Military Recruit with Borderline Cardiomyopathy

A 20-year old African American male presented with palpitations during a warm-up prior to a training session. He is a freshman in the Air Force Academy and plays power forward on the basketball team. He does not have a significant past medical or family history and does not consume alcohol, stimulants, or anabolic steroids. His blood pressure (BP) was 118/78, pulse 75 bpm, and cardiac examination was unremarkable. Electrocardiogram (ECG) showed left ventricular hypertrophy (LVH) by voltage criteria (Sokolow-Lyon) and deep T-wave inversions in the inferior and lateral leads (Figure 1). Echocardiography showed diffuse concentric LVH (maximal wall thickness:15mm; relative wall thickness 0.65), left ventricle (LV) mass 285gm, left ventricular internal diameter in diastole (LVIDd) 4.3cm, normal left atrial size, normal LV filling and a hyperdynamic ejection fraction of 83%. There was no LV outflow tract obstruction during exercise. An MRI corroborated these findings and post contrast imaging did not demonstrate delayed myocardial enhancement. A 14-day Zio patch recording showed no arrhythmias and genetic testing was negative for pathogenic variants of inherited cardiomyopathies.

Figure 1: 12-lead electrocardiogram (ECG)

Figure 1

Of the following choices, what would be the most reasonable next step?

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