College Baseball Player Who Had Near-Syncope While Lifting Weights | Patient Case Quiz

A 19-year-old male collegiate baseball player reports an episode of near syncope while lifting weights. After performing several repetitions while bench pressing, he began to experience lightheadedness and decreased vision. He stopped exercising and after several seconds his symptoms began to resolve. He reports no loss of consciousness, no chest pain, no palpitations, and no shortness of breath. He has not had any similar prior episodes, Otherwise, has exercised without symptoms, and has no difficulty keeping pace with his teammates in both practice and in competition. There is no family history of sudden, early, or unexplained death. Physical examination is grossly normal. Electrocardiogram, shown in Figure 1, was concerning for the question of an epsilon wave in lead V1. A Holter monitor was placed which was grossly normal. Echocardiogram revealed normal right ventricular systolic pressure. Cardiac magnetic resonance imaging (MRI) was performed and is shown in Video 1.

Figure 1

Figure 1

Video 1

At this point, which of the following describes the next best step in management?

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