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However, patients with significant myocardial injury at presentation often continue to have cardiac dysfunction and remain at increased risk for cardiac issues, including sudden death. Patients who experience myocardial infarction are at increased risk for lethal arrhythmias and may be candidates for automatic implanted cardiac defibrillators. The coach and the team trainer immediately evaluate the teenager and find him to be unresponsive and with short gasping breaths.

On arrival to the field, paramedics find that the young man is in ventricular fibrillation. There are also inverted T-waves in the left precordial leads, but ventricular voltages are normal. Sudden collapse in an otherwise healthy teenager is most likely due to a primary cardiac arrest. If there were history of trauma immediately preceding the arrest, commotio cordis would also be considered. The finding on history that the patient had episodes of chest pain and dizziness suggests some sort of an ischemic process, which makes an anomalous coro- nary artery more likely in this case.

Basic labs would rule out an electrolyte abnormality, and the negative toxicology screen is helpful to rule out drugs of abuse e. However, if there were serious concern for substance abuse, specific test would have to be done. Regardless, an echocardiogram is indicated to assess the coronaries and to evaluate for any other congenital defect.

Detailed echocardiogram demonstrates a mildly dilated left ventricle that has moderately decreased function, most notably in the anterior left ventricular free wall and anterior ventricular septum. There is no congenital heart disease, but mod- erate mitral valve insufficiency is present. He has suffered a myocardial infarction of the left ventricular wall and anterior septum.

A week-old female infant is seen in the emergency room because of poor feeding and lethargy. She also notes that her baby looks somewhat gray and sweaty during these episodes. She has had a previous child who had significant reflux, but does not think that this is the same thing.

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