Sudden Death in Young Adults: A 25-Year Review of Autopsies in Military Recruits

Abstract

Cardiac abnormalities are the leading identifiable cause of sudden death among military recruits; however, more than one third of sudden deaths remain unexplained after detailed medical investigation.

Undiagnosed Heart Disease Leading to Sudden Unexpected Death in Childhood: A Retrospective Study

“…SUCD associated with coronary artery anomalies has been described for children of all ages and young adults; most commonly, SUCD is caused by an anomalous LCA origin from the right aortic sinus. 12,19 Other common anomalies associated with SUCD include an ectopic origin of the LCA from the pulmonary artery, an anomalous right coronary artery origin from the left aortic sinus, a "hightake-off" coronary ostia, or an ostial origin at a commissure. 18 One case (0.97%) each of an anomalous LCA origin from the right aortic sinus and an anomalous LCA origin from the pulmonary artery were detected in this series.…”

“…Furthermore, it has been proposed that a proportion of sudden infant death syndrome cases may be related to primary arrhythmogenic disorders. 2,5,19 Among all subjects 0 to 18 years of age, however, structural CHD and myocardial disease remain more important causes of SUCD than primary arrhythmogenic disorders. 5,20,21 In our series, structural CHD was seen less frequently than cardiomyopathies or acquired diseases (36% vs 64% of all cases).…”

“…In support of this, no disproportionate age distribution of SUD was identified in a large nonreferred cohort of patients with HCM, 41 and no overwhelming predominance of HCM was reported by authors studying SUD in general pediatric and young adult populations. 4,17,19,42,43 …”

Surgical treatment of a patient with heart disease and congenital coronary anomaly

“…A group of American Armed Forces Institute of the Pathology [7] reported that in a continuous series of 6.3 million 18-year-old recruits who underwent intense military training for 8 weeks, 21(33 %) of 64 cardiac deaths were related to the left coronary artery arising from the opposite sinus of Valsalva, which was confirmed by the clinical and necropsy examination. The highest risk lesions of the left main or left anterior descending branch artery arising from the opposite sinus of Valsalva include the inter-arterial course between the aorta and the pulmonary artery [8].…”

The role of genetic testing in unexplained sudden death

“…For example, a Danish nationwide analysis of deaths from 2000 to 2006 revealed an annual incidence of young SCD of 2.8 per 100,000, 7 whereas a retrospective US study of .6 million military recruits reported an incidence as high as 13 per 100,000 per annum. 8 Puranik et al 9 retrospectively reviewed pathologic reports from 427 autopsied sudden death cases aged 5-35 years at a forensic medical facility from 1995 to 2004 in Sydney. The most common cardiac cause of death was presumed arrhythmia in those with no (or minimal) structural heart disease (29%), that is, SADS.…”