Sudden death due to ischaemic heart disease in young aboriginal sportsmen in the Northern Territory, 1982-1996.

OBJECTIVE: To estimate the incidence of sport-related sudden cardiac death due to ischaemic heart disease (IHD) in competitive young Aboriginal sportsmen. SETTING: Northern Territory (NT), 1982-1996. DESIGN: Retrospective case series with cases identified from Australian Bureau of Statistics cause-of-death listings and NT coronial autopsy records. MAIN OUTCOME MEASURES: Circumstances and incidence of sport-related sudden cardiac deaths due to IHD; autopsy findings. RESULTS: Between 1982 and 1996, there were eight sudden cardiac deaths due to IHD and related to sporting activity among Aboriginal sportsmen aged 15-37 years in the NT. Six were associated with games of Australian (rules) football. All occurred in the Top End of the NT in the wet season, and all occurred after the first half, or within an hour of, a game. Four of the players had macrosopic myocardial abnormalities (hypertrophy or previous infarcts) on autopsy. The estimated incidence of IHD-related sudden cardiac death among Aboriginal Australian football players in the NT was 19-24 per 100,000 player-years, compared with 0.54 per 100,000 player-years among Australian rules footballers of similar ages in Victoria. CONCLUSIONS: Incidence of sudden cardiac death attributable to underlying IHD was extremely high among young NT Aboriginal Australian footballers. Prevention will best be achieved by funding culturally appropriate long-term strategies to reduce the incidence of IHD. However, in the short-term, community-controlled programs with education of athletes, heat-stress reduction strategies, and cardiovascular screening should reduce the incidence of sudden cardiac death in sport.     

Sudden cardiac death in Air Force recruits. A 20-year review

We reviewed the clinical and autopsy records of the 19 sudden cardiac deaths that occurred among the 1,606,167 US Air Force healthy, medically screened recruits (90% male; 17 to 28 years old) during a 42-day basic training period between 1965 and 1985. Sixteen (all male) died suddenly of underlying structural heart disease, whereas no anatomic cause of death was identified in the remaining three. Thirty-two nonsudden, noncardiac deaths occurred during the same period, and only two had structural heart disease. Strenuous physical exertion was associated with sudden death in 17 of 19 cases (0.017 deaths per 50,000 exercise-hours), and the most frequent underlying etiology was myocarditis. Sudden cardiac death, a rare event in healthy young adults, is usually associated with exertion.     

Aborted sudden nocturnal cardiac death in a young man with structurally normal heart

Sudden cardiac death is a devastating event, particularly when it occurs to young, otherwise healthy individuals. We report here a young Burmese male who survived sudden cardiac death with structurally normal heart. His electrocardiogram revealed features consistent with Brugada syndrome. He was referred for intra-cardiac defibrillator implantation. In this article, in addition to the case presentation, a review of Brugada syndrome medical literature is also presented.     

全细胞膜片钳技术在遗传性长QT综合征和不明原因猝死中的研究进展

基因突变导致的心脏离子通道疾病被认为是引起不明原因猝死的首要死因,长QT综合征作为最常见的心脏离子通道疾病之一,其致病基因突变在各类SUD中被不断报道。利用全细胞膜片钳技术进行心脏离子通道功能验证对于评估基因突变的致病性、明确SUD死者的死亡原因、筛查SUD危险人群具有重要的法医学意义。对全细胞膜片钳技术的基本原理及其在长QT综合征的发病机制与不明原因猝死研究中的应用进行综述。     

T波峰末间期预警心脏性猝死研究进展

心脏性猝死是由于心脏方面的原因所导致的自然死亡,猝死事件发生的时间和方式难以预料,严重威胁人类的健康,T波峰末间期(Tp-Te间期)是新近发现的有助于心脏性猝死预测的指标。其产生的电生理机制尚未完全阐明,研究发现Tp-Te间期可以作为跨室壁复极离散度的量化指标,而跨室壁复极离散度的增大是恶性室性心律失常发生的基质,因此Tp-Te间期有助于预测恶性室性心律失常的发生。     

Physical exertion, exercise, and sudden cardiac death in women

Context  Exercise is associated with a lower risk of cardiovascular events but may transiently increase the risk of ventricular arrhythmias. Its short-term and long-term associations with risk of sudden cardiac death among women are unclear. Objectives  To compare the risk of sudden cardiac death in women during moderate to vigorous exertion with the risk of sudden cardiac death during lighter or no exertion; and to assess the long-term association between moderate to vigorous exercise and sudden cardiac death. Design, Setting, and Participants  Prospective, nested case-crossover study of 288 cases of sudden cardiac death within the Nurses' Health Study (1980-2004); and a prospective cohort analysis of 69 693 participants without prior cardiovascular disease followed up from 1986-2004. Main Outcome Measure  Risk of sudden cardiac death associated with moderate to vigorous exertion. Results  The absolute risk of sudden cardiac death associated with moderate to vigorous exertion was exceedingly low at 1 per 36.5 million hours of exertion. In case-crossover analyses, the risk of sudden cardiac death was transiently elevated during moderate to vigorous exertion (relative risk [RR], 2.38; 95% confidence interval [CI], 1.23-4.60; P = .01) compared with the risk during lesser or no exertion. Habitual moderate to vigorous exertion modified this transient risk (P = .005 for interaction) and the risk was no longer significantly elevated among those who exercised 2 or more hours per week. In the cohort analyses, an increasing amount of moderate to vigorous exercise was associated with a lower long-term risk of sudden cardiac death in age-adjusted and multivariable models that excluded biological intermediates (P = .006 for trend). This relationship was attenuated when biological intermediates were included (P = .06 for trend); however, the reduction in risk remained significant among women who exercised 4 or more hours per week (adjusted RR, 0.41; 95% CI, 0.20-0.83; P = .01) compared with women who did not exercise. Conclusions  These prospective data suggest that sudden cardiac death during exertion is an extremely rare event in women. Regular exercise may significantly minimize this small transient risk and may lower the overall long-term risk of sudden cardiac death.      

