Cause Of Sudden Cardiac Death Research Articles

Dilated phase of hypertrophic cardiomyopathy: A postmortem diagnosis

Cardiac pathology is one of the leading causes for global morbidity and mortality. Coronary heart disease is the commonest causes of sudden cardiac death throughout the world. Also, hypertrophic and dilated cardiomyopathies were recognized independently as the causes of sudden cardiac death in adults and elderly persons. However, progression of hypertrophic cardiomyopathy to a dilated cardiomyopathy resulting in death is less commonly reported. Herein, we discuss a case of hypertrophic cardiomyopathy with features of dilatation of the cardiac chambers in an adult male which was diagnosed during the postmortem examination.

Risk of sudden cardiac death and preventive measures in athletes

Arrhythmias, which are fatal in some patients, can be triggered by sports in vulnerable people. It is estimated that 1:40,000–1:250,000 athletes will suffer a sudden cardiac death (SCD). However, female athletes appear to have some level of cardiac protection, since suffering from SCD considerably less than male athletes during sports. Athletes with underlying coronary, valvular or myocardial disease, as well as channelopathies, may be particularly prone to SCD from exercise- and sports-related physical activity. There are three main causes of SCD in young athletes: Sudden Arrhythmic Death Syndrome (56%), congenital anomalous coronary arteries (7%–14%), and hypertrophic cardiomyopathy (36%–48%). In the context of exercise, acute ischemia, myocardial infarction, and stroke risk are increased by catecholamine surge and exercise-induced stress. In middle-aged athletes, excessive cardiovascular activity is associated with a higher risk of mortality related to cardiovascular disease. It is possible to detect at-risk athletes by conducting cardiac screening, which involves a family history, physical examination, and a resting electrocardiogram. Consequently, efforts have been made to better understand the causes of SCD in athletes and to develop appropriate prevention methods.

Detection of Premature Ventricular Contractions using 12-lead Dynamic ECG based on Squeeze-Excitation Residual Network

Premature ventricular contraction (PVC) is a very common arrhythmia that can originate in any part of the ventricle and is one of the important causes of sudden cardiac death. Timely and rapid detection of PVC on dynamic electrocardiogram (ECG) recording for patients with cardiovascular diseases is of great significance for clinical diagnosis. Furthermore, it can facilitate the planning and execution of radiofrequency ablation. But the dynamic ECGs can be easily contaminated by various noises and its morphological characteristics show significant variations for different patients. Though the deep learning methods achieved outstanding performance in ECG automatic recognition, there are still some limitations, such as overfitting, gradient disappearance or gradient explosion in deep networks. Therefore, a residual module is constructed using the squeeze-excitation method to alleviate the problems. A 20-layer squeeze-extraction residual network (SE-ResNet) containing multiple squeeze-extraction modules was designed for real-time PVC detection on 12-lead dynamic ECG. The algorithm was evaluated using the dynamic 12-lead ECGs in INCART database (168,379 heartbeats in total). The experimental results show that the test accuracy of the method proposed in this paper is 98.71%, and the specificity and sensitivity of PVC are 99.12% and 99.59%, respectively. Under the same dataset and experimental platform, the average recognition accuracy of our proposed method is increased by 0.73%, 1.55%, 2.9% and 1.65% compared with the results obtained by CNN, Inception, AlexNet and deep multilayer perceptron, respectively. The proposed scheme provides a new method for real-time detection of PVC on dynamic 12-lead ECGs. The experiment results show that the proposed method outperforms state-of-the-art methods, and has good potential for clinical applications.

