SUDDEN DEATH in YOUNG
ATHLETES
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Sudden Death in Young Athletes: Causes, Risks, and Prevalence, Slides of Pediatrics
An in-depth analysis of sudden death in young athletes, including clinical findings, circumstances of death, causes, and the magnitude of the problem. Topics covered include hypertrophic cardiomyopathy, abnormal origin of coronary arteries, and other causes such as marfan syndrome and myocarditis. The document also discusses screening methods and long-term experiences after cardiac surgery.
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2012/2013
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SUDDEN DEATH in YOUNG
ATHLETES
Clinical Findings
- F asymptomatic 21/
- F syncope 3/
- F presyncope 1/
- F chest pain 2/
- F mild fatigue 2/
Causes of Sudden Death 29 Probable CV Disease 6 5 1 Idiopathic Concentric hypertrophy (no fiber disarray) Hypoplastic coronaries 1 No CV disease 22 Unequivocal CV dis. 2 Ruptured aorta 3 Atherosclero. CA 3 ALCAPA 14 HOCM**
Magnitude of the Problem
F excluding trauma, cardiac death is the most frequent cause of sports related death. F 5/100,000 have a condition which predisposes them to sudden death. F 1/200,000 athletes per yr have sudden death F ~12 high school ath. die/yr in U.S.
Hypertrophic Cardiomyopathy
and Sudden Death
F Annual mortality rate 2-4% F Mechanism probably acute dysrhythmia(v.tach, v.fib., asystole) F Sudden death most common 10-25 yrs. F Peak age is 14 yrs. F Approx. 40% occur during ahtletics F If there is documented v. tach on holter,death rate 8%.
HCM and Sudden Death
Increased risk of sudden death ass. with: documented v. tach, family hx. of sudden death, young age of onset of symptoms. Sudden death not related to presence or degree of outflow gradient. NO INTERVENTION(SURG,MEDICAL) HAS BEEN SHOWN TO DECREASE RISK OF SUDDEN DEATH.
OTHER CAUSES of SUDDEN
DEATH in ATHLETES
F Marfan Syndrome: related to aortic rupture. F Myocarditis: may be associated with acute inflammation and chronic multifocal scarring-- arrthymias F Drugs: anabolic steroids predispose to thrombotic MI, CVA, and cardiomyopathy. COCAINE
Other Causes,
F Primary dysrhythmias: a. sudden death reported with SVT,long QT, SSS. b. exercise syncope most common presentation.
SCREENING?
F SMA 1: history and PE focused hx of syncope, chest pain, or seizures in patient- always ask about sudden death in family members focused PE looking for path. murmur, gallop, or S4, obvious ectopy
LONG TERM EXPERIENCE
AFTER CARDIAC SURGERY
F 60% of important CHD: VSD ASD PS PDA CoA
RESIDUAE & SEQUELAE of
CONGENITAL HEART
SURGERY
It ain’t over, til it’s over
Surgical Residuae & Sequelae
F Obstructive lesions F Hypertension F Shunts F pulm. artery hypertension/ distortion F valve regurg
Coarction of the Aorta
F 50 - 85% incidence of bicuspid Ao valve. -- Late developement of stenosis/insuf- ficiency. Associated with calcific changes midlife event -- infective endocarditis F >50% have mitral abnormalities
Coarctation of the Aorta
Associated abnormalities: -- intracranial aneurysms -- late aortic dissection -- intramural coronary artery disease