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

Abstract

BackgroundHypertrophic 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 presentationWe present a case of monozygotic twins with HCM who both had a cardiac arrest post physical exertion in 63rd year of their lives.ConclusionThis 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.

Different Clinical Presentation and Tissue Characterization in a Monozygotic Twin Pair with MYH7 Mutation-Related Hypertrophic Cardiomyopathy

“…In addition, Maron, et al provided an explanation that genetic background is a primary factor determining the morphological expression of HCM, whereas environmental factors may have a limited impact. However, these reports have not explored the change of tissue characteristics in monozygotic twins, and other study results [18][19][20][21][22] have not been consistent with these reports. Palka, et al reported there were different clinical presentations and morphological expressions in monozygotic twins with HCM.…”

Hypertrophic cardiomyopathy in identical twins: a case series

“…Another interesting pair of monozygotic twins was reported by Goh et al . 10 One patient survived a sudden cardiac arrest because he had had an ICD implanted a week after his twin brother’s fatal cardiac arrest 2 months prior. Our patients did not have any ventricular apical involvement and were at low risk for sudden cardiac death, so they did not require ICD placement.…”