Undiagnosed Giant Coronary Aneurysms Leading to Sudden Cardiac Arrest in a 15 Year Old Male- A Case Report

Background: The most common causes of sudden cardiac arrest (SCA) are congenital abnormalities in individuals 0 to 13 years of age, presumed primary arrhythmia in those 14 to 24 years of age, and coronary artery disease in individuals 25 to 35 years of age. Coronary artery aneurysms are extremely rare in paediatric population and mainly due to the sequelae of Kawasaki Disease.

Objective: We herein report a case of undiagnosed giant coronary aneurysms leading to SCA in 15-year-old previously well male patient.

Methods: A 15-year-old Caucasian male presented with sudden out of hospital cardiac arrest during a moderate exercise activity. He was successfully resuscitated and received one direct cardioversion by AED. AED recorded ventricular fibrillation. His past medical and family history were negative for cardiovascular disease as well as Kawasaki disease.

Results: His physical examination and the 15-lead ECG were unremarkable. Initial echocardiogram demonstrated dilated left ventricle with reduced systolic function. 24-hour ECG recording showed frequent monomorphic ventricular ectopics. Exercise testing demonstrated ST depression in the inferior leads. The CMRI study was diagnostic showing several small subendocardial areas of infarction and giant aneurisms with thrombi involving proximal left anterior descending and mid left circumflex coronary arteries. The patient was commenced on anticoagulation therapy and he had an S-ICD implanted. He was discharged home on beta blockers, ACEI and Warfarin. He remains under follow up.

Conclusion: This case demonstrates the importance of comprehensive evaluation and diagnostic workup in survivors of SCA. Coronary pathology although rare should be considered as possible aetiology of SCA in childhood, even in case of no clear history of Kawasaki disease. Our case illustrates the usefulness of advanced imaging modalities such as CMRI to identify a rare cause of cardiac arrest. In patients not previously identified as high risk, secondary prevention is as important as primary prevention.