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Sudden cardiac death with triple pathologies: A case report

R Razuin1,2, 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
PubMed

Insights

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.

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.

Keywords:
Acute myocardial infarctionArrhythmogenic right ventricular cardiomyopathyAutopsyNon-compaction cardiomyopathySudden cardiac death

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