Journal of Cardiology Cases最新文献

{"title":"Severe tirofiban-induced thrombocytopenia following percutaneous coronary intervention","authors":"John M. Sousou DO ,&nbsp;Kabeer Ali MD ,&nbsp;Melville C. O’Brien MD ,&nbsp;Jeremy M. Williams DO ,&nbsp;Fadi Kandah DO ,&nbsp;Francesco Franchi MD","doi":"10.1016/j.jccase.2025.04.007","DOIUrl":"10.1016/j.jccase.2025.04.007","url":null,"abstract":"<div><div>Tirofiban is an intravenous glycoprotein IIb/IIIa inhibitor (GPI) that can be used as a bailout strategy in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) with high thrombus burden. A rare complication of this agent is severe thrombocytopenia, with an incidence ranging from 0.1 % to 0.5 %. We present a case of a patient who presented with ACS, underwent PCI, and subsequently developed severe thrombocytopenia within 24 h of receiving tirofiban. Tirofiban-induced thrombocytopenia is a rare immune-mediated condition that significantly heightens the risk of bleeding complications. Management involves immediate cessation of the drug, close monitoring of platelet counts, and supportive care. Platelet transfusion is indicated when the count falls below 10,000/μL, or below 50,000/μL with significant bleeding. This case highlights the need for early identification with routine platelet checks and close monitoring in patients receiving GPIs to prevent severe adverse outcomes, such as life-threatening bleeding or thrombotic events.</div></div><div><h3>Learning objectives</h3><div>Severe thrombocytopenia is an exceptionally rare but serious complication of tirofiban. Gaining a comprehensive understanding of the role of tirofiban and other glycoprotein IIb/IIIa inhibitors in the management of acute coronary syndrome, along with recognizing potential complications and accurately differentiating drug-induced thrombocytopenia from other causes, is essential to prevent life-threatening outcomes.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 1","pages":"Pages 47-50"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SCN5A mutation-associated sick sinus syndrome revealed by atrial flutter in a pediatric patient","authors":"Yoshikatsu Takeda MD ,&nbsp;Shuhei Fujita MD, PhD ,&nbsp;Yusuke Yachi MD ,&nbsp;Mariko Honda MD ,&nbsp;Mayu Iwata MD ,&nbsp;Naoto Sakumura MD, PhD ,&nbsp;Kazuyuki Ueno MD, PhD ,&nbsp;Kengo Miyashita MD, PhD ,&nbsp;Takeshi Futatani MD, PhD ,&nbsp;Keisuke Usuda MD, PhD ,&nbsp;Akio Chikata MD, PhD ,&nbsp;Kazuo Usuda MD, PhD, FJCC ,&nbsp;Keigo Nishida MD ,&nbsp;Raita Araki MD, PhD ,&nbsp;Koichi Kato MD, PhD ,&nbsp;Seiko Ohno MD, PhD","doi":"10.1016/j.jccase.2025.03.001","DOIUrl":"10.1016/j.jccase.2025.03.001","url":null,"abstract":"<div><div>Atrial flutter (AFL) is uncommon in children without underlying heart disease. This report details the case of a 7-year-old boy with AFL detected during school electrocardiogram (ECG) screening. He had no prior arrhythmias, congenital heart disease, or cardiomyopathy. Initial evaluations showed AFL with right bundle branch block but no structural heart abnormalities. Radiofrequency catheter ablation (RFCA) was performed, initially resolving the AFL but resulting in a 13-s sinus arrest requiring atrial pacing. Post-RFCA, the patient experienced a sinus arrest lasting up to 7 s, leading to a diagnosis of sick sinus syndrome (SSS). A second RFCA was needed due to AFL recurrence, and post-ablation ECGs revealed saddleback-type ST-segment elevation and Brugada-type patterns, raising suspicion of Brugada syndrome (BrS). Genetic testing identified a loss-of-function (LOF) SCN5A variant (c.2678G &gt; A p.R893H) in the patient, his mother, and his sister. This case underscores that AFL in children without structural heart disease, especially when associated with SSS, may be linked to LOF SCN5A variants, which are also associated with BrS.</div></div><div><h3>Learning objective</h3><div>Atrial flutter in children without structural heart disease can be linked to genetic factors with Brugada syndrome (BrS). This case highlights the importance of thorough diagnostic evaluation, including family history and genetic testing, when rare arrhythmias are present. Early detection of BrS through detailed electrocardiographic findings and family screening can help identify at-risk individuals and guide appropriate management to prevent serious arrhythmias and sudden cardiac death.