Survived Sudden Cardiac Death in a Young Marathon Runner

Abstract

A healthy man, aged 20 years, experienced sudden cardiac death caused by ventricular fibrillation while running a half marathon. Cardiopulmonary resuscitation was initiated within 2 minutes of latency and was continued for 9 minutes with return of spontaneous circulation after defibrillation. The ECG showed ST-elevations in leads II, III, and aVF (Figure 1). Figure 1. Initial ECG with ST-elevations up to 0.2 mV in leads II, III, aVF, and subsequent ECG with normalized ST-elevations and T negativity in II, III, and aVF. A coronary artery disease could be excluded by coronary angiography. The left coronary artery had its orthotopic source on the left coronary cusp and arose anatomically regular with identification of a myocardial bridge in segment 7 (Figure 2 and Movies I and II in the online-only Data Supplement). The right coronary artery (RCA) arose atypically from the left coronary cusp. The proximal segment of the RCA was slightly narrowed with a length of 11 mm (Figure 3). The intubation of the RCA proved to be atypical. However, all of the coronary arteries showed thrombolysis in myocardial infarction 3 flow. No atherosclerotic lesions were detected (Figure 4 and Movies III through VII in the online-only Data Supplement). Figure 2. Myocardial bridge (right …