P193A silent cause of sudden cardiac death: anomalous coronary arteries

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Abstract

Background

Pathologists performing examinations on hearts of sudden cardiac death (SCD) victims are not actively excluding anomalous coronary arteries (ACA) as a cause of death. Our aim is to increase awareness of this cardiac anomaly, determine the incidence and educate the pathologist on a systematic approach to examining the coronary arteries.

Design

Retrospective non-case controlled analysis.

Setting

Cardiac pathology centre at the National Heart and Lung Institute and Royal Brompton Hospital.

Subjects

Between 1994 and 2011, the hearts of 2030 SCD victims were referred for pathological assessment to ascertain the precise aetiology of SCD.

Results

Twenty-nine (1.4%) of the 2030 cases of SCD have been associated with ACA (22 men (76%) and 7 women (24% age range [16 months-63 years]). The specific anomalies identified were 10 cases of anomalous right coronary artery arising from the left aortic sinus; 6 cases of anomalous left coronary artery (LCA) arising from the right coronary sinus; 7 cases of myocardial bridging; 3 cases of coronary artery ostial stenosis/atresia 2 cases of anomalous origin of the LCA from the pulmonary artery; and 1 case of high take off. The anomalous coronary artery had been identified by the referring pathologist in only 11 of the 29 cases (38%). Histological evidence of acute/chronic ischaemia in the regional myocardium supplied by the ACA was evident in 23 of the 29 cases (79%). In 15 cases (52%) SCD occurred during or immediately after physical exertion. Cardiac symptoms were documented to have occurred in only 7 patients (24%) prior to SCD.

Conclusion

Anomalous coronary arteries are an under-recognised cause of sudden cardiac death. Detailed examination of the coronary artery system identifying both coronary artery ostia and their course should be routinely performed on SCD victims.

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