Microvascular ischaemia after cardiac arrest in a patient with hypertrophic cardiomyopathy

An 11-year old boy was admitted to our intensive care unit following a successfully resuscitated ventricular fibrillation (VF) cardiac arrest during mild physical activity. Six months earlier he was diagnosed with non-obstructive hypertrophic cardiomyopathy (HCM) after an ECG at a pre-sport participating screening had shown left ventricular hypertrophy, marked repolarization abnormalities, and ST depression (Figure 1). There was no family history of HCM or sudden cardiac death (SCD). The child had been completely asymptomatic before the event; specifically, he had never experienced syncopal episodes. Maximal left ventricular wall thickness on echocardiography was 18 mm (z-score 4,5) and an Echo-bike and a 24h Holter monitor had been completely unremarkable. He was on no medications.