A Case of Sudden Cardiac Death in a Healthy, Athletic Woman
A 24-year-old female with no medical history was running when she suddenly collapsed. A bystander witnessed the event and immediately contacted emergency medical services who arrived in approximately three minutes. An automated external defibrillator is placed on the patient and the following rhythm is seen (Figure 1).
Figure 1: Initial rhythm strip in the field showing ventricular fibrillation
Cardiopulmonary resuscitation efforts are promptly started and an appropriate shock is delivered. The patient is rapidly transferred to the emergency department. After achieving hemodynamic stability, the patient's baseline electrocardiogram is obtained (Figure 2).
Figure 2: Initial 12-lead EKG showing sinus rhythm with a nonspecific intraventricular conduction block and ST and T wave abnormalities concerning for ischemia
Cardiology is promptly consulted for further evaluation including consideration for therapeutic hypothermia. The patient was brought to the cardiac catheterization lab for coronary angiography. Engagement of the left coronary ostium from the left coronary cusp proves challenging, warranting consideration of an anomalous left coronary artery. The following aortogram is obtained to help determine the origin of the left coronary artery (Figure 3).
Figure 3: Aortogram showing a suspected anomalous left main coronary artery with an intraarterial course and anterior "dot" sign
An anomalous left coronary artery with an inter-arterial course is suspected based on the presence of an anterior "dot" sign. Subsequent coronary computed tomography angiogramconfirm an anomalous left main coronary artery with a narrowed ostium and course between the aorta and pulmonary artery (Figures 4-5).
Figure 4: Coronary computed tomography angiogram showing an anomalous left main coronary artery with a narrowed ostium and coursing between the aorta and pulmonary artery
Figure 5: Coronary computed tomography angiogram showing an anomalous left main coronary artery with a narrowed ostium and coursing between the aorta and pulmonary artery
The patient is referred for surgical correction and undergoes a coronary unroofing procedure without complication.
After successful surgical repair, how long should the patient wait before discussing participation in sports?