Sudden death following myocardial infarction

A 62-year-old woman presented to the emergency department with chest pain. She had been a smoker for 20 years (from her 30s to her 50s), was moderately obese, and had a sedentary lifestyle coupled with a self-described penchant for fast food. At the age of 54 years, she was diagnosed with type 2 diabetes mellitus. She had no known family history of cardiovascular disease.

The patient’s electrocardiogram showed ST-segment elevation in the precordial leads, and she was found to have a mid-left anterior descending artery occlusion on catheterization, which was successfully opened and stented. The remainder of the patient’s hospital course was without complications. An echocardiogram on the third hospital day showed an ejection fraction of 40% and apical akinesis. The patient was discharged from the hospital 5 days after her infarction. Discharge medications included as­pirin, clopidogrel (Plavix), lisinopril (Prinivil; Zestril), and atorvastatin (Lipitor). One week after discharge, the patient died in her sleep.