Utilizing Cardiac Magnetic Resonance Imaging to Elucidate the Etiology of Sudden Cardiac Arrest

There is a lack of established methods to explore the etiology of sudden cardiac arrest. We herein report sudden cardiac arrest as pulseless electrical activity in a young woman triggered by coronary artery spasm. There were no health issues except for situs inversus totalis, but the patient experienced sudden cardiac arrest after suffering chest pain. ST-segment depression was observed in leads V3-V6 on electrocardiography. However, urgent angiography did not reveal any coronary stenosis. Cardiac magnetic resonance imaging revealed myocardial edema localized to the inferior and posterior segments without evidence of late gadolinium enhancement. Additionally, a provocation test with acetylcholine confirmed a coronary artery spasm. Inexplicable sudden cardiac arrest may result in missing the chance to detect hidden cardiac disease. Cardiac MRI may help to elucidate the etiology of sudden cardiac arrest.