Case 21-1979: A 17-Year-Old Boy with Cardiac Murmurs and Syncope

Presentation of Case A 17-year-old boy was admitted to the hospital because of a heart murmur. He was born the sixth of nine children, of a normal delivery. His early growth and development were normal. At the age of five years a routine examination at this hospital disclosed no abnormality; the blood pressure was 100/75 mm Hg. At 13 years of age he returned because of diarrhea. Examination revealed marked obesity. The heart was not enlarged; a Grade 3 systolic murmur was heard at the upper sternal border, with radiation over the entire precordium. During the year before entry the.