Sudden Cardiac Arrest in a Young Male: The Role of Intraplaque Hemorrhage and Coronary Spasm (JACC Case Reports May 2025)-Article: Sudden Cardiac Arrest in a Young Male: The Role of Intraplaque Hemorrhage and Coronary Spasm

Article: Sudden Cardiac Arrest in a Young Male: The Role of Intraplaque Hemorrhage and Coronary Spasm

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This article presents a case study of a 39-year-old male who experienced sudden cardiac arrest due to intraplaque hemorrhage (IPH) and coronary spasm, conditions commonly overlooked in instances of sudden cardiac death (SCD) traditionally attributed to plaque rupture or erosion in coronary artery disease (CAD). The patient had suffered from intermittent chest pain before collapsing with ventricular fibrillation. Subsequent coronary angiography revealed significant stenosis in the left anterior descending artery, while optical coherence tomography identified IPH. A test with acetylcholine confirmed coronary spasm.<br /><br />The case highlights a significant clinical observation: IPH, which is often coupled with coronary spasm, can precipitate acute coronary syndrome and, potentially, SCD. It suggests a complex interplay of physiological mechanisms beyond plaque rupture traditionally associated with CAD-related sudden cardiac events. Recent studies underline this interaction, with findings indicating that IPH, alongside inevitable coronary artery spasms, serves as a major cause in a considerable number of SCD cases.<br /><br />After treatment with percutaneous coronary intervention and long-term medication including antiplatelet therapy and calcium channel blockers, the patient showed no adverse events over a follow-up period exceeding three years. The medical team also opted to implant a cardioverter-defibrillator for secondary prevention of SCD.<br /><br />This case underscores the importance of considering diverse mechanisms like IPH and coronary spasm when diagnosing and managing cases associated with CAD-related SCD. It calls for more in-depth research into these lesser-understood pathways and their potential roles in the pathophysiology of sudden cardiac death, stressing the need for more comprehensive diagnostic and therapeutic strategies beyond those aimed at preventing plaque rupture or erosion alone. The authors advocate for expanded clinical awareness and research focus on these contributing factors in coronary artery disease management.

Keywords

sudden cardiac arrest

intraplaque hemorrhage

coronary spasm

sudden cardiac death

coronary artery disease

plaque rupture

optical coherence tomography

percutaneous coronary intervention

antiplatelet therapy

cardioverter-defibrillator