Cardiac arrest associated with sildenafil ingestion in a patient with an abnormal origin of the left coronary artery: case report

We report a case of cardiac arrest in a 59-year-old patient after sexual intercourse and Silde-nafil ingestion. A coronary arteriography and an angiographic computed tomography scan subsequently revealed a LCA origin from the right aortic sinus along with an intramural course of the left main stem. In addition a distal stenosis of the right coronary artery was detected. After successful resuscitation without neurological deficits coronary artery bypass surgery was performed.To our knowledge, this is the first report demonstrating sudden cardiac arrest associated with Sildenafil ingestion in a patient with this type of coronary anomaly. The question arises, whether a cardiac screening is necessary before a Sildenafil therapy is initiated.Coronary artery anomalies (CAAs) are a group of congenital disorders with different manifestations and supposed pathophysiological mechanisms [1]. In literature the overall incidence of CAAs in the general population has been described between 0.3% and 5.64%, which can be explained by the examined inhomogeneous populations and different definitions of CAAs [2]. In case of CAA the interarterial course between the aorta and pulmonary artery is associated with a severe prognosis [1]. In autopsy materials from previously healthy athletes who suffered a sudden death, a right coronary arterial origin from the left coronary sinus and a LCA origin from the right sinus have been described as the most common congenital coronary mal-formations [3]. Sudden death has been sometimes the first manifestation of these abnormalities, whereas CAAs rarely present with symptoms such as angina pectoris, dyspnoe or cardiac arrhythmias. In contrast to CAA with an interarterial course CAA with an extraarterial course are not associated with an increased risk of sudden cardiac death and do not require coronary interventions [1]. We report a case of cardiac arrest associated with Sildenafil ingestion in a patient with a CAA.A 59-year-old caucasian man was foun