A 17-Year-Old Boy with Cardiac Arrest Occurring during Exercise.

The patient is a 17-year-old boy who was ostensibly well until admission to the cardiac intensive care unit (ICU). While he was in his physical education class and running “the mile” he collapsed and was noted to have what appeared to be agonal breaths. He subsequently began to have what appeared to be a seizure. It was recognized that he had a cardiac arrest, so cardiopulmonary resuscitation (CPR) was begun by one of his classmates and 911 was called immediately. An automated external defibrillator (AED) was located in the principal’s office and a student ran to retrieve that device while CPR was continually performed. After approximately 5 minutes of CPR, the AED was placed and it advised that a “shock” be delivered. After a single shock, the patient began to breathe spontaneously and regularly and became conscious. By this time (8 minutes after the collapse), the paramedics arrived on the scene. They noted that the boy was breathing spontaneously and was awake but very confused. They prepared him for transport to the hospital. The eventual interrogation of the AED documented ventricular fibrillation and documented a return to spontaneous circulation after the single shock delivered by the AED. The patient was taken to the cardiac ICU where he was awake but confused, and he was noted to be hemodynamically stable. A careful review of his past medical history showed that he had been having intermittent chest pain over the past several months. The chest pain occurred twice per week, lasted about 10 minutes each time, and seemed to resolve spontaneously. It was midprecordial in location and occurred at rest as well as with exercise. In addition, he had an episode of syncope last summer. It occurred on a particularly hot day, while he was in church, and he admits that he was not drinking enough water. He was evaluated by his family physician who thought that this episode was most likely from neurocardiogenic syncope and the patient was encouraged to stay better hydrated. Finally, about 2 months prior to this episode of collapse at school, the patient complained about feeling palpitations, then a racing heart. This episode resulted in dizziness but spontaneously resolved after about 90 seconds. The patient’s family history is significant in that his father was evaluated for chest pain about 1 year prior to the patient’s presentation. The father presented to the emergency department and was then admitted to the hospital, where he received an echocardiogram and a cardiac catheterization study, at which time his coronary arteries appeared normal. A left ventricular angiogram was performed and he was started on a betablocker. The patient’s examination included an electrocardiogram (ECG) (Figure 1), an echocardiogram, and laboratory studies. Stuart Berger, MD, is a Professor of Pediatrics, University of California Davis. Emanuele Maccalli, MD, is a Resident in Pediatrics, University of California Davis. Address correspondence to Stuart Berger, MD, Department of Pediatrics, University of California Davis, 2516 Stockton Avenue, Sacramento, CA 95864; email: sberger@ucdavis.edu. Disclosure: The authors have no relevant financial relationships to disclose. doi: 10.3928/00904481-20151111-03 Figure 1. An electrocardiogram from the patient’s examination.