No abstract

Sudden cardiac death in young adults may be associated with rare cardiomyopathies such as left ventricular noncompaction (LVNC) and arrhythmogenic right ventricular (ARVC) cardiomyopathies. LVNC is characterised by hypertrabeculations and deep recesses of the left ventricle. ARVC presents with thin myocardium as a result of extensive fibro-fatty infiltrations. In both conditions, death may be due to arrhythmia, thromboembolic events or heart failure. We report a case of a 21-year old athletic young man who collapsed at the futsal court right after the game. He was resuscitated but expired at the hospital after a brief admission. A week earlier, he had a similar episode of syncope and revived through cardio-pulmonary resuscitation at the site. Post mortem examination showed extensive acute myocardial infarction (AMI) involving the papillary muscles and the left ventricular wall. Features of LVNC were also observed. On top of that, the right ventricle showed patchy thin myocardium as the wall was largely comprised of fat. Histology examination confirmed the presence of AMI and massive fibro-fatty infiltrations of the right ventricle. This unfortunate young man had co-existing cardiomyopathies which is rare indeed. As he succumbed to AMI, this mechanism of death is also uncommonly associated with neither LVNC nor ARVC. In conclusion, young and physically active individuals may not be spared of sudden cardiac death. Mild and non-specific symptoms should not be taken lightly as it may be the subtle signs of cardiomyopathies.

Heatstroke is defined as severe heat illness with elevated body temperature greater than 40.6⁰C associated with central nervous system dysfunction. In children, heatstroke as a result of vehicular entrapment is commonly encountered. We report a case of a six-year-old boy who was accidentally left in a school van under scorching hot afternoon for several hours. Upon discovery, he was rushed to a hospital where he was pronounced dead. His body temperature taken at the Emergency Department was 40.3⁰C. The body felt warm in spite of apparent presence of post mortem changes such as rigor and livor mortis. His clothes were drenched in sweat. A medico-legal autopsy was performed. On general examination, his body was pale and the lips were also parched and pale. Internally, there was subdural haemorrhage and petechial haemorrhages on the lungs and the epicardial surface of the heart. The cause of death was given as heatstroke as a result of vehicular entrapment. We wish to emphasize and appeal to the public that this tragic incident is preventable. Public and private sectors should help creating awareness of dangers in leaving a child unattended in a car.

Left ventricular non-compaction cardiomyopathy (LVNC) is a rare congenital cardiomyopathy, which is characterized by hypertrabeculations and deep recesses of the left ventricle. A patient could be asymptomatic or presented with common manifestations, including reduced systolic function, arrhythmia, thromboembolic events and heart failure. The rarity of the condition as well as lack of proper assessment has probably led to this condition to be largely underdiagnosed or unrecognized. A 23-year-old lady had collapsed at home thirty one days after delivering her first child. She had a history of goitre diagnosed a year ago and noted to be fairly well throughout the pregnancy. Post mortem findings showed increased trabeculations of the left ventricle. Further history was obtained after the procedure, revealing symptoms such as syncopal attacks and bilateral lower limb weakness dated back as far as five years prior to her sudden demise. These features were in keeping with hypotension hypoperfusion effects resulted from reduced systolic function and decreased ejection fraction, as a result of left ventricular dysfunction. While LVNC remains a rare type of disease, we would like to highlight the importance of a good anamnesis. It may help to uncover some uncommon pathology such as this heart disease, thus warranting an appropriate cardiac imaging to be engaged to clinch the primary diagnosis.