The correct answer is: H. Options D and G are both correct.

Given his arrest, he underwent right and left heart catheterization and electrophysiology study, both of which were unremarkable. In particular, he had normal coronary artery origins and angiography, and he had no inducible arrhythmias. A right heart biopsy was taken and later returned as normal.

A cardiac MRI revealed septal wall thickness of 14 mm and late gadolinium enhancement was identified in the inferior and apical walls. These features are consistent with hypertrophic cardiomyopathy with myocardial fibrosis.

This case highlights the importance of having a plan for management of sudden cardiac arrest. This player's ECG and echocardiogram are abnormal and consistent with hypertrophic cardiomyopathy, although prior to the arrest, his echocardiogram may have been seen as being consistent with "athlete's heart." Additionally, myocarditis and illicit drug use may have been clinically undetected as possible inciting events for sudden cardiac death.

This case illustrates the critical importance of being prepared for the undiagnosed patient at risk for sudden death. We know many patients have conditions that can predispose to sudden cardiac arrest. Some of these conditions, such as commotio cordis, are not detectable prior to the catastrophic event regardless of pre-participation efforts. Therefore, a plan for how to handle sudden cardiac arrest events, education on immediate CPR, and rapid access to AEDs is critical for all those who manage and care for athletes. This patient survived in large part to the first response by his coach until the AED was available. Ready availability of coaches and athletic trainers that can perform CPR and use AEDs on site are essential to limit the rare, but potentially tragic, impact of cases like this.

This patient was restricted from returning to play. His primary cardiologist placed an implantable cardioverter defibrillator (ICD) for secondary prevention of sudden cardiac death.