Letter by McGorrian et al Regarding Article, “A Shocking Development in a Young Male Athlete With Chest Pain”

Abstract

We read with interest the case presented by Alexander and colleagues 1 describing episodes of chest tightness in a healthy endurance athlete, with subsequent findings of coronary vasospasm, with polymorphic ventricular tachycardia in the setting of spasm events, and an aborted sudden death event with ventricular tachycardia. We note that the patient was known to have seasonal allergic rhinitis and a history of childhood asthma, and was an occasional user of cetirizine/pseudoephedrine.There is a recognized phenomenon of sudden death in association with coronary eosinophilic periarteritis, and although the literature focuses on coronary dissection as the key sequel, sudden cardiac death in the absence of dissection has been recognized. [2][3][4] We postulate that this cause should also be considered in this athlete. Kajihara et al 5 provide a recent review on this topic, and it is noted that the vasospastic angina is most common overnight, or in the early morning, as was the case here. Although a history of asthma or atopy is not consistently present in the case reports, this remains a potential pointer as to the underlying pathogenesis. DisclosuresNone. AFFiliATioNFrom Department of Cardiology and University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.