A 32-year-old man with no medical history went into ventricular fibrillation while running at the gym. He was transferred to our tertiary centre post successful resuscitation where admission electrocardiography and echocardiography were unremarkable. The initial cause of cardiac arrest was suspected arrhythmogenic and he was admitted for further investigations including exercise testing, ajmaline challenge, CT coronary angiography (CTCA) and cardiovascular MRI, with the likely outcome of cardioverter-defibrillator implantation. CTCA, however, revealed significant stenosis in the proximal left anterior descending artery as the likely cause for his arrest. Invasive coronary angiography confirmed this and facilitated successful stent implantation, avoiding the need for implantable cardioverter-defibrillator implantation. This case highlights the importance of CTCA, a non-invasive and readily-available test in the investigation of young patients postcardiac arrest, who require active exclusion of coronary artery disease and anomalous coronary anatomy, though they represent a low-risk population group.
- ischaemic heart disease
- interventional cardiology
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Contributors AMK-K and ASM: cardiology SpR involved in managing patient during inpatient admission, co-wrote first draft of manuscript, reviewed and edited subsequent drafts of manuscript, obtained and optimised invasive angiography images. Reviewed and edited manuscript for re-submission. LS: performed CT scan on patient, reviewed and edited drafts of manuscript. JNK: consultant involved in managing patient during inpatient admission, supervised and guided AMK-K and ASM in writing first draft of manuscript, reviewed and edited subsequent drafts of manuscript, obtained and optimised cardiac CT images. Reviewed and edited manuscript for re-submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.