A 17-year-old boy presents for a sports pre-participation physical. He reports that he occasionally gets short of breath and feels light-headed during exercise, and sometimes experiences chest pain. He lost consciousness once last season during a playoff basketball game. His grandfather died suddenly at age 35. What is the most likely diagnosis?

The 17-year-old boy's symptoms and family history suggest a likely diagnosis of Hypertrophic Cardiomyopathy, a heart condition causing shortness of breath, light-headedness during exercise, and occasional chest pain, with a risk of sudden cardiac death.

Explanation:

Given the symptoms presented and the family history of sudden death at a young age, the most likely diagnosis for the 17-year-old boy is Hypertrophic Cardiomyopathy (HCM). This condition, primarily a disease of the myocardium, is characterized by hypertrophy of the heart muscle which can cause shortness of breath, light-headedness during exercise, and occasional chest pain. In severe cases, HCM can lead to life-threatening abnormal heart rhythms or sudden cardiac death, particularly during intense physical activity like a sports event.

HCM is often undiagnosed because many people with the condition have few, if any, symptoms, and it may not affect their life expectancy. However, in some people, like the boy's grandfather, it can cause sudden cardiac arrest and is a common cause of sudden cardiac death in young people, particularly competitive athletes.

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