SUDDEN CARDIAC DEATH FROM MITRAL ANNULAR DYSJUNCTION AND COVID-19

Background

Mitral valve prolapse (MVP) affects approximately 1 to 3% of the population. Of these, 2 to 4% may present with sudden cardiac death (SCD). A rare subset of patients can have mitral annular dysjunction (MAD) which can lead to the development of myxomatous valvular disease causing MVP from excessive mechanical stress on the mitral valve apparatus. We present a unique patient with a history of recent COVID-19 infection who presented with SCD related to MAD and MVP.

Case

A 32-year-old female with history of anxiety and recent COVID-19 with ongoing sinusitis not on any recent antibiotics presented after a brief episode of cardiac arrest secondary to polymorphic ventricular tachycardia (VT). Restoration of spontaneous circulation was achieved after two rounds of CPR. A thorough medical history, physical exam, family history, social history were unremarkable except for an EKG showing QTc of 480. Echocardiogram showed mild global LV systolic dysfunction with an ejection fraction (EF) of 44%, bileaflet MVP, and mitral annulus dysjunction. Cardiac MRI noted myxomatous bileaflet MVP with mitral annulus dysjunction with marked billowing. Her hospitalization was complicated by numerous episodes of nonsustained VT.

Decision-making

Our patient was diagnosed with arrhythmogenic MVP syndrome complicated by COVID-19 that was unmasked by her unfortunate polymorphic VT cardiac arrest. She was initiated on beta-blocker, underwent ICD placement for secondary prevention and was recommended against vigorous exercise and any QTc prolonging medications.

Conclusion

MVP and MAD have been associated with SCD. Importantly, this rare case demonstrates the effects of a viral infection and the myxomatous changes of the mitral valve leading to MAD and VT and SCD.