Cardiac arrest in a young marathon runner

Abstract

A 28-year-old man had a cardiac arrest upon finishing a marathon in October, 2000. When he collapsed at the finish line, he was found to be in ventricular fibrillation, and a 45 min resuscitation effort including multiple defibrillations and intravenous epinephrine eventually restored sinus rhythm. He was transferred, comatose, to hospital where coronary angiography showed normal coronary arteries; an echocardiogram showed no structural cardiovascular disease and normal ventricular function. Blood tests showed metabolic acidosis, renal insufficiency, and raised creatinine kinase; 1272 U/L (NR: 29–235 U/L), potassium; 4·8 mEq/L and calcium; 2·4 mmol/L. 3 h later serum potassium was 7·4 mEq/L and calcium was 1·3 mmol/L, and the following morning creatinine kinase was 280 000 U/L. Compartment syndrome developed in both legs, and he had bilateral 4-compartment fasciotomies, but gangrene necessitated amputation of the right leg below the knee. The patient was transferred to another hospital where we excluded arrythmogenic right ventricular dysplasia by electron beam computed tomography and magnetic resonance imaging. An electrophysiologic study showed no signs of inducible ventricular arrhythmias but given the patient's youth and the circumstances of his cardiac arrest, we inserted an implantable cardioverter-defibrillator. Once the patient's neurologic status improved, he confirmed that he had had no problems running marathons previously, and had no medical history of note, but he did admit to having taken a nonsteroidal anti-inflammatory drug (NSAID) before the race for symptoms of a viral illness. His was discharged 8 weeks later, having fully recovered both neurologic and renal function.