During a routine preschool physical examina- tion, the physician notes that a 3-year-old girl has a machinery-type murmur on auscultation of the chest. The pulse is bounding and palpa- ble in the femoral and radial region of both sides of her body. There were no symptoms, and she has excellent exercise performance. Persistent PDA is confirmed on subsequent examination. The parents should be advised that the girl requires which of the following: 

At the age of 34 years, a female long-distance runner notes increasing dyspnea after running more than 10 mi. On inspection and palpation, a prominent right ventricular heave is noted. There is a loud systolic murmur in the left third interspace. The ECG shows right-axis devia- tion with right bundle branch block. An x-ray of the chest shows a small aortic knob. What sign or test will most likely reveal the cause of the congenital heart abnormality thought to be atrial septal defect? 

The only son of a physiology instructor dies suddenly at the age of 12 years following wors- ening symptoms of tetralogy of Fallot. What would an autopsy reveal? 

After suffering a streptococcal throat infection, a 12-year-old immigrant boy develops cardiac symptoms that are attributed to rheumatic fever. Years later, at the age of 34 he is admitted to the hospital with pulmonary edema. Further examination reveals a diastolic murmur at the apex and mitral stenosis is diagnosed. Before surgical evaluation, which of the following findings can be attributed to mitral stenosis? 

A 23-year-old ballet dancer is concerned about the recent sudden death of a young famous Russian dancer on a New York stage. The patient seeks advice about his own risk for developing cardiac disease. His father died suddenly from ischemic heart disease at the age of 40. What is the most important risk factor that would further indicate the possibility of coronary artery heart disease?