By the time you see Adam in A&E, his breathlessness has settled and chest pain resolved. He recalls the chest pain to be dull and sharp, but his predominant symptom prior to losing consciousness was breathlessness and then palpitation.

On questioning him further, Adam admits to having felt more breathless than usual during exercise over the last 6-12 months. This usually resolves once he stops exercise. He also admits to 2 episodes of severe pre-syncope associated with palpitation during 10km runs which have required him to stop exercising and sit or lie on the floor in order to prevent himself losing consciousness. The episodes have been short lived and last up to 5 minutes. He has not experienced any actual syncope or chest pain prior to today.

Adam has no past medical history of note and does not take any regular medications, including over-the-counter medications or training supplements. He denies any recreational drug use and has no drug allergies.

In terms of his family history, Adam recalls that his paternal uncle died suddenly aged 41. He also recalls that one of his uncle’s children was told that he had a “big heart,” but cannot remember the details. In terms of Adam’s own father, he has been experiencing breathlessness and palpitation but has not yet seen a doctor about these symptoms. Adam has 1 younger sister who is well and, as far as he is aware, there is no other family history of sudden death. There is no family history of early onset ischaemic heart disease.

Adam is married and has two children, a daughter aged 3 and a son aged 5, who are both well. As mentioned above, he is a banker and an ex-smoker but only drinks alcohol rarely.