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Sudden Cardiac Death in Young People

Sudden cardiac death is defined as an event that is non-traumatic, non-violent, unexpected, and resulting from sudden cardiac arrest within six hours of previously witnessed normal health.1

Epidemiology
  • The incidence of sudden cardiac death in those aged 35 years or less is approximately 1 in 100,000 per year.2
  • Sudden cardiac death in those aged 35 years or less is more common in males than females.3
  • Sports activity in adolescents and young adults is associated with an increased risk of sudden cardiac death.2 Sudden cardiac death is predominantly caused by pre-existing congenital cardiac abnormalities rather than the sporting activity.4
  • Premature atherosclerotic disease is an important cause in young adults.4
  • There is an increased risk of sudden cardiac death associated with cocaine abuse.5
Causes6
Differential Diagnosis

Other causes of sudden death in young people include:7

Investigations
  • The background history of the victim of sudden death should be elicited including preceding symptoms, previous medical history and circumstances of death.
  • The family history must be established including any histories of unexplained syncope, sudden death, muscle weakness or congenital deafness.
  • Sometimes the underlying diagnosis may only be identified by detecting abnormalities in relatives (e.g. cardiac ion channelopathies). The investigations of first degree relatives include:
  • Depending on these results, further specialist tests can be undertaken, e.g. contrast ventriculography in the diagnosis of arrhythmogenic right ventricular dysplasia.8
  • Genetic testing: current knowledge of specific genetic associations with various causes of sudden cardiac death, e.g. Long QT syndrome, Brugada syndrome and HOCM, helps in confirming diagnosis and following up family members. Increasing knowledge is likely to give genetic testing a greater role in diagnosis and management in the future.
Prevention
  • If a diagnosis has been made then advice on testing of other relatives is appropriate.
  • Pre-participation cardiovascular screening of young competitive athletes by 12-lead ECG (in addition to history and physical examination) has been recommended both in Europe and the United States.9
  • The detection of cardiac abnormalities such as hypertrophic cardiomyopathy, dilated cardiomyopathy, or arrhythmogenic right ventricular dysplasia offers the prospect of treatment that will improve symptoms and greatly reduce the risk of sudden death.10


Document References
  1. Sharma S, Whyte G, McKenna WJ; Sudden death from cardiovascular disease in young athletes: fact or fiction? Br J Sports Med. 1997 Dec;31(4):269-76.
  2. Corrado D, Basso C, Rizzoli G, et al; Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol. 2003 Dec 3;42(11):1959-63. [abstract]
  3. Wisten A, Forsberg H, Krantz P, et al; Sudden cardiac death in 15-35-year olds in Sweden during 1992-99. J Intern Med. 2002 Dec;252(6):529-36. [abstract]
  4. Bille K, Figueiras D, Schamasch P, et al; Sudden cardiac death in athletes: the Lausanne Recommendations. Eur J Cardiovasc Prev Rehabil. 2006 Dec;13(6):859-75. [abstract]
  5. Bauman JL, Grawe JJ, Winecoff AP, et al; Cocaine-related sudden cardiac death: a hypothesis correlating basic science and clinical observations. J Clin Pharmacol. 1994 Sep;34(9):902-11. [abstract]
  6. Basso C, Corrado D, Thiene G; Cardiovascular causes of sudden death in young individuals including athletes. Cardiol Rev. 1999 May-Jun;7(3):127-35. [abstract]
  7. Morentin B, Paz Suarez-Mier M, Audicana C, et al; [Incidence and causes of sudden death in persons less than 36 years of age] Med Clin (Barc). 2001 Mar 3;116(8):281-5. [abstract]
  8. Fontaine G, Fontaliran F, Hebert JL, et al; Arrhythmogenic right ventricular dysplasia. Annu Rev Med. 1999;50:17-35. [abstract]
  9. Corrado D, Pelliccia A, Bjornstad HH, et al; Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005 Mar;26(5):516-24. Epub 2005 Feb 2. [abstract]
  10. Goodwin JF; Sudden cardiac death in the young. BMJ. 1997 Mar 22;314(7084):843.

Internet and Further Reading
  • CRY; Cardiac Risk in the Young
Acknowledgements EMIS is grateful to Dr Colin Tidy for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2007.
DocID: 2818
Document Version: 21
DocRef: bgp2454
Last Updated: 14 Apr 2007
Review Date: 13 Apr 2009




















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PS - Health and Poverty

Perhaps the biggest cause of ill health in the world is poverty. Help to Make Poverty History. For example, why not lend some of your money to disadvantaged communities to enable them to trade their way out of poverty through schemes such as Shared Interest.

See also MAKEPOVERTYHISTORY North East for details and links to campaigns against poverty.

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