-old woman presents to your office complaining of shortness of breath. She reports that over the last two months, she has become progressively short of breath with activity. She feels dizzy when she walks faster; her abdomen feels distended; and her legs feel swollen. Her temperature is 98 °F, heart rate is 56 beats/min, blood pressure is 110/84 mm Hg, respirations are 19 breaths/min, and oxygen saturation is 94% on room air. Physical examination is notable for bilateral crackles in the lung fields and pitting edema in bilateral lower extremities. You ordered an ECG, which shows the right bundle branch block with low voltage QRS complexes. Later your order an echocardiogram which revealed a concentric thickening of the left ventricle; relative apical-sparing or “cherry-on-top” pattern on a longitudinal strain bull’s eye display with bright myocardium. Laboratory tests revealed elevated troponin. Abdominal fat biopsy shows apple-green birefringence with Congo red staining. Of the following, which is the most likely diagnosis in this patient?

A 26-year old male comes to the emergency room complaining of syncope. He passed out while exercising in the gym. His father died of sudden cardiac death in his early 40s. Physical examination is significant for paradoxical splitting of second heart sound, S4 gallop, sustained apical impulse and a systolic ejection murmur at left lower sternal border. The murmur increased with the Valsalva maneuver. Patient was admitted for investigative studies. ECG revealed left ventricular hypertrophy with exaggerated septal Q waves. Echocardiogram showed asymmetrical thickening of the interventricular septum, resulting in dynamic obstruction of the LV outflow tract and abnormal systolic motion of the mitral valve. Which of the following medications should be avoided in this patient?

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. 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. You suspect hypertrophic obstructive cardiomyopathy in this young man. Of the following, where would you expect to hear the murmur with the loudest intensity?

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?

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. 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. As you conclude the visit, the patient expressed his desire to continue participation in competitive sports. According to the 36th Bethesda Conference and European Society Cardiology, which of the following is the right recommendation for this patient concerning his sports participation?