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 1","pages":"Pages 5-9"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rescue balloon pulmonary angioplasty in patients with low cardiac output syndrome due to chronic thromboembolic pulmonary hypertension: A case series","authors":"Yoshitake Fukuda MD,&nbsp;Hiroto Shimokawahara MD, PhD,&nbsp;Ayane Miyagi MD,&nbsp;Chiaki Goten MD, PhD,&nbsp;Hirofumi Okada MD, PhD,&nbsp;Hiromi Matsubara MD, PhD","doi":"10.1016/j.jccase.2025.03.007","DOIUrl":"10.1016/j.jccase.2025.03.007","url":null,"abstract":"<div><div>Balloon pulmonary angioplasty (BPA) is an effective treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are ineligible for pulmonary endarterectomy. However, the treatment approach for patients with cardiogenic shock or refractory heart failure due to low cardiac output syndrome (LCOS) remains unclear, with limited studies on the efficacy and safety of rescue BPA in this population. Between 2011 and 2023, we performed rescue BPA on nine patients with CTEPH: two experienced severe CTEPH requiring extracorporeal membrane oxygenation or ventilator support due to complications from acute pulmonary embolism. Three had progressively worsening or drug-resistant right heart failure, three had syncope, and one had frequent ventricular tachycardia. Prior to BPA, cardiac indexes were below 2.0 L/min/m² without mechanical and inotropic support, and symptoms were likely related to LCOS. Although one patient died following BPA, the others experienced immediate hemodynamic improvements after the first BPA and were discharged alive. Rescue BPA may be a safe and effective treatment option for hemodynamically compromised patients with CTEPH and concomitant LCOS.</div></div><div><h3>Learning objectives</h3><div>Rescue balloon pulmonary angioplasty (BPA) improves hemodynamics and facilitates the withdrawal of mechanical and inotropic support for cardiogenic shock or worsening right heart failure in patients with chronic thromboembolic pulmonary hypertension. Rescue BPA may be a viable treatment option for hemodynamically compromised patients due to low cardiac output syndrome. However, given that these patients are at higher risk for complications, rescue BPA should be performed in specialized centers.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 1","pages":"Pages 15-18"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of congenital type 1 long QT syndrome which developed electrical storm with myocarditis","authors":"Shugo Yamada MD,&nbsp;Shohei Ikeda MD, PhD,&nbsp;Koichi Sato MD, PhD,&nbsp;Mariko Shinozaki MD,&nbsp;Keita Miki MD, PhD,&nbsp;Michinori Hirano MD, PhD,&nbsp;Koji Fukuda MD, PhD, FJCC,&nbsp;Morihiko Takeda MD, PhD","doi":"10.1016/j.jccase.2025.03.009","DOIUrl":"10.1016/j.jccase.2025.03.009","url":null,"abstract":"<div><div>This case report presents a 39-year-old woman with congenital type 1 long QT syndrome (LQT1) who was transported to the hospital after syncope. She had no previous history of syncope or ventricular fibrillation, but had a family history of LQT1 without sudden death. On arrival, she had regained consciousness with stable vital signs, although she reported cold symptoms starting a week previously. An electrocardiogram showed a prolonged QTc interval of 618 ms, and echocardiography revealed severe left ventricular dysfunction with an ejection fraction (EF) of approximately 15 %. She suddenly developed torsades de pointes and lost consciousness again, progressing to an electrical storm requiring repeated defibrillation. Emergency coronary angiography showed no stenosis, and right heart catheterization revealed hemodynamic parameters consistent with Forrester classification III. A myocardial biopsy from the right ventricular septum was performed due to suspected myocarditis. Treatment included sedation, mechanical ventilation, catecholamines, and intra-aortic balloon pump, stabilizing her hemodynamics. Pathological findings confirmed inflammatory cell infiltration in the myocardium. Her EF returned to normal within approximately two weeks. This report discusses an unusual case of electrical storm in LQT1 triggered by myocarditis, with a full recovery achieved.