Survived Sudden Cardiac Death in a Young Marathon Runner

A healthy man, aged 20 years, experienced sudden cardiac death caused by ventricular fibrillation while running a half marathon. Cardiopulmonary resuscitation was initiated within 2 minutes of latency and was continued for 9 minutes with return of spontaneous circulation after defibrillation. The ECG showed ST-elevations in leads II, III, and aVF (Figure 1).Figure 1. Initial ECG with ST-elevations up to 0.2 mV in leads II, III, aVF, and subsequent ECG with normalized ST-elevations and T negativity in II, III, and aVF.A coronary artery disease could be excluded by coronary angiography. The left coronary artery had its orthotopic source on the left coronary cusp and arose anatomically regular with identification of a myocardial bridge in segment 7 (Figure 2 and Movies I and II in the online-only Data Supplement). The right coronary artery (RCA) arose atypically from the left coronary cusp. The proximal segment of the RCA was slightly narrowed with a length of 11 mm (Figure 3). The intubation of the RCA proved to be atypical. However, all of the coronary arteries showed thrombolysis in myocardial infarction 3 flow. No atherosclerotic lesions were detected (Figure 4 and Movies III through VII in the online-only Data Supplement).Figure 2. Myocardial bridge (right …