Sudden cardiac arrest in an epicardial paced-dependent child: watch out, it’s a pitfall!

Abstract Coronary artery compression by epicardial leads is a rare complication in children and can be difficult to identify with potentially lethal outcomes. Herein, we report the case of a previously asymptomatic paced-dependant 5-year-old girl who presented to our institution with resuscitated cardiac arrest. We describe the atypical sequence of clinical findings misleading initial diagnosis. Hardware failure and the commonly occurring lead fracture were incriminated in the mechanism of cardiac arrest, precipitating implantation of a new pacing system while concealing dynamic compression of the left anterior descending coronary artery.

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Sudden Cardiac Arrest During Computed Tomography Examination: Clinical Findings and “Dense Abdominal Veins” on Computed Tomography

Journal of Computer Assisted Tomography ◽

10.1097/00004728-200301000-00017 ◽

2003 ◽

Vol 27 (1) ◽

pp. 93-97 ◽

Cited By ~ 12

Author(s):

Sheung-Fat Ko ◽

Shu-Hang Ng ◽

Min-Chi Chen ◽

Tze-Yu Lee ◽

Chung-Cheng Huang ◽

...

Keyword(s):

Computed Tomography ◽

Cardiac Arrest ◽

Sudden Cardiac Arrest ◽

Clinical Findings

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Sudden Cardiac Arrest in Adult Due to Anomalous Origin of Left Main Coronary Artery From Pulmonary Artery

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2018.09.025 ◽

2018 ◽

Vol 11 (24) ◽

pp. e203-e205

Author(s):

Bharat Marwaha ◽

Owais Idris ◽

Mobasser Mahmood ◽

Archana Gundabolu ◽

Syed Sohail Ali ◽

...

Keyword(s):

Cardiac Arrest ◽

Coronary Artery ◽

Pulmonary Artery ◽

Left Main Coronary Artery ◽

Sudden Cardiac Arrest ◽

Anomalous Origin ◽

Left Main

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P269 When sudden cardiac death is the first symptom

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.127 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

J Abdala Lizarraga ◽

S Sanchez Alvarez ◽

P Garcia Gonzalez ◽

B Trejo Velasco ◽

V Vidal Urrutia ◽

...

Keyword(s):

Cardiac Arrest ◽

Coronary Artery ◽

Physical Exercise ◽

Left Main Coronary Artery ◽

Sudden Cardiac Arrest ◽

Anomalous Origin ◽

Moderate Intensity ◽

Sinus Of Valsalva ◽

Left Main ◽

The Right

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

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Familial clustering of cardiac conditions in patients with anomalous aortic origin of a coronary artery and myocardial bridges

Cardiology in the Young ◽

10.1017/s1047951118000835 ◽

2018 ◽

Vol 28 (9) ◽

pp. 1099-1105 ◽

Cited By ~ 1

Author(s):

Hitesh Agrawal ◽

Carlos M. Mery ◽

S. Kristen Sexson Tejtel ◽

Charles D. Fraser ◽

E. Dean McKenzie ◽

...

Keyword(s):

Coronary Artery Disease ◽

Cardiac Arrest ◽

Coronary Artery ◽

Family History ◽

Positive Family History ◽

Sudden Cardiac Arrest ◽

Coronary Anomalies ◽

Myocardial Bridge ◽

Familial Clustering ◽

Artery Disease

AbstractBackgroundAnomalous aortic origin of a coronary artery is the second leading cause of sudden cardiac arrest/death in young athletes in the United States of America. Limited data are available regarding family history in this patient population.MethodsPatients were evaluated prospectively from 12/2012 to 02/2017 in the Coronary Anomalies Program at Texas Children’s Hospital. Relevant family history included the presence of CHD, sudden cardiac arrest/death, arrhythmia/pacemaker use, cardiomyopathy, and atherosclerotic coronary artery disease before the age of 50 years. The presence of one or more of these in 1st- or 2nd-degree relatives was considered significant.ResultsOf 168 unrelated probands (171 patients total) included, 36 (21%) had significant family history involving 19 (53%) 1st-degree and 17 (47%) 2nd-degree relatives. Positive family history led to cardiology referral in nine (5%) patients and the presence of abnormal tests/symptoms in the remaining patients. Coronary anomalies in probands with positive family history were anomalous right (27), anomalous left (five), single right coronary artery (two), myocardial bridge (one), and anomalous circumflex coronary artery (one). Conditions present in their family members included sudden cardiac arrest/death (15, 42%), atherosclerotic coronary artery disease (14, 39%), cardiomyopathy (12, 33%), CHD (11, 31%), coronary anomalies (3, 8%), myocardial bridge (1, 3%), long-QT syndrome (2, 6%), and Wolff–Parkinson–White (1, 3%).ConclusionIn patients with anomalous aortic origin of a coronary artery and/or myocardial bridges, there appears to be familial clustering of cardiac diseases in approximately 20% of patients, half of these with early occurrence of sudden cardiac arrest/death in the family.

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