P269 When sudden cardiac death is the first symptom

Abstract

A 43-year-old male was brought to the emergency department due to a recovered sudden cardiac arrest that occurred while performing physical exercise of moderate intensity. The patient was admitted in a coronary care unit and performed complementary tests to rule out immediate causes of cardiac arrest electrocardiogram showed sinus rhythm, no repolarization abnormalities and normal QTc interval. Echocardiogram revealed no evidence of cardiac tamponade, massive pulmonary embolism (PE), ventricular dysfunction or valvular heart disease. Absence of pneumothorax in chest X-ray. Arterial blood gas test revealed a high lactate concentration with other parameters in normal range. Cerebral tomography showed absence of an acute hemorrhagic event. To continue with the study an emergent coronarography was performed showing epicardial arteries with no significant obstructive coronary artery disease associated with an anomalous origin of left main coronary artery in the right sinus of Valsalva with possible interarterial course. Coronary tomography confirmed the origin of the right coronary artery and the left main coronary artery in the right sinus of Valsalva with an interarterial course, proceeding to the reconstruction of the images with the volume rendering (VR) technique (Figure 1). Congenital anomalies of the coronary arteries are a rare but life-threatening condition. Most coronary abnormalities are asymptomatic and follow a benign course, however, in some cases they present with ischemic symptoms, heart failure, myocardial infarction, syncope or sudden death. The anomalous origin of the left main coronary artery in the right sinus of Valsalva can cause myocardial ischemia and should be ruled out in young patients who present sudden cardiac arrest induced by physical exercise. Abstract P269 Figure 1