A dramatic African holiday

Dr Martin Brown MBBS, FRCP (UK), FRACP, FCSANZ, FESC
General and Advanced Heart Failure Cardiologist, Sydney Cardiology Group;
Senior Lecturer, University of Queensland

A 59-YEAR-OLD businessman presents for a work medical check and his ECG is noted to be abnormal. He is commenced on metoprolol and sent to you for assessment.

He exercises regularly, cycling long distance, and has noticed a slight decline in his exercise tolerance over the last few months. He has no other cardiovascular symptoms and has no past medical history.

He has no