Aborted sudden cardiac death in a 39-year-old security guard
█ Case report
Szabó Liliána1, Pozsonyi Zoltán2, Peskó Gergely2, Dohy Zsófia1, Czimbalmos Csilla1, Heltai Krisztina1, Becker Dávid1, Merkely Béla1, Vágó Hajnalka1
1Városmajori Szív- és Érgyógyászati Klinika,
2III. sz. Belgyógyászati Klinika, Budapest
Myocardial infarction with non-obstructive coronary arteries, the so called MINOCA is responsible for up to 6-8% of the infarctions.
In our case presentation we aim to describe the story of a 39-year-old security guard who after a night of going out visited his GP doctor with the symptoms of acute epigastric pain, sweating, fatigue and general weakness. During physical examination, the patient had a cardiac arrest and resuscitation was performed immediately with an automatic external defibrillator. After five DC shocks the patient was successfully resuscitated. According to heteroanamnestic information he has taken designer drugs a few hours prior to the incident. The patient was taken to the PCI centre on duty and during the acute coronary angiography normal coronary arteries were observed. Transthoracic echocardiography showed preserved left ventricular systolic function. Several etiologic factors have arisen in the background of circulatory arrest, but the real cause remained unclear.
Our patient arrived at the Heart and Vascular Centre after post-resuscitation therapy for further cardiac evaluation and consideration of an ICD device implantation. Upon his admission his resting 12-lead ECG showed that there was a right bundle branch block, ST-segment elevation and Q-wave in precordial V1 and V2 leads. For the etiological clarification we performed a cardiac magnetic resonance (CMR) examination, which showed typical signs of acute septal myocardial infarction.
Our case highlights that normal coronary angiography does not exclude acute myocardial infarction. In case of differential diagnostic difficulties despite of the routinely preformed diagnostic tests, CMR can help to clarify the diagnosis.