Sudden death in young athletes.

Abstract

The causes of sudden and unexpected death in 29 highly conditioned, competitive athletes, ages 13-30 years, are summarized. Sudden death occurred during or just after severe exertion on the athletic field in 22 of the 29 athletes. Structural cardiovascular abnormalities were identified at necropsy in 28 of the 29 athletes (97%), and in 22 (76%) were almost certainly the cause of death. The most common cause of death in this series was hypertrophic cardiomyopathy, which was present in 14 athletes. Other cardiovascular abnormalities that occurred in more than one athlete were anomalous origin of the left coronary artery from the right (anterior) sinus of Valsalva, idiopathic concentric left ventricular hypertrophy, coronary heart disease and ruptured aorta. Cardiac disease was suspected during life in only seven of the 29 patients, and in only two of the seven was the correct diagnosis made clinically. Hence, in this series of young athletes, sudden death was usually due to structural cardiovascular disease, and hypertrophic cardiomyopathy was a frequent cause of sudden death; atherosclerotic coronary heart disease was relatively uncommon.

Arrhythmogenic right ventricular cardiomyopathy/dysplasia: a not so rare “disease of the desmosome” with multiple clinical presentations

“…In Italy, however, this figure is tenfold higher 9 . This difference may be due to a different genetic background, or due to the fact that there is a unique screening program for athletes engaging in competitive sports in Italy 10 . ARVC/D also accounts for a significant number of non-exercise-related sudden deaths in the young, i.e.…”

Inter Association Task Force Recommendations on Emergency Preparedness andManagement of Sudden Cardiac Arrest in High School andCollege Athletic Programs: A Consensus Statement

“…Hypertrophic cardiomyopathy and coronary artery anomalies represent approximately 25% and 14% of cases, respectively, in the United States. 1 Commotio cordis is caused by a blunt, nonpenetrating blow to the chest that induces a ventricular arrhythmia in an otherwise structurally normal heart and accounts for approximately 20% of SCD in young athletes. 1 A variety of other structural cardiac anomalies account for most of the remaining causes of SCD in athletes.…”

“…1 Commotio cordis is caused by a blunt, nonpenetrating blow to the chest that induces a ventricular arrhythmia in an otherwise structurally normal heart and accounts for approximately 20% of SCD in young athletes. 1 A variety of other structural cardiac anomalies account for most of the remaining causes of SCD in athletes. These include conditions such as myocarditis, arrhythmogenic right ventricular dysplasia, Marfan syndrome, valvular heart disease, dilated cardiomyopathy, and atherosclerotic coronary artery disease.…”

“…1,2 Athletes are considered the healthiest members of our society, and their unexpected death during training or competition is a catastrophic event that stimulates debate regarding both preparticipation screening evaluations and appropriate emergency planning for athletic events. Despite preparticipation screening, healthy-appearing competitive athletes may harbor unsuspected cardiovascular diseases with the potential to cause sudden death.…”

A rare combination of coronary anomalies

“…Coronary anomalies are responsible for approximately 13% of sudden cardiac death in young athletes. 5,6 Hypertrophic cardiomyopathy is the only cardiovascular cause more frequently found as cause of sudden cardiac death in young athletes. The understanding of the pathophysiological mechanisms leading to sudden cardiac death is still far from clear and so is the role of the anomalous coronary anatomy.…”