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A 45-year-old woman presents to clinic for an employment physical. She has no current complaints. She has no significant past medical history, does not smoke or drink alcohol, and leads an active lifestyle. Upon further questioning, you discover that she is a second generation immigrant from Brazil and frequently returns to South America to visit family. Vital signs are as follows: T 37 C, BP 110/70 mmHg, HR 70, and RR 14. On physical exam, you note a widely-split S2 heart sound. An EKG is performed (Figure A). What is the likely etiology of this patient's cardiac manifestations?
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