An unexpected cause of sudden cardiac arrest in a young swimmer

Abstract

Sudden cardiac arrest (SCA) is an uncommon but devastating event among young adults. While inherited cardiomyopathies and channelopathies represent an important proportion of sudden deaths, coronary artery disease remains a significant contributor in this age group. ECG findings are essential to guide the first steps of diagnostic work-up of SCA, but sometimes can overlap between different etiologies. In this article we present a 16-year-old female who experienced SCA during vigorous swimming whose ECG was compatible with long QT syndrome. However, evaluation of the coronary anatomy provided the diagnosis of Kawasaki disease.

Keywords: Kawasaki disease; coronary aneurysms; sudden cardiac arrest.

FIGURE 1

Initial ECG at the ICCU showing QTc up to 500 ms and slight ST depression and negative T waves in V3, V4, and the inferior leads

FIGURE 2

ECG after a few days of admission. QTc interval normalized without further repolarization changes

FIGURE 3

Submaximal treadmill stress test achieving 90% of maximum predicted heart rate. Image corresponds to peak exertion, without observing ST segment or T‐wave alterations respect to baseline ECG

FIGURE 4

Coronary computed tomography angiography and coronary angiography showing a giant calcified aneurysm of the right coronary artery (RCA) (A) and a severe stenosis in the mid segment of left anterior descending artery (LAD) (B)