Left Coronary Artery Anomaly: An Often Unsuspected Cause of Sudden Death in the Military Athlete

Abstract

More than 300,000 cases of sudden cardiac death (SCD) occur in the United States each year. Left coronary artery anomaly (LCAA), although rare, is second only to hypertrophic cardiomyopathy as the most common cause of SCD associated with structural cardiovascular abnormalities. This case illustrates SCD secondary to LCAA in a military athlete. A 19-year-old soldier collapsed after an 8-km run. On arrival at the emergency room, he was unresponsive and in asystole. Despite successful resuscitation and aggressive management, the patient died the next morning. Autopsy revealed an anomalous left coronary artery. LCAA-associated SCD is rare and usually seen in young individuals who collapse (and/or die) while exercising. A substantial proportion of these individuals experience prodromal symptoms of exertional chest pain, syncope, and/or sudden collapse. Early recognition and intervention are key to survival. Rapid, early imaging and invasive therapeutic measures leading to surgical correction may be the difference between life and death.