Hypertrophic Obstructive Cardiomyopathy with SAM Phenomenon: A Case Report and Literature Review

Hypertrophic cardiomyopathy (HCM) is defined by the presence of left ventricular hypertrophy (LVH) in the absence of other potentially causative cardiac, systemic, syndromic, or metabolic diseases [1]. It is the most common genetic abnormality of the myocardium, with an anaesthetized prevalence ranging from 1:500 to as high as 1:200 [2-4]. It is the primary cause of sudden cardiac death (SCD) among teenagers and athletes. A 56-year-old man presented with chest tightness and palpitations which had been occurring post-activity for the previous 6 months. The patient was advised to be admitted. He underwent echocardiography, cardiac magnetic resonance (CMR), coronary angiography (CAG) examination, and left ventriculography. He was diagnosed with hypertrophic obstructive cardiomyopathy (HOCM) with systolic anterior motion (SAM) phenomenon. Echocardiography results showed that the interventricular septal thickness was 14-16 mm and that there were 2 degrees of SAM of the mitral valve. This resulted in severe stenosis of the left ventricular outflow tract (LVOT) and moderate to severe mitral insufficiency. Left ventriculography confirmed mitral regurgitation (MR) associated with HOCM with SAM phenomenon. Under the protection of a permanent pacemaker, the patient was treated with alcohol septal ablation (ASA). After discharge, the symptoms of chest tightness and palpitation did not recur. Beneficial effects were observed when patients with HOCM and SAM were treated with ASA under the condition of a permanent pacemaker.

HISTOMORPHOLOGICAL SPECTRUM OF VARIOUS CARDIAC CHANGES IN SUDDEN DEATH: AN AUTOPSYSTUDY

INTRODUCTION : Cardiovascular disease (including coronary artery disease, stroke and peripheral vascular disease) is no.1 cause of worldwide mortality, with about 80% of burden occurring in developing countries. Sudden cardiac death is dened as unexpected death from cardiac causes either without symptoms or within 1-24 hours of onset of symptoms(1). The common cause of sudden cardiac death is ischaemic heart disease. Non ischaemic sudden cardiac death occurs in hypertrophic obstructive cardiomyopathy and in severe left ventricular hypertrophy(2). The purpose of this study will be to determine the causes of sudden death and observe the spectrum of morphological and histopathological changes in heart after sudden death. MATERIALS AND METHODS: This autopsy study was conducted on 121 cases of sudden death over a period extending from January 2019 to August 2020 in autopsy section of Pathology department of BJGMC, Pune. In this autopsy study hearts of patients with a history of sudden death were evaluated for histological and morphological changes. Each heart was grossed adopting the inow outow method and short axis method. Staining solutions used were Solution A: Alum Hematoxylin and Solution B: 1% Eosin Y. OBSERVATIONS : 50 (41.32%) cases out of 121 cases had coronary artery disease along with myocardial infarction of which 43 cases were males and 7 cases were females. No cardiac aetiology was found in 23.96% cases. Coronary artery disease was independently seen in 14.87% cases. Left ventricular concentric hypertrophy was noted in 4.13% cases. Myocardial infarction independently was noted in 3.30%cases, Myocarditis in 2.47% cases, myocarditis with pericarditis in 1.65% cases, HOCM, lipoma, mitral stenosis, pericarditis, septic infarct, secondaries of adenocarcinoma, early vegetation and small vessel disease in 0.82% cases. Calcic aortic stenosis was demonstrated in 1 case. Brown atrophy was demonstrated in 1 case. DISCUSSION : Out of 69 cases of coronary artery disease calcication was commonly seen in 34(49.27%) cases. 47(82.45%) (M-39,l F-8) out of 57 cases of myocardial infarction demonstrated chronic or old infarct. Single vessel involvement was most common in which left anterior descending coronary artery was signicantly involved in 68.75 % cases. Posterior wall was most commonly involved by myocardial infarction which included posterior, posteroseptal, and posterolateral infarcts.

