Mitral valve prolapse and out-of-hospital sudden death: a case report and literature review

The emergency medical services were called to the workplace of a 25-year-old woman who appeared to be dead. The alarm was raised by employees who had found her unconscious at her desk. There was no semi-automatic defibrillator on the premises and no member of staff had received specific training in management of cardiac arrest. External cardiac massage was immediately started as advised by telephone by the emergency physician and ventricular fibrillation was diagnosed on arrival of the medical team. Despite continuous resuscitation, the victim did not revive. The death certificate was signed with a medicolegal objection to burial, leading to an inquiry. Several causes were suggested by the emergency physician who had been called to the patient, and who was unable to account for the death. Autopsy established the diagnosis of mitral valve prolapse. The authors stress that autopsy is imperative and detail the implications of such a procedure.