Razuin R, Nurquin F, Shahidan M N, Julina M N
Centre for Diagnostic & Research Laboratories, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.
Department of Forensic Medicine, Hospital Sungai Buloh, Selangor, Malaysia.
Egypt Heart J. 2017 Jun;69(2):157-160. doi: 10.1016/j.ehj.2017.02.001. Epub 2017 Mar 6.
Sudden cardiac death in young adults may be associated with rare cardiomyopathies such as left ventricular noncompaction (LVNC) and arrhythmogenic right ventricular (ARVC) cardiomyopathies. LVNC is characterised by hypertrabeculations and deep recesses of the left ventricle. ARVC presents with thin myocardium as a result of extensive fibro-fatty infiltrations. In both conditions, death may be due to arrhythmia, thromboembolic events or heart failure. We report a case of a 21-year old athletic young man who collapsed at the futsal court right after the game. He was resuscitated but expired at the hospital after a brief admission. A week earlier, he had a similar episode of syncope and revived through cardio-pulmonary resuscitation at the site. Post mortem examination showed extensive acute myocardial infarction (AMI) involving the papillary muscles and the left ventricular wall. Features of LVNC were also observed. On top of that, the right ventricle showed patchy thin myocardium as the wall was largely comprised of fat. Histology examination confirmed the presence of AMI and massive fibro-fatty infiltrations of the right ventricle. This unfortunate young man had co-existing cardiomyopathies which is rare indeed. As he succumbed to AMI, this mechanism of death is also uncommonly associated with neither LVNC nor ARVC. In conclusion, young and physically active individuals may not be spared of sudden cardiac death. Mild and non-specific symptoms should not be taken lightly as it may be the subtle signs of cardiomyopathies.
年轻人心脏性猝死可能与罕见的心肌病有关，如左心室心肌致密化不全（LVNC）和致心律失常性右心室心肌病（ARVC）。LVNC的特征是左心室肌小梁增多和深陷。ARVC由于广泛的纤维脂肪浸润而表现为心肌变薄。在这两种情况下，死亡可能是由于心律失常、血栓栓塞事件或心力衰竭。我们报告一例21岁的年轻运动员，他在一场五人制足球比赛结束后立即在球场晕倒。他被复苏，但入院不久后在医院死亡。一周前，他曾有过类似的晕厥发作，并在现场通过心肺复苏恢复。尸检显示广泛的急性心肌梗死（AMI）累及乳头肌和左心室壁。还观察到LVNC的特征。此外，右心室壁可见散在的薄心肌，因为其壁主要由脂肪组成。组织学检查证实存在AMI和右心室大量纤维脂肪浸润。这个不幸的年轻人患有并存的心肌病，确实很罕见。由于他死于AMI，这种死亡机制也罕见地与LVNC或ARVC均无关。总之，年轻且身体活跃的个体也可能无法幸免心脏性猝死。轻微和非特异性症状不应被轻视，因为它可能是心肌病的微妙迹象。
