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Sudden cardiac death with triple pathologies: A case report.

R Razuin^1,2, F Nurquin², M N Shahidan²

¹Centre for Diagnostic & Research Laboratories, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.

The Egyptian Heart Journal : (EHJ) : Official Bulletin of the Egyptian Society of Cardiology

|April 7, 2018

Summary

Sudden cardiac death in young adults can stem from rare cardiomyopathies like left ventricular noncompaction (LVNC) and arrhythmogenic right ventricular (ARVC). This case highlights co-existing conditions and acute myocardial infarction as a fatal mechanism.

Keywords:

Acute myocardial infarction Arrhythmogenic right ventricular cardiomyopathy Autopsy Non-compaction cardiomyopathy Sudden cardiac death

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Area of Science:

Cardiology and Pathology
Sudden Cardiac Death (SCD) in young adults

Background:

Rare cardiomyopathies, including left ventricular noncompaction (LVNC) and arrhythmogenic right ventricular cardiomyopathy (ARVC), are implicated in sudden cardiac death (SCD) in young individuals.
LVNC is characterized by excessive left ventricular trabeculations, while ARVC involves fibro-fatty infiltration of the right ventricular myocardium.
Both conditions can lead to fatal arrhythmias, thromboembolic events, or heart failure.

Observation:

A 21-year-old athletic male experienced syncope and subsequently collapsed during a futsal game, requiring resuscitation.
Post-mortem examination revealed extensive acute myocardial infarction (AMI) affecting the left ventricle and papillary muscles.
Pathological findings also showed features consistent with LVNC and ARVC, including myocardial thinning and fibro-fatty infiltration of the right ventricle.

Findings:

The case presented with co-existing LVNC and ARVC, a rare occurrence.
The primary cause of death was acute myocardial infarction (AMI), an uncommon mechanism associated with isolated LVNC or ARVC.
Histological confirmation of AMI and massive fibro-fatty infiltration of the right ventricle was established.

Implications:

Young, physically active individuals are not immune to sudden cardiac death, even with seemingly mild or non-specific preceding symptoms.
The presence of co-existing cardiomyopathies can present complex diagnostic and prognostic challenges.
This case underscores the importance of thorough investigation of cardiac symptoms in athletes, as they may indicate underlying, potentially life-threatening cardiomyopathies.