Вероятность желудочковой экстрасистолии высоких градаций у пациентов с хронической сердечной недостаточностью в коморбидности с хронической обструктивной болезнью легких

Ventricular arrhythmias, including extrasystoles, are among the leading causes of sudden cardiac death, including in patients with chronic heart failure, therefore, the identification of ventricular extrasystoles (VE) of high gradations, as well as the prediction of adverse cardiovascular events (ACE) in this group of patients remain the priority tasks of cardiology. The purpose — to develop an integrative model of the probability of high-grade ventricular extrasystoles in patients with chronic heart failure (CHF) in association with chronic obstructive pulmonary disease (COPD). Material and methods. 134 patients with CHF and ischemic heart disease were included, 67 of them also suffering from COPD (groups 1 and 2). All patients underwent the following examinations: 6-minute walking test, assessment of clinical status, assessment of life quality by Minnesota scale, examination of respiratory function, echocardiography, and daily electrocardiogram monitoring. The classification of ventricular extrasystoles by Ryan M. (1975) in McKenna W. modification was used. Ventricular extrasystoles grade IIIА and higher were classified as high grade extrasystoles. To develop a model for predicting high-grade ventricular extrasystoles, the method of binary logistic regression was used. Results. No significant differences were found for functional class (FC) of CHF, walking test results, and gender. The average number of VE in the CHF group was 7 [0; 232.0] per day, while with CHF in combination with COPD — 27 [2.0; 292.0], (p = 0.142). The structure in the patients with CHF differed from those with CHF combined with COPD. So, in the CHF group, there was no VE in 30 people (44.8%), grade 1–2 was observed in 17 people (25.4%), grade 3А and higher — in 20 people (29.8%). In patients with CHF in combination with COPD, VE was absent in 17 people (25.4%), grade 1–2 was observed in 22 people (32.8%), 3А and above — in 28 people (41.8%). In patients with CHF in combination with COPD, VE was less often absent (chi-square = 5.54, p = 0.018). In the CHF group, correlations were found between the number of VE and the male gender (r = -0.31, p <0.05), age (r = 0.30, p <0.05), end diastolic volume (r = 0.51, p <0.05), end systolic volume (r = 0.54, p <0.05), end diastolic size (r = 0.36, p <0.05), end systolic size (r = 0, 51, p <0.05), left ventricular ejection fraction (r = -0.52, p <0.05), and left ventricle myocardium mass (r = 0.52, p <0.05). In the CHF group in combination with COPD, correlations were different. We found correlations between the number of premature ventricular contractions and male gender (r = -0.34, p <0.05), forced expiratory volume in the first second (r = -0.34, p <0.05), forced vital capacity of the lungs (r = -0.27, p <0.05), minute volumetric velocities during exhalation of 25% (r = -0.25, p <0.05) and 50% (r = -0.31 , p <0.05), end diastolic size (r = 0.43, p <0.05), end systolic size (r = 0.50, p <0.05), and left atrial size (r = 0, 29, p <0.05). According to the obtained data, in the CHF with COPD group, the predictors of high grade VE are of forced expiratory volume in the first second (р = 0,004, Wald = 8,22) and the end diastolic size of the left ventricle (р=0,027, Wald=4,90). Conclusion. The results of the study demonstrated that in CHF and CHF in combination with COPD, the predictors of high grade ventricular extrasystoles are different. Thus, in CHF, the parameters of echocardioscopy are interrelated to a greater extent with ventricular extrasystoles, and in the combination of CHF and COPD, spirometry parameters, which probably leads to unfavorable outcomes and requires an integral approach to patient management tactics and stratification of the risk of adverse events.

Prevention and Management of Sudden Cardiac Death in Athletes

Sudden cardiac death (SCD) is the biggest challenge of all sports emergencies, as it is the leading cause of preventable deaths in both professional and recreational athletes. There is also an ongoing concern about COVID-19-associated cardiac pathology among athletes because myocarditis is an important cause of SCD during exercise. Hypertrophic cardiomyopathy represents 24% of SCD and Sudden Unexplained Death (normal heart at autopsy) represents 34% of SCD. To make sports participation safer, it is important to synergistically combine primary prevention of SCD by pre-participation identification of athletes affected by at-risk cardiomyopathies and secondary prevention with backup defibrillation of unpredictable sudden cardiac arrest on the field. The prompt application of an automated external defibrillator itself is associated with a greater likelihood of survival. With the advancement in the field of sports cardiology, the implantation of implantable cardioverter defibrillator has been promising in getting the athlete back on the field including in contact sports. Hence, knowledge of primary and secondary prevention is of great importance in reducing the incidence of SCD as well as improvising existing strategies.

