Sudden Cardiac Death, Aborted, in Healthy 34-Year-Old Male

Abstract

A 34-year-old male, non-hypertensive, non-diabetic, had a sudden onset of cardiac arrest, he was revived and then referred to a cardiologist at an advanced center for further care. His 2D echo revealed hypertrophic obstructive cardiomyopathy, all the other investigations were normal. His father was also found to have a similar condition however the father was asymptomatic. The patient underwent an automated implantable cardioverter-defibrillator implantation and was advised the necessary precautions and care.

Introduction

A 34-year-old male, non-hypertensive, non-diabetic, had a sudden onset of cardiac arrest, he was revived and then referred to a cardiologist at an advanced center for further care.

His 2D echo revealed hypertrophic obstructive cardiomyopathy (HOCM), all the other investigations were normal. His father was also found to have a similar condition; however, the father was asymptomatic. The patient underwent an automated implantable cardioverter-defibrillator (AICD) implant and was advised the necessary precautions and care.

Case Report

The present case is about a 34-year-old male presented in a small city hospital in India with c/o breathlessness and chest pain, and also complaining of cough since 4-5 days. Where he went into cardiac arrest and was resuscitated and then put on inotropes and antiarrhythmic. He was subsequently discharged with hemodynamically normal status.

No H/O diabetes, hypertension, bronchial asthma.

On examination

S1 and S2 normal but systolic murmur III/IV was heard, murmur increased on standing and reduced on sitting.

Rest all systems normal.

Investigations

Electrocardiogram series shows left ventricular hypertrophy, and promanent P waves [Figure 1].

Figure 1.

Electrocardiogram series shows left ventricular hypertrophy, and prominent P waves

His coronary angiogram was done which was normal.

Magnetic resonance imaging brain was normal.

2D Echo revealed left ventricular ejection fraction 60%, left ventricular hypertrophy and HOCM, mild mitral regurgitation [Figure 2].

Figure 2.

2D Echo report showing hypertrophic obstructive cardiomyopathy with good ejection fraction

Further course

He was referred to a cardiologist in an advanced center for further management.

He underwent an AICD implantation under local anesthesia and was subsequently discharged with a follow-up schedule.

Discussion

Sudden cardiac death

• The most common cause of Sudden cardiac death (SCD) in adults over the age of 30 is coronary artery atheroma.

  Although the most frequent cause of SCD is coronary artery disease, other causes include:

• Non-atherosclerotic coronary artery abnormalities

• Hypertrophy of ventricular myocardium

• Myocardial diseases and heart failure.

• Arrhythmogenic right ventricular cardiomyopathy

• Hypertrophic cardiomyopathy (HCM)

• Dilated cardiomyopathy

• Myocardial infarction.

HCM

Is a primary disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is hypertrophied (thickened) without any obvious cause. It is perhaps best known as a leading cause of SCD in young athletes.

The occurrence of HCM is a significant cause of sudden unexpected cardiac death in any age group and as a cause of disabling cardiac symptoms. Younger people are likely to have a more severe form of HCM.

HCM is frequently asymptomatic until SCD, and for this reason some suggest routinely screening certain populations for this disease.

Familial HCM is inherited as an autosomal dominant trait and is attributed to mutations in one of a number of genes that encode for one of the sarcomere proteins, as was the case in our patient.

The treatment modalities for HOCM range from

Medications, surgical myomectomy, alcohol septal ablation, ventricular pacing, cardiac transplantation.