A 21-Year-Old College Football Player with an Abnormal ECG

A 21-year-old Black male, collegiate football player (defensive back), was referred for evaluation of an abnormal electrocardiogram (ECG) following an episode of atypical chest pain [Figure 1].

Figure 1: 12-lead ECG of a 21-year-old "genotype-positive, phenotype-negative" collegiate football player

Figure 1

His chest pain symptoms, described as "sharp and brief", were noted at the time of an allergic flare. The patient reported no decline in exercise capacity or recent flu-like symptoms and had never experienced syncope or near syncope. His mother had been diagnosed with hypertrophic cardiomyopathy (HCM) in her 30's (MYH7 mutation) and required cardiac transplantation at age 51 for refractory heart failure symptoms. Her son was found to be a carrier of the same MYH7 gene variant (c.2543 A> p.Glu848Gly [E848G]). There was no personal or family history of sickle cell disease/trait.

Coronary computed tomography (CT) angiography demonstrated no anomalous coronary artery origins, myocardial bridge, or obstructive atherosclerotic lesions. Transthoracic echocardiography (TTE) revealed normal left ventricular (LV) chamber dimensions and wall thickness (septum and posterior wall 0.7 cm) with a left ventricular ejection fraction (LVEF) of 69%. LV diastolic function indices were normal. There was no evidence of mitral regurgitation, systolic anterior motion (SAM), or left ventricular outflow tract (LVOT) gradient at rest and with Valsalva. Cardiac magnetic resonance imaging (MRI) confirmed normal LV wall thickness measures with no delayed gadolinium enhancement evident. During treadmill exercise testing, the patient completed 14.5 minutes on a Bruce protocol achieving a heart rate of 166/minute without symptoms, diagnostic ST segment changes, or ventricular dysrhythmias. The blood pressure (BP) response to exercise was normal. A repeat TTE performed the following year showed no changes, and 48-hour Holter monitor identified no ventricular tachycardia.

Regarding the athlete described, which of the following statements is true?

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