A Comparison of QT Interval Correction Methods on Electrocardiograms (ECG) of Athletes and Young People: A Systematic Review

Undiagnosed long QT syndrome is a potential cause of sudden cardiac death. QT interval varies with heart rates and is corrected (QTc) using one of several algorithms. Heart rate variability and sinus bradycardia is common in athletes and young people. Currently, international guidelines for athlete ECG interpretation recommend the use of Bazett’s formula for QTc (QTcB).

Medikal Tedavi ile İyileşen Yaygın, İdiyopatik, Tekrarlayan Spontan Koroner Arter Diseksiyonu

Spontaneous coronary artery dissection is a rare cause of sudden cardiac death and acute coronary syndrome, and mainly affects young female. Treatment of this condition depends on the clinical features, hemodynamic and angiographic findings of the patient, but due to the rarity of the disease, guideline support was insufficient until the last period. Depending on the condition of the patient and the coronary blood flow, medical observation, percutaneous coronary intervention or coronary artery bypass graft surgery are used in the treatment. We present a young female patient who underwent emergency coronary artery bypass graft surgery after spontaneous left main coronary artery dissection four years ago and was recently diagnosed with extensive spontaneous coronary artery dissection in her right coronary artery. After the diagnosis, the patient was given medical treatment and recovered completely.

On-device artificial intelligence: mobile solution for detecting severe aortic valve stenosis based on heart sounds

Abstract Background Aortic stenosis is still one of the major causes of sudden cardiac death in the elderly. Noninvasive screening for severe aortic valve stenosis (AS) may result in early cardiac diagnostic leading to an appropriate and timely medical intervention. Purpose The aims of this study were 1) to develop an artificial intelligence to detect severe AS based on heart sounds and 2) to build an application to screen patients using electronic stethoscope and smartphones, which will provide an efficient diagnostic workflow for screening as a complementary tool in daily clinical practice. Methods We enrolled 100 patients diagnosed with severe AS and 200 patients without severe AS (no echocardiographic sign of AS [n=100], mild AS [n=50], moderate AS [n=50]). The heart sounds were recorded in 4000 Hz waveform audio format at the following 3 sites of each patient; the 2nd intercostal right sternal border, the Erb's area and the apex. Each record was divided into multiple data of 4 seconds duration, which built 10800 sound records in total. We developed multiple convolutional neural networks (CNN) designed to recognize severe AS in heart sounds according to the recorded 3 sites. We adopted a stratified 4-fold cross-validation method by which the CNN was trained with 60% of the whole data, validated with 20% data and tested with the remaining 20% data not used during training and validation. As performance metrics we adopted the accuracy, F1 value and the area under the curve (AUC) calculated as the average of all cross-validation folds. For the smartphone application, we combined the best CNN-models from each recorded site for the best performance. Further 40 patients were newly enrolled for its clinical validation (no AS [n=10], mild AS [n=10], moderate AS [n=10], severe AS [n=10]). Results The accuracy, F1 value and AUC of each model were 88.9±5.7%, 0.888±0.006 and 0.953±0.008, respectively. The sensitivity and specificity were 87.9±2.2% and 89.9±2.4%. The recognition accuracy of moderate AS was significantly lower as compared to the other AS grades (moderate AS 74.1±6.1% vs no AS 98.0±1.4%, mild AS 97.6±1.2%, severe AS 87.9±2.2%, respectively, P<0.05). Our smartphone application showed a sensitivity of 100% (10/10), a specificity of 73.3% (22/30), and an accuracy of 80.0% (32/40), which implicated a good utility for screening. In the detailed analysis of 8 mistaken decisions, these were highly affected by the presence of severe mitral or tricuspid valve regurgitation despite of non-severe AS (7/8 [87.5%]). Conclusions This study demonstrated the promising possibility of an end-to-end screening for severe aortic valve stenosis using an electronic stethoscope and a smartphone application. This technology may improve the efficacy of daily medicine particularly where the human resource is limited or support a remote medical consultation. Further investigations are necessary to increase accuracy. Funding Acknowledgement Type of funding sources: None.

