Patient case (clinical description): A 23-year-old man comes to the emergency department following an episode of syncope.  He was working out when he felt dizzy and passed out without head injury.  He has had 3 other episodes of light-headedness over the last year, all happening during physical activity. He never had this experience while resting. He has no other medical conditions.  The patient does not use tobacco, alcohol, or illicit drugs.  His father died suddenly at age 35.  Vital signs are within normal limits.  On physical examination, the patient has a harsh systolic murmur.  The lungs are clear with no peripheral edema. Echocardiography shows asymmetric interventricular septal hypertrophy.

Patient's own account: I'm 23, and I got admitted to the ER because I fainted all of a sudden. I was in the gym, working out, when all of a sudden, I just got dizzy and passed out. Hopefully, I didn't hit my head. It's not my first time having that kind of dizziness at the gym, never when I'm chilling at home tho. I don't have any special medical conditions and I'm not even smoking, drinking or doing drugs! My dad died suddenly when he was 35, so I'm kind of scared. My vitals were normal while at the ER and they did a physical exam and they told me my heart sounds abnormal. My lungs are ok, but I had to do an echography of my heart, and they told me it is bigger than average.

Clinical trial: High Intensity Exercise for Increasing Fitness in Patients With Hypertrophic Cardiomyopathy

Eligibility criteria:
Inclusion Criteria:

          -  Male and female patients aged 18 - 80 years old

          -  Diagnosed HCM defined by the presence of unexplained left-ventricular hypertrophy with
             end-diastolic wall thickness ≥ 15 mm on 2D echocardiography or wall thickness between
             13 and 15 mm along with at least one other piece of evidence of hypertrophic
             cardiomyopathy, such as systolic anterior motion of the mitral valve leaflets, family
             history of hypertrophic cardiomyopathy, or positive genetic test result.

        Exclusion Criteria:

          -  A history of exercise-induced syncope or arrhythmias (ventricular tachycardia;
             sustained or non-sustained)

          -  Left ventricular outflow obstruction (≥ 50 mm Hg at rest)

          -  Less than 3 months post septal reduction therapy (surgery or catheter based
             intervention)

          -  Pregnancy

          -  Worsening clinical status or advanced heart failure (New York Heart Association class
             IV symptoms)

          -  A hypotensive responsive to exercise (an increase in exercise systolic BP throughout
             the exercise test of < 20mmHg compared with resting values, or an initial increase in
             systolic BP > 20mmHg with a subsequent fall by peak exercise of > 20mmHg, or a
             continuous decrease in systolic BP throughout the test of > 20mmHg, compared with
             baseline BP)

          -  Left ventricular systolic dysfunction (left ventricular ejection fraction < 55 % by
             echocardiography)

          -  Coronary artery disease as evidenced by prior myocardial infarction or angina

          -  Cerebrovascular disease as evidenced by prior transient ischemic attack or stroke

          -  A chronic orthopaedic injury which limits the ability to exercise

          -  Subjects unable to speak English will not be recruited because of the complex
             experimental studies and the need for precise communication between the volunteers and
             the research staff to ensure safety.
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 18 Years old.
Subject must be at most 80 Years

Eligibility (NLI label): Entailment