How many clues make an evidence? An unusual case of aborted cardiac arrest due to mitral valve prolapse

There is an increasing awareness on the association between mitral valve prolapse (MVP) and sudden cardiac death. Mitral annular disjunction (MAD) is a phenotypic risk feature that can help in risk stratification. We present a case of a 58-year-old woman who experienced an out-of-hospital cardiac arrest caused by ventricular fibrillation interrupted by a direct current-shock. No coronary lesions were documented. Echocardiogram showed myxomatous MVP. Nonsustained ventricular tachycardia have been registered during hospital stay. Interestingly, cardiac magnetic resonance revealed MAD and a late gadolinium enhancement area in inferior wall. Finally, a defibrillator has been implanted. For arrhythmic risk stratification of MVP with MAD, multimodality imaging is the diagnostic tool to find out the disease behind many cardiac arrests of unknown cause.

Automated summary

This case report describes a 58-year-old woman who experienced an out-of-hospital cardiac arrest due to ventricular fibrillation. No coronary lesions were found, but echocardiogram showed myxomatous mitral valve prolapse (MVP). Cardiac magnetic resonance revealed mitral annular disjunction and late gadolinium enhancement in the inferior wall. A defibrillator was implanted for arrhythmic risk stratification of MVP. Multimodality imaging is crucial for identifying underlying diseases in cardiac arrests of unknown cause.