Prediction and classification of ventricular arrhythmia based on phase-space reconstruction and fuzzy c-means clustering

Background and objectivePrediction and classification of Ventricular Arrhythmias (VA) may allow clinicians sufficient time to intervene for stopping its escalation to Sudden Cardiac Death (SCD). This paper proposes a novel method for predicting VA and classifying its type, in particular, the fatal VA even before the event occurs. MethodsA statistical index J based on the combination of phase-space reconstruction (PSR) and box counting has been used to predict VA. The fuzzy c-means (FCM) clustering technique is applied for the classification of impending VA. Results32 healthy and 32 arrhythmic subjects from two open databases - PTB Diagnostic database (PTBDB) and CU Ventricular Tachyarrhythmia (CUDB) database respectively; were used to validate our proposed method. Our method showed average prediction time of approximately 5 min (4.97 min) for impending VA in the tested dataset while classifying four types of VA (VA without ventricular premature beats (VPBs), ventricular fibrillation (VF), ventricular tachycardia (VT), and VT followed by VF) with an average 4 min (approximately) before the VA onset, i.e., after 1 min of the prediction time point with average accuracy of 98.4%, a sensitivity of 97.5% and specificity of 99.1%. ConclusionsThe results obtained can be used in clinical practice after rigorous clinical trial to advance technologies such as implantable cardioverter defibrillator (ICD) that can help to preempt the occurrence of fatal ventricular arrhythmia - a main cause of SCD.

Identifying Vulnerable Impact Locations to Reduce the Occurrence of Deadly Commotio Cordis Events in Children's Baseball: A Computational Approach.

Commotio cordis is the second leading cause of sudden cardiac death in young athletes. Currently available chest protectors on the market are ineffective in preventing cases of commotio cordis in young athletes who play baseball. This study focused on using contour maps to identify specific baseball impact locations to the chest that may result in instances of commotio cordis to children during baseball games. By identifying these vulnerable locations, we may design and develop chest protectors that can provide maximum protection to prevent commotio cordis in young athletes. Simulation cases were run using the validated CHARM-10 chest model, a detailed finite element model representing an average 10-year-old child's chest. A baseball model was developed in company with the chest model, and then used to impact the chest at different locations. A 7 × 8 impact location matrix was designed with 56 unique baseball impact simulations. Left ventricle strain and pressure, reaction force between the baseball and chest, and rib deformations were analyzed. Left ventricle strain was highest from baseball impacts directly over the left ventricle (0.34) as well as impacts slightly lateral and superior to the cardiac silhouette (0.34). Left ventricle pressure was highest with impacts directly over the left ventricle (82.94 kPa). We have identified the most dangerous impact locations resulting in high left ventricle strain and pressure. This novel study provided evidence of where to emphasize protective materials for establishing effective chest protectors that will minimize instances of commotio cordis in young athletes.

Mutational spectrum of congenital long QT syndrome in Turkey; identification of 12 novel mutations across KCNQ1, KCNH2, SCN5A, KCNJ2, CACNA1C, andCALM1.

