Sudden cardiac death: Beware of hasty diagnosis!

Abstract

We report the case of a 21-year-old man admitted to the intensive-care unit after resuscitation from a sudden cardiac death (SCD) while he was playing football. Using a wide range of imaging techniques, we diagnosed a singular association between a hypertrophic cardiomyopathy (HCM) and an abnormal left coronary artery origin from the right coronary artery. Coronary artery anomalies, after HCM, are the second most common cause of SCD during exercise in young athletes, but the association between these 2 diseases is very uncommon. Following international guidelines, the patient received an implantable cardioverter-defibrillator; the coronary abnormal origin was not corrected by surgical bypass given the pre pulmonary pathway. However, this young athlete has decided to practice football again despite being advised against it. After resuscitation of an exercise-induced SCD, the possibility of an association between two pathologies should be carefully taken into account. <Learning objective: Coronary artery anomalies, after hypertrophic cardiomyopathy, are the second most common cause of sudden cardiac death during exercise in young athletes, but the association of both diseases is very uncommon. In this case, either of the two diseases could have triggered the sudden cardiac arrest. The use of a wide range of cardiac imaging techniques guided the clinical management. After resuscitation of an exercise-induced sudden cardiac arrest, the possibility of an association between two pathologies should be carefully taken into account.>.

Keywords: Cardiac magnetic resonance; Coronary artery; Hypertrophic cardiomyopathy; Sport medicine; Sudden cardiac death.

Fig. 1

3D volume rendering technique coronary computed tomography scan: anterior to pulmonary outflow pathway of the left coronary artery from the right coronary artery.

Fig. 2

Horizontal long-axis late-gadolinium enhanced cardiac magnetic resonance image, showing asymmetric myocardial hypertrophy, predominant in the lateral wall associated with diffuse mid-myocardial late gadolinium enhancement, suggesting primary hypertrophic cardiomyopathy.