An 18-Year-Old Wrestler With Sudden Cardiac Death

A previously healthy 18-year-old high school wrestler with no known prior medical history collapses during a school match. He is unresponsive, pulseless, and apneic. Bystanders initiate CPR and quickly bring an automated external defibrillator to him. The device shows ventricular fibrillation and delivers a successful defibrillating shock. Sinus rhythm is restored, and he regains a pulse but remains unresponsive.

EMS personnel arrive, intubate the patient, and transport him to a local hospital, where he recovers gradually, including making a full neurologic recovery. His course is notable for aspiration pneumonia, methicillin-resistant Staphlococcus aureus infection, and a newly noted left bundle branch block. Exercise stress testing revealed no inducible ischemia or arrhythmias. Cardiac catheterization showed normal coronary artery anatomy without evidence of myocardial bridging, anomalous vessels, or obstructive atherosclerotic disease. Cardiac MRI revealed moderate global LV hypokinesis (LVEF 40%) with a small area of apical enhancement interpreted as consistent with sarcoidosis. He has been in the hospital for the past two weeks and is now referred to you for further management.

The patient's family reveals that his paternal uncle was an illicit drug user who died suddenly at the age of 35. The family history is otherwise completely unremarkable. Physical examination is normal.

The patient is resting comfortably, eager to go home.

At this point, you would advise:

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