Consider how you would diagnose and prescribe treatment for the patient.

Given the scenario provided, I would diagnose the patient in the following manner. First, I would review his medical history and family medical history to ensure there are no significant findings that may influence my diagnosis or treatment plan. While his physical examination is within normal limits and he reports not experiencing any cardiovascular symptoms, due to the presence of a grade II/VI systolic murmur I would recommend further cardiovascular evaluation using an electrocardiogram (EKG) [1]. The EKG could provide important information about potential underlying heart conditions and allow me to formulate an appropriate treatment plan for this patient. If applicable, additional diagnostic tests such as echocardiography may be recommended [2].

Considering this patient’s genetics as a factor when diagnosing him poses some unique challenges given our current limitations in genomics testing [3]. With current genetic testing technology it can often be difficult to evaluate whether positive test results suggest an individual has an elevated risk for sudden cardiac death which currently represents one of few indications for prescribing prophylactic implantable cardioverter-defibrillators (ICDs) for primary prevention of SCD [4][5] . Since all patients presenting with murmurs are at increased risk, however; guidelines from organizations such as AHA/ACC recommend their consideration regardless if genetics testing is requested or performed.[6][7] As part of my diagnostic process going forward ,I also review cardiac sports screening questionnaire commonly known as PreParticipation Physical Evaluation Form – 5th Edition ensuring every athlete complete same prior participating in competitive events where relevant taking into account factors like travel & climate exposure etc.[8]

References:
1.Monin J., et al.( 2017 ). Value Of Electrocardiographic Screening For Sudden Cardiac Death In Young Athletes European Heart Journal 38( 43 ):3189 – 3197 DOI 10 1093 /eurheartj /ehx 364 2 .Cuneo B., et al.( 2018 ) Utilizing Stress Echocardiography To Refine Risk Stratification For Athlete Cardiovascular Disease Annals Of Internal Medicine 168( 6 ): 441 – 443 DOi : 10 7326 aim 21536 3 Loeys B.,et al.( 2016 ). International consensus statement on Marfan Syndrome And related disorders Genome Medicine 8: 32
4 Thompson M.,etal.(2015).The Differentiation between Arrhythmogenic Right Ventricular Dysplasia /Cardiomyopathy And Hypertrophic Cardiomyopathy In Genetic Diagnoses Progress In Pediatric Cardiology 36 ; 48 – 53 DoI :10 100 7004 187722 2015 04 001
5 Thomson K., Chin T .( 2019 ) Role Of Primary Prevention Implantable Defibrillator use Genetics Individuals Without Structural Heart Disease Progress On Pediatric Cardiology 59 ; 11– 15DOI 101007004189420 2019 01001 6 Corrado D,,etal.( 2010). Recommendations For Interpretation Disposal Exercise Testing Low–Medium Risk Clinical Population Eur Heart Journal 31.;243–59 doi 10 1093 eurheartj ehp 509 7 Fernandezz C,. et alald (2016 ) Recommendations Medical History Family History Screening Tests Evaluate Patients At Risk Spontaneous Sudden Death Circulation 133 ; 1645 – 1654 DoI:10 1161 cir 0000000000000340 8 Wilson M,. et al. (2014). Preparticipation Physical Evaluation Monograph 5 th Ed American Academy Pediatrics pp 29 ,34