</div></div><div><h3>Learning objective</h3><div>This case emphasizes that careful management is required for patients with type 1 long QT (LQT1) syndrome. Despite guideline-based management, this case developed an electrical storm triggered by myocarditis as a cardiac event. This case suggests the need to re-evaluate the implantable cardioverter defibrillator implantation criteria for high-risk LQT1 cases.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 1","pages":"Pages 27-30"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic delay in patients diagnosed with Lyme carditis presenting with cardiac symptoms","authors":"Jon Are Sørås MD ,&nbsp;Gard Frodahl Tveitevåg Svingen MD, PhD ,&nbsp;Terje H. Larsen MD, PhD ,&nbsp;Håvard Keilegavlen MD, PhD ,&nbsp;Trygve Kristiansen MD ,&nbsp;Øystein Wendelbo MD, PhD","doi":"10.1016/j.jccase.2025.03.011","DOIUrl":"10.1016/j.jccase.2025.03.011","url":null,"abstract":"<div><div>In this case report, we describe two previously healthy young males who presented with cardiac symptoms suggestive of Lyme carditis (LC). LC-associated arrhythmia is a potentially fatal complication of Lyme disease, which typically occurs during the early disseminated and late stages. In high endemic areas a high degree of suspicion is vital to avoid misdiagnosis and delayed treatment, and to prevent long-term complications of disseminated infection and potentially fatal outcome.</div></div><div><h3>Learning objective</h3><div>Lyme carditis (LC) can present with a wide array of symptoms. The following two cases illustrate the diverse clinical manifestations of LC, as well as the potential for ‘doctor's delay’ in diagnosing patients with LC.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 1","pages":"Pages 19-22"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated right ventricular infarction – Unmasking the masquerader","authors":"Srista Manandhar MBBS,&nbsp;Sunit Chhetri MBBS,&nbsp;Jordan Tannenbaum MD,&nbsp;Manrique Alvarez MD,&nbsp;Yashashwi Pokharel MD, MSCR","doi":"10.1016/j.jccase.2025.04.005","DOIUrl":"10.1016/j.jccase.2025.04.005","url":null,"abstract":"<div><div>Right ventricular (RV) infarction is commonly associated with left ventricular (LV) myocardial infarction. Isolated RV infarction is a rare entity and the diagnosis is challenging. We present a case of a 65-year-old man with non-ST elevation myocardial infarction without obvious culprit obstructive coronary artery disease on coronary angiogram. There was late gadolinium enhancement (LGE) of RV free wall without LGE of the LV in magnetic resonance imaging (MRI) which helped in diagnosing isolated RV infarction. On follow up, the patient’s RV dysfunction normalized on echocardiogram. Our case shows the importance of cardiac MRI in the diagnosis of isolated RV infarction and that it can have a good prognosis.</div></div><div><h3>Learning objectives</h3><div>Diagnosis of isolated right ventricular (RV) infarction needs high degree of suspicion especially in absence of hemodynamic findings. Late gadolinium enhancement in cardiac magnetic resonance imaging can help diagnose RV infarction when there is diagnostic uncertainty. Early therapy helps in RV recovery.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 1","pages":"Pages 36-38"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe cibenzoline toxicity in hypertrophic obstructive cardiomyopathy successfully managed with extracorporeal membrane oxygenation and percutaneous transluminal septal myocardial ablation — A case report","authors":"Hiroto Yagasaki MD ,&nbsp;Takeki Suzuki MD, MPH, PhD ,&nbsp;Keitaro Watanabe MD ,&nbsp;Shunichiro Warita MD, PhD ,&nbsp;Makoto Iwama MD, PhD ,&nbsp;Toshiyuki Noda MD, PhD, FJCC","doi":"10.1016/j.jccase.2025.02.006","DOIUrl":"10.1016/j.jccase.2025.02.006","url":null,"abstract":"<div><div>Cibenzoline (CBZ), a class I antiarrhythmic drug, is used for patients with hypertrophic obstructive cardiomyopathy (HOCM). However, it requires careful monitoring in patients with renal dysfunction for potential toxicity. We present a case of severe CBZ toxicity in a 72-year-old woman with HOCM, previous ascending