Sudden Arrhythmic Death Presenting with Convulsive Syncope In A Young Man With Severe Coronary Atherosclerosis And Hyperthyroidism: A Case Report.

Abstract

Background: The classic symptoms of coronary atherosclerotic disease (CAD), such as chest pain, are easily recognized in clinical practice. However, atypical manifestations like convulsive syncope can lead to misdiagnosis or delayed diagnosis, resulting in a poor prognosis.

Case presentation: We report an unusual case of a 36-year-old male who experienced recurrent convulsive episodes over 2 days. Initially, on the first day, the patient was diagnosed with epilepsy in the outpatient department, although the electroencephalogram revealed no abnormalities. He was admitted the following day after experiencing a recurrence of the same symptoms. Further investigation revealed severe hyperthyroidism and an electrocardiogram showing a short PR interval and T-wave inversions. The patient ultimately succumbed to sudden cardiac arrest after the final convulsive episode, with ventricular tachycardia documented on electrocardiogram monitoring. Post-mortem examination confirmed severe CAD, left ventricular hypertrophy, and thyroid hyperplasia.

Conclusion: The most likely explanation for the patient's clinical presentation is a fatal arrhythmia arising from the synergistic effects of severe CAD, left ventricular hypertrophy, and hyperthyroidism, ultimately leading to cardiogenic syncope and sudden cardiac death. This case highlights that arrhythmias secondary to CAD can mimic epilepsy-like seizures and, therefore, need to be carefully distinguished from epilepsy.