Background: Anomalous origin of a coronary artery (AAOCA) carries an associatedrisk of Sudden Cardiac Death (SCD) with interarterial anomalous left or right coronaryartery course (ALCA and ARCA respectively). Myocarditis, especially with extensivebrosis at MRI is also a risk factor for SCD in young population. Increasing use ofcardiac imaging techniques is enhancing myocarditis and AAOCA diagnosis, previ-ously completely skipped.Clinical case: We present a 23y/o woman without any relevant previous disease(except for BMI 15 Kg/m2) resuscitated by a relative from SCD while she wassleeping (5 DC shocks due to ventricular brillation, VF), followed by unevent-ful course and full recover. A cardiac CT scan showed an ARCA with interarte-rial course (between aorta and pulmonary artery) and moderate narrowing of RCAlumen at rest (Fig.1) and she was referred at our hospital for surgical coronary arteryre-implantation, asymptomatic with no further arrhythmias. Blood sample showednormal CBC, Troponin, C-reactive protein values. A cardiac MRI showed a pictureconsistent with a previous, subclinical, myocarditis with diffuse myocardial brosis(non-ischemic pattern) and mild reduction in ejection fraction (Fig.1). A right sidemyocardial biopsy failed to take a pathological sample due to epicardial brosisdistribution. Both cardiac tissue PCR and serum antibodies were negative for com-mon myocarditis viruses. Patient underwent an electrophysiological study withoutinduced arrhythmias. A Subcutaneous Debrillator (S-ICD) was implanted and shewas discharged with no complications.Discussion: In this peculiar case 2 diagnosis could be responsible for the abortedSCD. A recent review on AAOCA underlines the importance of ischemia in patientswith ARCA where, particularly without proximal vessel narrowing, a conservativeapproach may be reasonable. In this woman affected both by AAOCA and myocar-dial brosis the culprit disease is debatable, but in absence of recurring events, signsof ischemia and imaging criteria for malignant pattern (acute take-off, slit-like, severecompression), eventual surgery was postpone and she was protected with a S-ICD(SCD secondary prevention). Furthermore the occurrence of VF at rest is less typi-cal for AAOCA, mostly occurring during exercise. At 6 months she is asymptomaticwithout clinical events.Conclusions: We present a case of an aborted SCD with 2 possible culprit diagno-sis in which multimodality imaging is fundamental in case management and clinical decisions.
An unusual case of aborted sudden cardiac death in a young woman: which is the culprit? / M. Mapelli, E. Conte, A. Dello Russo, G. Vettor, A. Baggiano, M. Muratori, L. Fusini, D. Andreini, G. Pontone, M. Pepi, P. Agostoni. - In: EUROPEAN JOURNAL OF HEART FAILURE. - ISSN 1879-0844. - 20:suppl. 1(2018), pp. 59.16-59.16.
An unusual case of aborted sudden cardiac death in a young woman: which is the culprit?
M. Mapelli
Primo
;E. ConteSecondo
;A. Baggiano;L. Fusini;D. Andreini;G. Pontone;P. Agostoni
2018
Abstract
Background: Anomalous origin of a coronary artery (AAOCA) carries an associatedrisk of Sudden Cardiac Death (SCD) with interarterial anomalous left or right coronaryartery course (ALCA and ARCA respectively). Myocarditis, especially with extensivebrosis at MRI is also a risk factor for SCD in young population. Increasing use ofcardiac imaging techniques is enhancing myocarditis and AAOCA diagnosis, previ-ously completely skipped.Clinical case: We present a 23y/o woman without any relevant previous disease(except for BMI 15 Kg/m2) resuscitated by a relative from SCD while she wassleeping (5 DC shocks due to ventricular brillation, VF), followed by unevent-ful course and full recover. A cardiac CT scan showed an ARCA with interarte-rial course (between aorta and pulmonary artery) and moderate narrowing of RCAlumen at rest (Fig.1) and she was referred at our hospital for surgical coronary arteryre-implantation, asymptomatic with no further arrhythmias. Blood sample showednormal CBC, Troponin, C-reactive protein values. A cardiac MRI showed a pictureconsistent with a previous, subclinical, myocarditis with diffuse myocardial brosis(non-ischemic pattern) and mild reduction in ejection fraction (Fig.1). A right sidemyocardial biopsy failed to take a pathological sample due to epicardial brosisdistribution. Both cardiac tissue PCR and serum antibodies were negative for com-mon myocarditis viruses. Patient underwent an electrophysiological study withoutinduced arrhythmias. A Subcutaneous Debrillator (S-ICD) was implanted and shewas discharged with no complications.Discussion: In this peculiar case 2 diagnosis could be responsible for the abortedSCD. A recent review on AAOCA underlines the importance of ischemia in patientswith ARCA where, particularly without proximal vessel narrowing, a conservativeapproach may be reasonable. In this woman affected both by AAOCA and myocar-dial brosis the culprit disease is debatable, but in absence of recurring events, signsof ischemia and imaging criteria for malignant pattern (acute take-off, slit-like, severecompression), eventual surgery was postpone and she was protected with a S-ICD(SCD secondary prevention). Furthermore the occurrence of VF at rest is less typi-cal for AAOCA, mostly occurring during exercise. At 6 months she is asymptomaticwithout clinical events.Conclusions: We present a case of an aborted SCD with 2 possible culprit diagno-sis in which multimodality imaging is fundamental in case management and clinical decisions.File | Dimensione | Formato | |
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