aortic dissection repair, and renal dysfunction. She was maintained on CBZ 300 mg daily despite fluctuating renal function. She presented with acute respiratory distress. On presentation, she was found to have bradycardia with QRS prolongation (340 ms) and markedly elevated CBZ levels (1973 ng/mL, therapeutic range: 200–800 ng/mL). She developed sudden cardiac arrest in the emergency room. Following cardiac arrest, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated. Direct hemoperfusion yielded minimal reduction in CBZ levels. With increased urine output, CBZ levels normalized, accompanied by electrocardiographic improvement. After VA-ECMO withdrawal, percutaneous transluminal septal myocardial ablation (PTSMA) was performed as definitive treatment to eliminate CBZ dependency. This case illustrates the complex interaction between HOCM, renal impairment, and CBZ toxicity, emphasizing the importance of careful drug monitoring in patients with renal impairment. Additionally, it demonstrates the potential role of PTSMA as a definitive treatment for selected patients with HOCM at high risk of medication-related complications.</div></div><div><h3>Learning objectives</h3><div><ul><li><span>•</span><span><div>Understand the pharmacokinetics of cibenzoline and its need for monitoring in elderly patients with hypertrophic obstructive cardiomyopathy (HOCM) and impaired renal function.</div></span></li><li><span>•</span><span><div>Recognize the mechanisms of cibenzoline toxicity and its acute management strategies, including mechanical circulatory support and direct hemoperfusion.</div></span></li><li><span>•</span><span><div>Identify the acute management strategies and long-term treatment options for complications arising from medical therapy in patients with HOCM.</div></span></li></ul></div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 6","pages":"Pages 158-161"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sudden cardiac death unveiling a mitral annular disjunction in a young man: The role of multimodal cardiac imaging for diagnosis","authors":"Waly Niang Mboup MD,&nbsp;Clément N'guyen Ngok MD,&nbsp;Jean-François Riviere MD,&nbsp;Nicolas Delarche MD","doi":"10.1016/j.jccase.2025.03.004","DOIUrl":"10.1016/j.jccase.2025.03.004","url":null,"abstract":"<div><div>Non-ischemic structural heart diseases, such as mitral annular disjunction (MAD) and/or mitral valve prolapse (MVP), are known to increase the risk of arrhythmias and sudden cardiac death (SCD). We report a rare case of SCD in a young patient, secondary to ventricular fibrillation, revealing a MAD. A 20-year-old man was admitted to our hospital after a sudden cardiac arrest at home. Immediate cardiopulmonary resuscitation was initiated with chest compressions. Semi-automatic defibrillator tracings demonstrated ventricular fibrillation, and three rounds of defibrillation were performed with return of spontaneous circulation within approximately 15 min. Electrocardiogram showed T-wave inversion in inferior-lateral leads. Transthoracic echocardiography and cardiac magnetic resonance imaging revealed a MAD and a bileaflet MVP without obvious valve regurgitation. The patient was diagnosed with ventricular fibrillation, likely resulting from MAD. He was initiated on a daily regimen of bisoprolol and received a subcutaneous implantable cardioverter-defibrillator. In-hospital evolution was favorable. Cognitive impairment was noted, leading to a referral for rehabilitation. In conclusion, this case involves a cardiac arrest likely caused by valvular heart disease. Multimodal cardiac imaging contribution is fundamental in the diagnosis of MAD with MVP, which is an uncommon cause of cardiac arrest.</div></div><div><h3>Learning objectives</h3><div>This case highlights the utility of multimodal cardiac imaging in mitral annular disjunction (MAD) diagnosis and the management of emergency care. Isolated MAD is not an indication for implantable cardioverter-defibrillator (ICD) placement, but the sudden death due to ventricular fibrillation that was recovered in this patient makes the implantation of a prophylactic ICD worth considering.