History and physical findings requiring further cardiac workup Historical findings Sudden cardiac death of a family member before the age of 50 Palpitations during exercise Dyspnea with exercise Chest pain with exercise Syncope or near syncope with exercise Physical findings Abnormal heart rhythms Diastolic murmurs Systolic murmurs that increase with Valsalva or decrease in the supine position Asymmetric pulses Findings consistent with Marfan syndrome Table 3.