Murmur and Palpitations in an 18-Year-Old Male Seeking Sports Clearance

An 18-year-old man is seen in the cardiology clinic for evaluation of a murmur first noted during a recent sports physical examination. He reports occasional brief episodes of palpitations occurring at rest a few times per week. He denies exertional symptoms, chest pain, and syncope. He has no other significant medical conditions and his family history is unremarkable.

His physical examination findings are notable only for a midsystolic click and a harsh grade 3/6 late-peaking systolic regurgitant murmur best heard at the apex. An electrocardiogram (ECG) and transthoracic echocardiogram are performed (Figure 1; Videos 1, 2).

Figure 1: Twelve-Lead Electrocardiogram

Figure 1

Video 1: Echocardiogram

Video 1
Parasternal long-axis view.

Video 2: Echocardiogram

Video 2
Four-chamber view with color Doppler imaging of the mitral valve.

Which one of the following is the most appropriate next step in his management?

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