A 32-year-old male pharmacist complained of having had palpitations for the past month. Using his index finger and tapping the table top, he replicated a pattern that simulated extrasystoles. He exercised daily, running 3 miles and lifting weights for 1 ½ hours and was asymptomatic prior to, during, and after exercise. There was no past history of illness or allergies, and he was not taking any medications on a regular basis. He had a lean physical habitus and his weight had been stable. Family history revealed that both parents were being treated for essential hypertension; one sister was living and well.

On physical examination: height 5 ft 11 in (1 m 80), weight 172 lb (78 kg; in street clothes and stocking feet), pulse 72/min, and blood pressure 150/90 mm Hg. The cardiac examination revealed a regular sinus rhythm...

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