Outcome of early intervention in sudden cardiac arrest during exercise: case series

Introduction Exercise is frequently promoted in the realm of health and wellness as a cornerstone of vitality and longevity especially in young healthy individuals. However, for individuals with undiscovered coronary artery disease (CAD), an unexpected threat can emerge from sudden cardiac arrest (SCA). Purpose We are evaluating young patients presenting with cardiac arrest during strenuous exercise and found to have significant CAD. Methodology In this cross-sectional study all patients who were admitted as a case of post-exercise cardiac arrest between the years 2020 to 2023 and found to have CAD were evaluated. Their demographics, past medical history, laboratory workup findings, quality of CPR, coronary angiography (CAG) findings and outcomes were evaluated. Descriptive analyses were used to report results. Results 7 cases fulfilled the inclusion criteria all of which were male with a mean age of 41 years old (range: 28-51). All patients had immediate high-quality cardiopulmonary resuscitation (CPR) starting at the time of collapse, the average CPR time till ROSC was 32.4 minutes (range: 10-47). Three patients (43%) were not known to have any comorbidities; 14% had diabetes mellitus, 29% had dyslipidemia, and 29% had previous ischemic heart disease. Furthermore, analysis of the laboratory workup of the three patients not known to have any comorbidities did not reveal any undiscovered comorbidity. Post-ROSC ECGs showed 3 anterior (43%), 3 inferior (43%) and 1 posterior (14%) territory changes and urgent CAG showed the Left Anterior Descending artery to be the culprit artery in four of the patients, Right Coronary artery in two and the Left Circumflex in the other two. 57% of patients were discharged alive, 29% of which had a neurological deficit, while 43% were deceased. Discussion: Although cardiac arrest is not a common presentation of CAD, exercise can induce coronary stenosis and an adrenaline surge that can cause ventricular arrhythmias and/or cardiac arrest. While most patients in our study experienced positive outcomes, it's important to note that not all shared this favorable result. This variation emphasizes the importance of early intervention managing exercise-related cardiac events. Moreover, our study illustrates the importance of immediate high-quality CPR for better outcomes. Conclusion Strenuous exercise may precipitate cardiac arrest in individuals with undiscovered coronary artery disease; however, early life-saving interventions including high-quality CPR and percutaneous coronary intervention (PCI) have the potential to improve the overall prognosis.