Bates Alexander, Ullah Waqas, Wilkinson James, Shambrook James
Department of Cardiology, E Level, North Wing, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.
Department of Cardiothoracic Radiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.
Eur Heart J Case Rep. 2020 Dec 2;4(6):1-6. doi: 10.1093/ehjcr/ytaa425. eCollection 2020 Dec.
Discovering concomitant diagnoses results in a challenge to determine the true cause of a patient's presentation. Evaluating this fully is vital to plan appropriate and avoid inappropriate therapy.
A 55-year-old gentleman presents in cardiac arrest whilst watching an unusual occurrence of England dominating a Football World Cup game vs. Panama in 2018. Diagnostic coronary angiography discovered an anomalous right coronary artery from the opposite sinus (R-ACAOS), but clinical suspicion this was incidental lead to a further diagnosis of Type 1 Brugada Syndrome (BrS) following a positive Ajmaline provocation challenge. Risk stratification of these two zebras using computed tomography coronary angiography (CTCA), Cardiac magnetic resonance imaging (CMRI), Exercise Stress Echocardiography was performed and following a multi-disciplinary meeting, BrS was felt to be the primary diagnosis. The patient received a secondary prevention implantation of a cardiac defibrillator and avoided cardiac surgery.
Diagnosing a rare condition does not necessarily mean it is the cause of a patient's presentation and should not end the investigative process. Right coronary artery from the opposite sinus rarely causes cardiac arrest in middle age and is typically associated with peak exercise. Type 1 BrS is associated with cardiac arrest with vagal activity, perhaps such as England winning a World Cup game! Clinical correlation and risk stratification is required for suspected incidental findings.
发现合并诊断会给确定患者临床表现的真正原因带来挑战。全面评估这一点对于规划适当的治疗并避免不适当的治疗至关重要。
一名55岁男性在观看2018年英格兰队在世界杯比赛中战胜巴拿马队这一不寻常赛事时发生心脏骤停。诊断性冠状动脉造影发现一条来自对侧窦的异常右冠状动脉（R-ACAOS），但临床怀疑这是偶然发现，在阿义马林激发试验呈阳性后进一步诊断为1型Brugada综合征（BrS）。使用计算机断层扫描冠状动脉造影（CTCA）、心脏磁共振成像（CMRI）、运动负荷超声心动图对这两种罕见情况进行了风险分层，经过多学科会诊，认为BrS是主要诊断。患者接受了心脏除颤器二级预防植入术，避免了心脏手术。
诊断出一种罕见疾病并不一定意味着它是患者临床表现的原因，也不应结束调查过程。来自对侧窦的右冠状动脉很少在中年时导致心脏骤停，通常与运动高峰有关。1型BrS与伴有迷走神经活动的心脏骤停有关，也许就像英格兰队赢得世界杯比赛那样！对于疑似偶然发现的情况，需要进行临床关联和风险分层。