Long QT syndrome (LQTS) is of great importance as it is the most common cause of sudden cardiac death in childhood. The diagnosis is made by the prolongation of the QTc interval on the electrocardiography. However, clinical heterogeneity and nondiagnostic QTc intervals may cause a delay in the diagnosis. In such cases, genetic tests such as next-generation sequencing (NGS) panel analysis enable a definitive diagnosis. We present the first study that aimed to expand the LQTS's mutational spectrum by NGS panel analysis from Turkey. Fifty-seven unrelated patients with clinically diagnosed LQTS were investigated using an NGS panel that includes six LQTS-related genes. Clinical aspects, outcome, and molecular analysis results were reviewed. Pathogenic (53%)/likely pathogenic (23%)/variant of unknown significance (4%) variants were detected in any of the genes examined in 79% of the patients. Among all detected variants, KCNQ1(71%) was the most common gene, followed by SCN5A (11%), KCNH2 (10%), CALM1 (5%), and CACNA1C (3%). Twelve novel variants were detected. Among the variants in KCNQ1, the c.1097G>A variant was present in 42% of patients. This variant also composed 31% of the variants detected in all of the genes. Our study expands the spectrum of the variations associated with LQTS with twelve novel variants in five genes. And also it draws attention to the frequency of the KCNQ1 c.1097G>A variant and forms the basis for new studies to determine the possible founder effect in the Turkish population. Furthermore, identifying new variants and clinical findings has importance in elaborating the roles of related genes in pathophysiology and determining the variable expression and incomplete penetration rates in this syndrome.

218 Coronary artery disease in athletes: a case report

Abstract Aims Despite the proven benefits of regular physical exercise, and although sportsmen are the paradigm of healthy individuals, the athletes population is not risk-free and can suffer severe clinical conditions including coronary artery disease (CAD) and sudden cardiac death (SCD). Identification of athletes with higher cardiovascular risk is a crucial goal of pre-participation screening. Methods and results In this report, we discuss the case of a 79-year-old male. He was a cyclist, who performed a visit to the sports doctor to have issued a certificate for competitive fitness. He was dyslipidaemic, hypertensive, diabetic, and he reported no symptoms. The patient’s ECG revealed an advanced second-degree atrioventricular block. For this reason, he was admitted to the emergency department and he underwent urgent coronary angiography and a temporary Pacemaker. Indeed, a diagnosis of bivasal coronary artery disease was made, and for the first time the patient was subjected to angioplasty of the anterior descending branch and circumflex branch. Subsequently, for the persistence of bradyarrhythmia, he was subjected to a definitive Pacemaker implant. Conclusions The benefits of exercise in the overall population are multiple and indisputable, but in athletes with cardiovascular disease exercise can also be associated with adverse clinical events, including SCD. In veterans, a growing group of athletes, CAD is the most common cause of SCD. Detection of subclinical CAD should be the main objective of veteran athlete screening, since the performance of classical cardiovascular risk stratification based on clinical factors appears to be suboptimal.

430 Diagnosis and management of a case of biventricular arrhythmogenic cardiomyopathy: a case report

Abstract Arrhythmogenic cardiomyopathy (ACM) is a genetically determined heart muscle disorder characterized by fibro-fatty replacement of myocardium which may affect the right ventricle (‘dominant right’ variant), the left ventricle (‘dominant left’ variant) or both (‘biventricular disease’ variant). Despite of ACM is one of the main causes of sudden cardiac death (SCD) in young people and athletes as well, the diagnosis of this complex clinical entity still remains a challenge. We report on a case of a 29 years old non-athletic woman with family history of SCD and a long-standing personal history of palpitations leading to frequent accesses to the Accident & Emergency Department. Her echocardiogram was normal while twelve leads ECG revealed negative T waves in the right precordial leads (V1–V3) and post-excitation epsilon waves. ECG Holter monitoring recorded frequent (up to 17 000 in 24 h) polymorphic premature ventricular contractions (PVCs) seldom organized in couplets or triplets. She was followed-up in our clinic and started on Propanolol 40 mg bid with slight relief of symptoms and reduction of PVCs. Cardiac magnetic resonance (CMR) showed regional dyskinesia of both ventricles and RV dilatation. Moreover, tissue characterization findings revealed the presence of diffuse subepicardial late gadolinium enhancement (LGE) of the LV. Genetic analysis was performed and a variant of uncertain significance (VUS) in Desmoplakin was identified. Non sustained monomorphic ventricular tachycardia was induced during electrophysiologic study by programmed ventricular stimulation. In light of these results, we diagnosed biventricular ACM and, after carefully discussion with the patient, a subcutaneous implantable cardioverter defibrillator (ICD) was implanted. The present case should be a persisting reminder that must be considered more than just a single diagnostic tool when dealing with arrhythmic presentations especially in young patients and the importance of contrast CMR along with genetic testing in order to aid clinicians in the demanding selection of the best candidates for ICD implantation.

