Abstract 16538: Heads or Tails?
Objective: We present the case of a 61-year-old female who presented with cardiac arrest and was diagnosed with hypertrophic obstructive cardiomyopathy and anomalous right coronary artery.
Background: Hypertrophic cardiomyopathy (HCM) and anomalous coronary arteries are rare conditions that are frequently asymptomatic but may produce highly variable symptoms including dyspnea, chest discomfort, syncope, and ventricular arrhythmias/sudden cardiac death.
Case: A 61-year-old female health insurance worker, with a history of hypertension, asthma and obesity had a witnessed cardiac arrest at work and was resuscitated and defibrillated by a colleague. She sustained a cervical spine fracture and diaphragmatic paralysis as a result, without serious anoxic brain injury or multi-organ failure. She had a history of syncope, three weeks prior, with abnormal echocardiogram showing likely HCM (ejection fraction 65%, left ventricular hypertrophy, left ventricular outflow tract obstruction, mild systolic anterior motion of the mitral valve leaflet). Coronary and computed tomography angiography revealed an anomalous right coronary artery (RCA) originating from the left sinus of Valsava and traversing between the ascending aorta and main pulmonary artery. An implantable cardioverter defibrillator was placed and she was discharged on metoprolol.
Discussion: Both HCM and anomalous RCA origin are infrequent conditions that may cause ventricular arrhythmias and sudden cardiac death. This patient had non-exertional syncope and subsequent cardiac arrest highlighting the need for providers to consider rare but potentially treatable causes of fatal arrhythmias. Therapy for HCM consists of beta-blockers, calcium channel blockers, disopyramide, surgical myectomy or alcohol septal ablation. Anomalous RCA origin is usually managed with surgical bypass or “unroofing”. The coexistence of these distinct clinical entities is exceedingly rare and led to challenging decision-making and management.
Author Disclosures: A. Singhvi: None. S. Shah: None. J. Frank: None. M.P. Hudson: None.
- © 2014 by American Heart Association, Inc.