Case report the sudden cardiac death of a food delivery service worker due to unrecognized myocarditis

Introduction/Objective The COVID-19 pandemic enabled an increase in the use of food delivery apps and provided more work for delivery services, especially while the lockdown measures were in place. Many scientific papers have been written about epidemiological measures and the safety of delivered food in the prevention of COVID-19, but there is little research dedicated to the pressures suffered by delivery service workers and the health consequences that may have arisen due to their unregulated work status. We present the rare combination of difficult work conditions and myocarditis, which led to the sudden cardiac death of a food delivery worker. Case report The Emergency Medical Team (EMT) was dispatched to help a person lying in a corridor of a building showing no signs of life. Upon arrival at the scene, they found an approximately 30-40-year-old man lying on the ground near the entrance of the building next to his bicycle with a delivery bag still on his back. He was unconscious, with no breathing or pulse, and with no visible signs of injury. Information was obtained from bystanders about a delivery to the fifth floor of the building with no elevator, but there was no reliable information about the time of cardiac arrest. The initial rhythm was asystole, so the non-shockable rhythm cardiopulmonary resuscitation (CPR) protocol was immediately initiated. During CPR, two IV lines were opened, seven adrenaline injections were administered intravenously (IV), a 0.9% NaCl solution was initiated, and the airway was secured by placing an endotracheal tube. Despite all the efforts, the resuscitation measures were unsuccessful, and the patient was pronounced dead. Because the patient had died in a public place of an unknown cause, the police was notified, and the body was transferred to forensic pathology. The autopsy revealed no macroscopic changes in the myocardium, but pathohistology did reveal myocarditis. Since all this occurred during the COVID-19 pandemic, a PCR test was performed, which was negative. Toxicology findings revealed the presence of amphetamine and THC in traces, which were not thought to have affected the fatal outcome. Conclusion Myocarditis is an important but underrecognized cause of sudden death in young people, including delivery workers. Future research should be focused on adopting more precise criteria for myocarditis detection in such high-risk occupations.