462 Accidental detection of an anomalous origin of the coronary arteries in a patient with STEMI: a case report

Abstract Coronary artery anomalies and variants are relatively uncommon congenital disorders of the coronary artery anatomy and constitute the second most common cause of sudden cardiac death in young competitive athletes. Normally there are two main coronary arteries, which stem from the sinuses of Valsalva and descend towards the cardiac apex. The most frequent anomalous origin of the coronary arteries associated with sudden cardiac death is the anomalous origin of a coronary artery from the contralateral sinus, particularly if the anomalous coronary artery has a course between the aorta and the pulmonary artery. The diagnosis of a coronary artery anomaly is insidious since patients are usually asymptomatic. Indeed, in most of the cases, coronary anomalies are discovered incidentally during coronary angiography or on autopsy following sudden cardiac death. However, in some cases, symptoms like angina, syncope, heart failure, and myocardial infarction may occur. We want to describe the case of a 54 years old man who went to another hospital of our district with chest pain. The EKG showed an infero-lateral STEMI. The patient underwent systemic thrombolysis complicated by arrhythmic storm, treated with effective DC shock, then he was urgently transferred to our Hospital to perform a PCI rescue. The coronary angiography showed a critical stenosis of the right coronary artery, treated with the implantation of a zotarolimus-eluting coronary stent system. Surprisingly, an abnormal origin of the anterior interventricular artery and circumflex artery from seperated hosts in the right coronary sinus was detected. A computed tomography showed the separated origin of the right coronary artery and the left main from the right coronary sinus; moreover, the left main presented a retroaortic course between the bulb and the left atrium; the left anterior intraventricular artery run anterior to the aortic root. During hospitalization, a diagnosis of diabetes was made with consequent setting of adequate hypoglycemic therapy. Serial echocardiograms showed an improval in the ejection fraction (from 35–40% to 50%). The patient was discharged in well clinical conditions and 1 month later at the follow-up, during an outpatient visit, he was fully asymptomatic. The dynamic EKG according to Holter showed rare isolated ventricular beats; laboratory tests were normal. The anomalous origin of a coronary ostium from the contralateral sinus is the most frequently anomaly which is associated with sudden cardiac death, in particular when the left coronary artery origins from the right sinus. The rapid advancement of the imaging techniques, including CT, CMR, intravascular ultrasound, and optical coherence tomography, have provided us with a wealth of new information on this subject. Coronary artery CT offers the best performance in terms of spatial resolution, acquisition time, and image contrast but the use is limited due the dose of ionizing radiation and the use of contrast agents, in particular taking into account that most patients are young. CMR is capable of visualizing the origin of the coronary arteries non-invasively, without use of ionizing radiation and contrast agents. Currently however, due to spatial resolution, the capability of CMR to visualize smaller coronary branches is still a limiting factor preventing full assessment of coronary arteries using this modality. Developments and more widespread access to advanced cardiac imaging will undoubtedly lead to earlier diagnoses. The taxonomies of the anomalous origin of coronary arteries are inconsistent and complex and so we want to make our contribution to the register of cases of abnormal origin of coronary arteries for the risk of sudden cardiac death and ischaemic events related to.

