Cardiac arrest in an 18-year-old man caused by anomalous right coronary artery origin

Area of Science:

• Cardiology
• Sports Medicine
• Medical Imaging

Background:

• Sudden cardiac arrest in young athletes is a critical concern.
• Anomalous coronary artery origins are a known, albeit rare, cause of exertional syncope and cardiac arrest.
• Early diagnosis and appropriate management are crucial for patient outcomes.

Observation:

• An 18-year-old male presented with out-of-hospital ventricular fibrillation during a football game.
• CT coronary angiogram revealed an anomalous right coronary artery originating from the left coronary sinus with an interarterial course.
• Cardiac MRI indicated a small subendocardial infarct.

Findings:

• The anomalous right coronary artery course between the aorta and pulmonary artery likely caused myocardial ischemia during exertion.
• Surgical intervention with coronary artery bypass grafting (CABG) successfully rerouted the anomalous artery.
• The patient achieved a full recovery without the need for an implantable cardioverter-defibrillator.

Implications:

• This case highlights the importance of thorough cardiac evaluation in young athletes experiencing syncope or arrest.
• Anomalous coronary arteries, particularly those with interarterial courses, must be considered in the differential diagnosis.
• Management strategies, including surgical revascularization, can be highly effective, allowing for return to daily activities but often precluding return to high-level competitive sports.