Resuscitated sudden cardiac death due to diminutive coronary artery syndrome

Diminutive coronary artery syndrome (DCAS) refers to myocardial ischemia occurring as a consequence of coronary artery hypoplasia. DCAS was first described in 1964 in a report of 2 previously healthy men, aged 18 and 25, who suffered acute myocardial infarctions (MI) and were found on rudimentary coronary angiography to have hypoplastic right coronary arteries. Subsequent case reports have described an association between DCAS and sudden cardiac death (SCD), with postulated mechanisms of ischemiainduced or scar-mediated reentrant ventricular arrhythmia. The incidence of DCAS is unclear and, to date, antemortem clinical criteria for this disorder have not been proposed, which may lead to substantial under-diagnosis. Herein, we describe clinical and pathophysiologic features of a patient experiencing SCD owing to MI and found to have diminutive coronary arteries on angiography.