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 6","pages":"Pages 186-188"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidental acute cholecystitis as a gateway to the diagnosis of AL cardiac amyloidosis","authors":"Haruhiko Higashi MD, PhD ,&nbsp;Yukihiro Miyazaki MD, PhD ,&nbsp;Mitsuharu Ueda MD, PhD ,&nbsp;Shunsuke Tamaki MD, PhD ,&nbsp;Kazuhisa Nishimura MD, PhD ,&nbsp;Katsuji Inoue MD, PhD, FJCC ,&nbsp;Shuntaro Ikeda MD, PhD, FJCC ,&nbsp;Osamu Yamaguchi MD, PhD, FJCC","doi":"10.1016/j.jccase.2025.03.006","DOIUrl":"10.1016/j.jccase.2025.03.006","url":null,"abstract":"<div><div>Amyloid light-chain (AL) amyloidosis is characterized by the deposition of amyloid fibrils in various organs, although gallbladder involvement is rare. We present the case of a 62-year-old female patient initially diagnosed with heart failure with preserved ejection fraction (HFpEF), who incidentally developed acute cholecystitis during her evaluation for HFpEF. Following a cholecystectomy, amyloid deposits were identified in the resected gallbladder. Subsequent investigations confirmed cardiac amyloidosis through imaging, bone marrow analysis, and M-protein detection, leading to a diagnosis of AL λ amyloidosis associated with multiple myeloma. The patient favorably responded to chemotherapy. This case emphasizes the importance of considering gallbladder amyloidosis, which may aid in avoiding unnecessary biopsies and facilitate timely diagnosis and treatment of amyloidosis.</div></div><div><h3>Learning objective</h3><div>Gallbladder amyloidosis is rare. However, recognizing that the gallbladder may be a site of amyloid deposition is crucial in cardiac amyloidosis management. This awareness can help clinicians avoid unnecessary biopsies by considering the gallbladder as a potential source of diagnostic tissue.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 6","pages":"Pages 182-185"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival post out-of-hospital cardiac arrest from anomalous right coronary artery: A case report and insight into management","authors":"Haowen Jiang MBBS ,&nbsp;Samuel Ji Quan Koh MBBS, MRCP, MMED ,&nbsp;Jeffrey Lau BA, MD, PhD ,&nbsp;Swee Yaw Tan MBChB, MRCP","doi":"10.1016/j.jccase.2025.02.004","DOIUrl":"10.1016/j.jccase.2025.02.004","url":null,"abstract":"<div><div>Anomalous coronary arteries originating from the opposite sinus of Valsalva are rare causes of sudden cardiac death (SCD), and when present are associated with poor outcomes. We present a rare case of a young man with an anomalous right coronary artery (RCA) presenting with out of hospital cardiac arrest and provide insights into management. A 27-year-old healthy Chinese man presented with out of hospital cardiac arrest during exertion, with initial electrocardiogram and echocardiography unrevealing for an underlying cause of collapse. Subsequent computed tomography coronary angiogram revealed the presence of an anomalous origin of the RCA from the left coronary sinus with acute angle take-off and slit-like orifice, with an inter-arterial course. Other investigations, including flecainide challenge test, cardiac magnetic resonance imaging, and treadmill stress tests were unyielding. He subsequently underwent an uneventful surgery to unroof the origin of the anomalous RCA without the need for an implantable cardiac defibrillator. The patient made a full recovery post-surgery and was discharged well. Anomalous coronary arteries with an inter-arterial course are a rare cause of SCD and where responsible, these anomalies are often found postmortem after SCD. In our case, the patient successfully underwent surgical correction.</div></div><div><h3>Learning objectives</h3><div>Anomalous coronary arteries are a rare cause of cardiac arrest and when present, are often associated with poor neurological and functional outcomes. The long-term management of this group of patients is not well known. After appropriate surgical correction and with preserved cardiac function, an implantable cardiac defibrillator may not always be necessary. This decision should follow a detailed discussion between the cardiologist, cardiothoracic surgeons, and patient.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 6","pages":"Pages 162-165"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}