A 25-year-old man, who is slender and athletic, comes to your offi ce because of an episode of syncope immediately aft er playing basketball. He exercises diligently but says that he has experienced...

A 25-year-old man, who is slender and athletic, comes to your offi ce because of an episode of syncope immediately aft er playing basketball. He exercises diligently but says that he has experienced mild dyspnea on exertion over the past 2 months. On physical examination, his blood pressure is 175/90 mm Hg, his carotid pulse is bounding, and there is an early systolic click immediately followed by a late peaking 3/6 systolic murmur heard best at the right second intercostal space and radiating to the carotids. Th ere is no dynamic increase in murmur intensity with the Valsalva maneuver and no change in the timing of the click with squatting. Th e apical impulse is sustained. A radial femoral delay is suspected on examination. What should be the next step in the evaluation or management of this patient? a. Coronary angiogram b. Use of a 24-hour Holter monitor c. Computed tomographic (CT) scan of the chest d. Reassurance with recommendations for warm-up and cooldown routines with exertion e. Use of a 24-hour blood pressure monitor