1/424. Coronary artery aneurysms in a young adult: a case of sudden death. A late sequelae of Kawasaki disease? The case concerns the sudden death of a 21-year-old male during a soccer game. The autopsy revealed large, calcified saccular aneurysms at the origins of both the left anterior descending and the right coronary arteries. Histologically, the wall of the aneurysms was thin and composed of an internal fibro-calcified layer and an external thin tunica media. There was no evidence of active inflammation. The autopsy findings and a detailed medical history support the diagnosis of a late fatal sequela of Kawasaki disease. ( info) |
2/424. Anomalous left coronary artery arising from right sinus of valsalva could be a minor congenital anomaly--a case report and review of the literature. Left coronary artery arising from the right sinus of valsalva is a rare congenital coronary anomaly. This anomaly is either benign or serious, depending on the relation of the anomalous left coronary artery to the aorta and pulmonary artery. Potentially serious anomaly is associated with sudden cardiac death and warrants prophylactic coronary bypass surgery. A rare case of anomalous left coronary artery arising from the right sinus of valsalva is reported, documented by coronary angiography; however, it took a safer course between the aorta and pulmonary artery. Prophylactic surgery was not performed, for this benign anomaly may not carry the same risk of sudden cardiac death. ( info) |
3/424. Potential proarrhythmic effects of implantable cardioverter-defibrillators. Implantable cardioverter-defibrillator (ICD) interventions have the potential to be proarrhythmogenic. New arrhythmias can occur in the setting of clinically appropriate therapies, as well as during a cardiac rhythm for which therapy is not intended. Cardioversion/defibrillation therapies, antitachycardia pacing, and antibradycardia pacing are potential triggers for the development of new arrhythmias. Newer ICDs allow better recognition and interpretation of the arrhythmias that are induced by delivered therapies. Two cases of ICD-induced proarrhythmias are described. Based on the course of these patients and review of previous reports, proarrhythmic effects of ICD interventions along with prevention and management strategies are discussed. ( info) |
| A 35-year-old woman presented with dyspnea and chest pain. She had a large aneurysm of the non-coronary sinus of valsalva. Before her scheduled urgent surgery, the patient collapsed and died of cardiac tamponade secondary to intrapericardial rupture of the aneurysm. We would advocate urgent repair of this type of lesion to prevent such an outcome. We are aware of no other specific reports addressing extracardiac rupture of non-coronary cusp aneurysms [corrected]. ( info) |
5/424. Combining nonpharmacologic therapies for advanced heart failure: the Munster experience with the assist device-defibrillator combination. Implantable cardioverter defibrillators (ICDs) and ventricular assist devices (VADs) have been used as a bridge to cardiac transplantation. In selected patients, the combined implantation may be required. This study was motivated by a case of a 33-year-old female patient with giant cell myocarditis who died of ventricular tachyarrhythmias after having been placed on a VAD with which she had been treated on an out-of-hospital basis for a prolonged period of time. A subsequent retrospective analysis of our data showed that, of 73 patients who had to be bridged mechanically (54 Novacor, 12 TCI Heartmate, 4 Thoratec, 3 Medos) in our institution between 1993 and 1998, 10 patients had undergone defibrillator implantation either before (n = 8) or after (n = 2) implantation of a VAD. The cases are presented, and the feasibility of the combination therapy discussed. ( info) |
6/424. Sudden death in right ventricular dysplasia with minimal gross abnormalities. Arrhythmogenic right ventricular cardiomyopathy is emerging as a relatively common cause of exercise-induced sudden death in the young. The diagnostic criteria at autopsy are, however, not fully established, leading to both over- and underdiagnosis. We report a young man and a young woman dying suddenly of right ventricular dysplasia during exercise, in whom the gross autopsy findings in the right ventricle were minimal or even absent. However, the histologic features in both right and left ventricles were typical of the disease, and consisted of fibrofatty infiltrates with typical myocyte degeneration of the right ventricle and subepicardial regions of the left ventricle. These cases illustrate that microscopic findings are diagnostic and may be present in the absence of gross findings. Marked fat replacement is not essential for the diagnosis of right ventricular dysplasia, and the right ventricle should be extensively sampled histologically in all cases of sudden unexpected death, especially those that are exercise related. ( info) |
7/424. Procuring organs from a non-heart-beating cadaver: a case report. organ transplantation is an accepted therapy for major organ failure, but it depends on the availability of viable organs. Most organs transplanted in the U.S. come from either "brain-dead" or living related donors. Recently organ procurement from patients pronounced dead using cardiopulmonary criteria, so-called "non-heart-beating cadaver donors" (NHBCDs), has been reconsidered. In May 1992, the University of Pittsburgh Medical Center (UPMC) enacted a new, complicated policy for procuring organs from NHBCDs after the elective removal of life support. Seventeen months later only one patient has become a NHBCD. This article describes her case and the results of interviews with the health care team and the patient's family. The case and interviews are discussed in relation to several of the ethical concerns previously raised about the policy, including potential conflicts of interest, the definition of cardiopulmonary death, and a possible net decrease in organ donation. The conclusion is reached that organ procurement from non-heart-beating cadavers is feasible and may be desirable both for the patient's family and the health care providers. ( info) |
8/424. Sudden death associated with group A streptococcal infection in an 8-year-old girl with undiagnosed hypertrophic cardiomyopathy. An 8-year-old girl died suddenly without prior symptoms. Post-mortem examination identified both systemic group A streptococcal infection and hypertrophic cardiomyopathy. She had no history of cardiac symptoms and was not in a high-risk group for sudden death due to hypertrophic cardiomyopathy. We believe the disseminated but asymptomatic group A streptococcal infection precipitated her early death from hypertrophic cardiomyopathy. Sudden unexpected death during systemic infection should be followed by post-mortem examination to look for evidence of hypertrophic cardiomyopathy, as this diagnosis has genetic implications for other family members. ( info) |
| patients with primary aldosteronism often present with hypokalemia and hypertension. Primary aldosteronism presenting as sudden death due to ventricular fibrillation is described in an otherwise healthy 37-year-old woman. After successful direct current cardioversion, serum potassium was 1.4 mmol/L. Investigations revealed a suppressed renin level, elevated serum aldosterone and a right adrenal nodule found on imaging. ventricular fibrillation has not previously been described as a presention of a biochemically and surgically proven aldosterone-producing adenoma. This case highlights the importance of early detection and proper diagnosis of secondary hypertension before serious sequelae occur. ( info) |
10/424. Sudden death after a cold drink: case report. We report a case of sudden cardiac death in a 12-year-old boy after rapid ingestion of a frozen slurry drink. The cause of death was determined to be a cardiac arrhythmia secondary to a previously undiagnosed cardiac rhabdomyoma with associated myocardial scarring. Ingestion of cold liquids has been associated with syncope, but not sudden cardiac death. In this case, bradycardia induced by cold-induced vasovagal reflex may have precipitated the terminal arrhythmia. Ingestion of cold liquids should be considered a potential trigger for fatal cardiac arrhythmias in patients with underlying heart disease. ( info) |