Our patient is an 18-year-old man referred for medical evaluation of a heart murmur noted on a pre college examination. The experienced examiner considers the murmur pathologic, prompting specialist referral.
The pertinent features of his history include the presence of a heart murmur heard initially at age six weeks, normal growth and development and normal exercise tolerance. His parents were told that he would outgrow the murmur.
There is no history of palpitations, significant chest pain, shortness of breath, cyanosis or syncope, no rheumatic fever or recent significant febrile illness.
The patient denies substance abuse, including smoking tobacco and the use of illicit drugs. There is no family history of acquired cardiovascular disease, including hypertension or early age heart attack. There is a positive history of congenital heart disease, as the patient has a first cousin who underwent surgery at age one for some type of heart defect.