A 16 year old boy presents with a recent history of increased dyspnea and palpitations on exertion as well as intermittent dizziness and chest heaviness during football practice. He states he was at practice today and felt very weak and lightheaded and almost passed out while running down the field. He admits to mild nausea without vomiting. He has been eating well and was insistent that he had been hydrating with gatorade during practice.
He admits it was the first week of practice, and he had not really kept in shape over the summer. In fact, he had gained over 10 kg since last season. The coach said “I’m just out of shape”, he states.
He otherwise has no significant past medical history. He takes Loratadine and Fluticasone nasal spray for seasonal allergies. He otherwise denies use of tobacco, alcohol or recreational drugs.
Temp: 98.2 °F (37.8°C), HR: 88, RR: 18, BP: 112/70, Sat.100%
He is 5 ft.10 inches tall and weighs 205 lbs (93 kg). His exam is unremarkable except for a grade 3/6 systolic ejection murmur at the left sternal border. Lungs are CTA B/L. No JVD noted. Given his symptoms and cardiac exam findings you obtain basic labs which are normal and an ECG.
1. What is your interpretation of this ECG?
2. What is your suspected diagnosis?
3. What is the next step?