Ertrinken vs. kardiale Ischämie

Zusammenfassung

Diese Kasuistik beschreibt den plötzlichen Herz-Kreislauf-Stillstand und die anschließende Versorgung eines 11-jährigen Kindes am Ufer eines Badesees. Die Ereignisbeschreibung durch Augenzeugen schließt die naheliegende Verdachtsdiagnose eines Ertrinkungsunfalls quasi aus. Die Obduktion ergibt einen plötzlichen Herztod aufgrund einer kongenitalen Koronaranomalie („abnormal left coronary artery“, ALCA). Begünstigt durch körperliche Anstrengung kommt es in solchen Fällen mitunter zu akuten malignen Rhythmusstörungen, da die ektope Koronararterie in ihrem intramuralen Verlauf durch die Aortenwand während jeder Systole komprimiert wird.

Abstract

This report describes a case of sudden cardiac arrest and subsequent attempted cardiopulmonary resuscitation of an 11-year-old child on the shores of a swimming lake. Reports of eyewitnesses excluded the obviously suspected diagnosis of a drowning accident. The result of the autopsy was sudden cardiac death due to a congenital coronary anomaly (abnormal left coronary artery, ALCA). Favored by vigorous physical activity, this anomaly can lead to malignant arrhythmias because the ectopic coronary artery with its intramural course through the aortic wall is compressed during every systole. This pathology was not known to the boy or his family; in fact he liked sports but had suffered of a syncope once which was not followed up. Without a strong suspicion it is difficult to diagnose a coronary artery anomaly and it is often missed even in college athletes. Tragically, sudden cardiac arrest may be the first symptom of an undiagnosed abnormal coronary artery. Following syncope or chest pain during exercise with a normal electrocardiogram (ECG) cardiac imaging, such as computed tomography (CT) or angiography should be initiated in order to enable surgical repair of an abnormal coronary artery.