Sudden Cardiac Death: Was It Possible to Prevent It?

Introduction Hypertrophic cardiomyopathy (HCM) is a genetic heart condition that can lead to sudden cardiac death (SCD), especially in young adults [1]. In this case a 32 year old man with HCM ignored medical advice for further tests and later suffered SCD, raising the question of whether these missed evaluations could have changed the outcome. Case Presentation In 2023 patient visited a cardiologist, who recommended further investigations: cardiac MRI, Holter monitoring, and genetic consultation and prescribed beta-blocker. Unfortunately, the patient did not undergo the tests as he felt satisfied with his current state of health. One year later, he suffered a SCD and was successfully resuscitated after eight minutes. After hospital admission, diagnostic tests were made. Echocardiography showed left (LV) and right ventricle hypertrophy with mildly reduced ejection fraction. Cardiac MRI showed left ventricle fibrosis. Based on European Society of Cardiology (ESC) guidelines, an implantable cardioverter-defibrillator (ICD) was implanted for secondary prevention of SCD. Discussion ESC guidelines recommend a comprehensive SCD risk assessment, including validated risk scores, for primary prevention in HCM patients. These evaluations consider age, syncope history, LV function and structure, scaring of myocardium [2]. Although the patient did not undergo the recommended diagnostic measures, post-event findings indicated he would have been classified as low-risk patient and would not have qualified for primary prophylactic ICD implantation. It is also unclear whether the patient would have suffered SCD if he had undergone diagnostic investigations and received additional pharmacological treatment, as there is limited literature on the effect of drugs on mortality as one evidence based article states that while medications alleviate symptoms, they do not improve long-term mortality [3]. Conclusions This case emphasis the difficulties of preventing SCD, as the ESC guidelines give a strong foundation for managing HCM patients, there is still uncertainty regarding primary prophylaxis. Additionally, there are very few studies on the effect of pharmacological treatment on the disease progression and mortality. Increased research in this field could provide valuable insights into improving SCD prevention strategies.