19 year old boy Passes out while running- Next Step in Management ?

A 19 year old boy with no past medical history passes out while running at a school evnt. He states that he was feeling a little dizzy prior to the event, but does not complains of chest pain or palpitations. His blood pressure is 120/85, heart rate 85/min, Respiratory Rate 12/min, and he is afebrile. His physical examination reveals normal lung sounds, a II/VI mid-sytolic creshendo-decreshndo murmur is heard at the right upper sternal border which increases in intensity with Valsalva, an S4 heart sound is also present. Laboratory studies are normal. What is the most appropriate treatment at this time?

 A) Start a Diuretic

 B) Permanent Pacemaker Implantation

 C) AICD Implantation

 D) Observation
 
 E) Start  Beta Blocker


Please leave your Answers in the Box Below.  

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