title: [Drowning versus cardiac ischemia: Cardiac arrest of an 11-year-old boy at a swimming lake].
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.
authors.affiliation: Univ.-Klinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
authors.forename: A
authors.initials: A
authors.lastname: Födinger
authors.affiliation: Institut für Rechtsmedizin, Medizinische Universität Innsbruck, Innsbruck, Österreich.
authors.forename: C
authors.initials: C
authors.lastname: Wöss
authors.affiliation: Univ.-Klinik für Herzchirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich.
authors.forename: S
authors.initials: S
authors.lastname: Semsroth
authors.affiliation: Univ.-Klinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
authors.forename: K H
authors.initials: KH
authors.lastname: Stadlbauer
authors.affiliation: Univ.-Klinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich. volker.wenzel@tirol-kliniken.at.
authors.forename: V
authors.initials: V
authors.lastname: Wenzel
mesh_terms: D001344:Autopsy; D016887:Cardiopulmonary Resuscitation; D002648:Child; D003330:Coronary Vessel Anomalies / Q000175:diagnosis* / Q000473:pathology; D016757:Death, Sudden, Cardiac; D004332:Drowning / Q000175:diagnosis*; D017809:Fatal Outcome; D006801:Humans; D060106:Lakes; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology; D013550:Swimming; D013575:Syncope / Q000209:etiology
keywords: Asystole; Cardiopulmonary resuscitation; Coronary vessel anomalies; Sports; Sudden cardiac death