Synchronous cardiac arrest in monozygotic twins with hypertrophic cardiomyopathy - Is sudden cardiac death genetically pre-programmed?

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a myocardial disorder characterised by left ventricular hypertrophy (LVH) in the absence of another cardiac or systemic disease capable of producing the magnitude of LVH evident. HCM causes variable symptoms and is one of the leading causes of sudden cardiac death (SCD) in young adults. While various phenotypic features of HCM among monozygotic twin pairs are not uncommonly reported, occurrence of synchronous cardiac arrest among them is not known from literature. CASE PRESENTATION: We present a case of monozygotic twins with HCM who both had a cardiac arrest post physical exertion in 63rd year of their lives. CONCLUSION: This case highlights potential genetics predisposition of cardiac arrest in patients with HCM despite having different phenotypic expression. SCD may be the only manifestation of patients with HCM. Decision of implantable cardioverter-defibrillator (ICD) placement for primary prevention of SCD should be based on the recommended guidelines, clinical judgment and patient's preference.