Sudden death in athletes—Conduction system: Practical approach to dissection and pertinent pathology

Bharati, Saroja; Lev, Maurice

doi:10.1016/1054-8807(94)90042-6

Cited by 13 publications

(18 citation statements)

References 7 publications

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“…There were no signs of the congenital abnormalities or cardiomyopathy sometimes found in humans [3,26]. The findings of this study closely resembled those observed in racehorses with AF [1,18,22] and/or the exercise-induced VPCs [22] and SCD [20] we reported previously.…”

Section: Discussionsupporting

confidence: 77%

“…This alteration in the regional refractory period may have been associated with the preceding APC, which occurred abruptly and was accompanied by a wide T wave and long QTc. Accordingly, the R-on-T phenomenon [31] occurred and rapidly degenerated into VF, which led to arrhythmic death [3,11,23,33,36]. Therefore, the SCD in this training Thoroughbred horse can be categorized clearly by the complete ECG recording as an arrhythmic death, although we have confirmed one racehorse with SCD that exhibited ventricular tachycardia (VT) in part of the terminal episode [20].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, in support of our previous case report [25], the myocardial fibrosis located close to the BBs in the present study coincided with that detected in a 20-year-old pony mare with persistent VT that led to cardiac arrest. In the case of racehorses, it is reasonable to suppose that there is a relationship between the genesis of instantaneous death and the fibrotic and/or fibroplastic lesions in the areas of the AV bundle and BBs, regardless of age [25,27], in the same way that there is a relationship between instantaneous death and congenital abnormalities in the human heart [3,26]. Humans with LBB and/or RBB block who have no clinical evidence of cardiovascular disease have an increased risk of developing overt cardiovascular disease and SCD [5,9,11,23].…”

Section: Discussionmentioning

confidence: 99%

“…In humans, SCD generally denotes death that is non-violent or non-traumatic, unexpected, witnessed and occurs within a few minutes ('instantaneous death') or up to a maximum of 1 hr after the onset of an abrupt change in clinical status [33]. Most human SCD cases are assumed to be due to acute fatal arrhythmias -ventricular tachycardia or ventricular fibrillation [3,11,23,33,36].…”

Section: Methodsmentioning

confidence: 99%

“…matter what conclusions have been drawn thus far about human SCD, the precise relationship between the prodromal signs (including fatal arrhythmias) and the pathologic condition is still controversial [3,5,8,9,11,23,26,36]. This paper reports the cardiopathologic changes found in 5 racehorses that had been in apparently normal condition when they succumbed to SCD or instantaneous death during or shortly after intensive training exercise.…”

mentioning

confidence: 99%

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Pathologic and Electrocardiographic Findings in Sudden Cardiac Death in Racehorses.

Kiryu

Motomura

Kashida

et al. 1999

The Journal of Veterinary Medical Science

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ABSTRACT. Five racehorses in apparently normal condition succumbed to sudden cardiac death (SCD) during or shortly after intensive training exercise. Cardiopathologic examination was performed. In 1 of the 5 horses, the use of an electrocardiogram (ECG) recording taken continuously for 440 sec enabled us to analyze some of the arrhythmias in the terminal event of SCD. The ECG tracing exhibited the R-on-T phenomenon following a pair of ventricular premature contractions (VPCs). The phenomenon rapidly degenerated into ventricular fibrillation, which led to cardiac arrest. In all 5 horses cardiopathologic examination revealed the following lesions: (i) foci of myocardial fibrosis in the right atrium located close to the sinoatrial (SA) node, (ii) fibrotic and/or fibroplastic changes in the upper portion of the interventricular septum, including the atrioventricular (AV) conduction system, and (iii) arterio-and arteriolosclerosis of the SA and AV node vessels. Pathogenetically, the process by which the focal lesions of myocardial ischemia secondary to vascular sclerosis progressed into fibrosis and/or fibroplasia could play a major role in the genesis of arrhythmias. Presumably the fibrotic and/or fibroplastic changes in the area of the AV bundle and its bundle branches are closely related to the onset of fatal ventricular arrhythmias such as VPCs, deteriorating into ventricular fibrillation. SCD in training and racing Thoroughbred horses appears to be due to arrhythmia.-KEY WORDS: arrhythmia, equine, heart, pathology, sudden death.J. Vet. Med. Sci. 61(8): 921-928, 1999 matter what conclusions have been drawn thus far about human SCD, the precise relationship between the prodromal signs (including fatal arrhythmias) and the pathologic condition is still controversial [3,5,8,9,11,23,26,36]. This paper reports the cardiopathologic changes found in 5 racehorses that had been in apparently normal condition when they succumbed to SCD or instantaneous death during or shortly after intensive training exercise. It also describes the terminal electrocardiographic events in 1 of the 5 animals. MATERIALS AND METHODSNecropsy of the 5 racehorses in this study (Table 1) was performed as soon as possible after SD, usually within 3 hr. Fortuitously, when horse 1 fell and lay down suddenly shortly after a training exercise, it was possible to record an electrocardiogram (ECG). For the ECG recording, a baseapex lead was used [29]; the positive electrode was positioned over the apex-beat area of the heart and the negative electrode over the cardiac base. The recording was performed continuously over the 400-sec terminal event of the SD, at a paper speed of 25 or 50 mm/sec. So that we could analyze the arrhythmias, the onset of the R-on-T phenomenon was set up as a 0-sec point, and the beginning point of the recording was calculated back to 370 sec (Table 2). For measurements of the Q-T interval, 5 successive intervals with sinus rhythm were randomly taken from the ECG tracing, mainly at a paper speed of 50 mm/sec. The corrected Q-...

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Pathologic and Electrocardiographic Findings in Sudden Cardiac Death in Racehorses.

Kiryu

Motomura

Kashida

et al. 1999

The Journal of Veterinary Medical Science

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Forensic significance of conduction system abnormalities as a precise cause of accidental death

et al. 2002

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We examined the pathology findings of the cardiac conduction system in 42 human autopsies who were considered to have died an accidental death. Abnormalities in serial sections of the conduction system were found in seven and of these three had an accessory pathway in the conduction system. In one of these there was mild Ebstein's anomaly (ME), two had fibromuscular dysplasia of the atrioventricular node artery with mitral valve prolapse, and two others had abnormal routes showing fragmentation of the bundle of His with ME. A full investigation of the cardiac conduction system can therefore be useful for determining the precise cause in cases of accidental death.

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The scene investigation, postmortem changes, and time of death

Ely¹,

Keyes²,

Gill³

2023

Principles of Forensic Pathology

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Sudden death in athletes—Conduction system: Practical approach to dissection and pertinent pathology

Cited by 13 publications

References 7 publications

Pathologic and Electrocardiographic Findings in Sudden Cardiac Death in Racehorses.

Pathologic and Electrocardiographic Findings in Sudden Cardiac Death in Racehorses.

Forensic significance of conduction system abnormalities as a precise cause of accidental death

The scene investigation, postmortem changes, and time of death

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