ECG Quiz Question

Sudden Death in a Young Athlete

G. Michael Vincent, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 7 - JULY 98

A 14-year-old girl suffered cardiac arrest, collapsing in midstride while sprinting during a sports event. Her teammates and coaches found her unconscious and gasping for breath. She had no pulse and quickly became cyanotic.

Cardiopulmonary resuscitation was started and paramedics were called. On their arrival, ventricular fibrillation was identified. Following tracheal intubation, several attempts at defibrillation were unsuccessful.

The patient was transported to the hospital, where full resuscitation efforts were continued. Defibrillation to sinus rhythm was subsequently accomplished (figure 1). She remained obtunded and had persistent hypotension at 80/60 mm Hg, but otherwise the physical exam was normal. Electrolyte levels and other laboratory findings were normal. The patient required pressor support, and later that day she had a second cardiac arrest from which she could not be resuscitated. An autopsy revealed no abnormalities.

The patient's history was remarkable only for a brief syncopal episode 2 years earlier during a school sports event; she had recovered quickly and spontaneously without sequelae. It was reported by observers that gum was found in the back of her throat, and it was assumed that she had choked and had syncope. A subsequent physical examination was normal, and an electrocardiogram (ECG) was obtained (figure 2). No other studies were performed and no treatment was instituted. Family history was unremarkable, with no sudden deaths, asthma, or congenital diseases.

What is your interpretation of the rhythm strip and the ECG? Are there any clues to the cause of her cardiac arrest?

Dr Vincent is chairman of the department of internal medicine, director of medical education, and director of the internal medicine residency program at LDS Hospital in Salt Lake City, and professor and associate chairman of the department of internal medicine at the University of Utah School of Medicine in Salt Lake City. Address correspondence to G. Michael Vincent, MD, LDS Hospital, 8th Ave and C St, Salt Lake City, UT 84143; e-mail to Ldgvince@ihc.com.

RETURN TO JULY 1998 TABLE OF CONTENTS