A Case of Malignant Right Coronary Artery: Frequent Angina in Young Person

Highlight:A young adult has activity-triggered atypical chest pain and diagnosed malignant RCA.Congenital anomalies needed to be aware by cardiologists to help clinical practice.Planning a treatment about management of the CAAs condition should be undertaken by the inter-specialist team. Abstract:We presented a case a young adult with activity-triggered atypical chest pain and diagnosed with anomalous origin of right coronary artery (RCA) from the left coronary sinus with an interarterial course between the aorta and the main pulmonary artery that was detected by CT coronary angiography. This anomaly has been called malignant RCA. Coronary artery anomaly is a congenital condition. Most of the cases remain asymptomatic. This condition is also one of the most causes of sudden cardiac death, because the coronary artery examination is not regularly done. Nevertheless, during high intensity activity, it could be symptomatic and might be lethal. Diagnosing coronary artery anomalies might be tricky and cardiologists must be aware of this. The CAAs condition is a rare situation. The CAAs condition is associated with sudden death, especially intense physical activity. There was no rigid guideline for the management of the CAAs condition, so that planning a treatment in the inter-specialist team should be done.

Beware of the octopus trap: A case of mid-ventricular hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited disorder characterised by a genetic defect resulting in mutation of the sarcomere and consequently myocardial dysfunction. It has a prevalence of 1 in 500 and an important cause of sudden cardiac death. HCM has several variations, with asymmetric septal hypertrophy being most prevalent (90%) while mid-ventricular hypertrophy with apical aneurysm has rarely been reported.

CHARACTERISATION OF HYPERTROPHIC CARDIOMYOPATHY BY CARDIAC MAGNETIC RESONANCE IMAGING

Background: There are many causes of left ventricular hypertrophy which can result in arrhythmias and sudden cardiac death. Hypertrophic cardiomyopathy (HCM) is one of the commonly encountered cause of sudden cardiac death in young adults. Aim: Identifying the role of Cardiac MRI in characterising the diagnostic parameters of HCM. Materials and methods: 125 patients with clinical suspicion or genetic evidence of HCM referred for cardiac MRI between June 2013 to June 2021 were included under the study. Image interpretations were done by fellowship qualified cardiac imaging radiologist. Categorical variables were expressed using frequency and percentage. Numerical variables were presented using mean and standard deviation. Results: Out of the total population, 119 patients (95 %) had LV wall thickness > 13 mm, 48 patients (38.4%) had Left ventricle outflow tract obstruction (LVOTO) and 32 patients (25.6 %) had mid cavity obstruction, 39 patients (37.9 %) had myocardial scar > 15 % and asymmetric septal hypertrophy was the most frequently encountered left ventricle morphology Conclusion: Cardiac MRI detected HCM has a statistically significant association with the final diagnosis (histopathological and genetic correlation). CMRI hence serves as a reliable tool in identifying and characterising the various diagnostic and non- diagnostic parameters of HCM.

Electrocardiographic abnormalities and psychotropic polypharmacy in schizophrenia and schizoaffective disorders

Background: Sudden cardiac death (SCD) is a significant cause for increased mortality in people with schizophrenia and schizoaffective disorders. Cardiac arrhythmia is one cause of SCD. Electrocardiographic (ECG) abnormalities predictive of arrhythmias are associated with antipsychotic drug use. Method: This chart audit examined the types and frequency of ECG abnormalities (ECG-Abs) in 169 patients with schizophrenia and schizoaffective disorder in a long-stay inpatient unit. We examined the association of ECG-Abs with demographic details and psychotropic drug prescription using chi-square test, Fisher’s Exact test, independent two-sample t-test, Pearson’s correlation, and one-way ANOVA. Results: Eighty-eight patients (52.1%) recorded at least one ECG-Ab, and 20.7% had two or more ECG-Abs. The use of multiple antipsychotics, with or without other psychotropic drugs, did not associate significantly with the presence or number of ECG-Abs. Conclusion: A significant proportion of patients with schizophrenia and schizoaffective disorder have ECG-Abs other than prolonged QTc interval, which can predispose them to cardiac arrhythmias. The abnormalities were not limited to patients on psychotropic polypharmacy. ECG evaluation is indicated for all patients and should consider various electrical abnormalities to identify arrhythmia risk.