Study of sudden cardiac deaths in young athletes

Sudden cardiac deaths in athletes are usually due to underlying cardiovascular disease. The final pathway is usually ventricular fibrillation following hypertrophic cardiomyopathy and coronary artery anomalies in young persons below the age of 30 years. Sudden cardiac death in young is rare but remains as a source of concern. A postmortem study was conducted to ascertain the cardiac causes of sudden death in persons below the age group 30 years following exercise in games or otherwise. Out of 15 cases in autopsy finding, hypertrophic cardiomyopathy (n=7) was the commonest cause followed by coronary artery anomalies (n=4). Sudden unexpected death is a source of concern and careful screening of history and physical examination for potential athletes should identify majority of people at risk.     

致心律失常性右室心肌病的临床诊断特点

致心律失常性右室心肌病（ARVC）是遗传性心肌病的一种,以右心室心肌细胞被纤维、脂肪组织代替为主要病理特征.临床主要表现为反复发生心律失常、心衰和猝死,在年轻人及运动员猝死中具有重要地位.因此,有必要进一步加深对该疾病的病理、生理和临床特征的认识和进一步研究.该文就ARVC的临床特点、心电图表现、超声心动图特点和核磁共振成像特点作一综述.     

Cost-Effectiveness of Implantable Cardioverter-Defibrillators in Brugada Syndrome Treatment

Brugada syndrome is characterized by an ST-segment elevation in the right precordial ECG leads and a high incidence of sudden death in patients with structurally normal hearts. Some trials have demonstrated that the cost-effectiveness of ICD implantation treatment in patients with structurally abnormal hearts is more favorable than that of control treatment. We used Treeage pro 2005 to estimate costs and survival among the Brugada syndrome patients who received either an ICD or were treated by control therapy of I_to-blocking properties (quinidine) or β-blockers (propranolol). In conclusion, our analysis suggests that prophylactic implantation of an ICD has good cost-effectiveness in patients with Brugada syndrome who are at high risk of sudden death. ICD treatment has shown a cost-effectiveness ratio below $9,591 per QALY gained from trials of defibrillator vs β-blockers for Unexplained Death in Thailand (DEBUT). The control therapy of quinidine may be a good choice for patients who are infants or living in developing countries.     

急性冠脉综合征患者心源性猝死的相关因素分析

目的探讨急性冠状动脉综合征患者心源性猝死（SCD）的相关因素。方法回顾性分析江苏省金坛市人民医院80例急性冠状动脉综合征SCD患者以及85例江苏省金坛市人民医院心内科同期住院患者作为非SCD病例对照，分析其临床资料特征，探讨发生SCD的相关因素。结果低射血分数（EF）值、心肺复苏术（CPR）术后、脑利钠肽（BNP）、肾功能不全、持续性高血压、持续性心律失常、情绪刺激、过度劳累在两组患者中分布的差异有统计学意义（P〈0．05）；在其他条件等同的情况下，CPR术后、低EF值、持续性心律失常、持续性高血压、过度劳累、情绪刺激等对患者有影响（P〈0．05）；尤其是CPR术后（OR值：11．48）、低EF值（OR值：9．53）、持续性心律失常（OR值：6．87）对患者有显著影响（P〈0．05）。结论急性冠状动脉综合征患者发生SCD的因素有很多，临床上应密切观察急性冠状动脉综合征患者的临床症状，及时改善不利因素，降低SCD的发生率。     

Primary prevention of sudden cardiac death by implantable cardioverter-defibrillator therapy in Chinese patients with heart failure: a single-center experience

Background An implantable cardioverter-defibrillator （ICD） has been suggested for heart failure patients for primary prevention of sudden cardiac death. However, few data have been reported on the application of ICD as primary prevention of sudden cardiac death in China. We evaluated the value of primary prevention ICD therapy in Chinese patients with heart failure.Methods Thirty-four patients at an average age of （60.2±13.7） years seen in Peking Union Medical College Hospital were treated with ICD implantation for primary prevention of sudden cardiac death from November 2005 to July 2009. Single-chamber ICDs were implanted in 16 （47.0%） cases, and dual-chamber or cardiac resynchronization therapy defibrillators in 18 （53.0%） cases. The patients had an average left ventricular ejection fraction of （26.9±5.5）% （11% to 35%）, of which 18 （53.0%） patients had ischemic cardiomyopathy and 16 （47.0%） patients had non-ischemic cardiomyopathy. All patients were followed up at three months after the implantation and every six months thereafter or when prompted by an ICD event.Results There were five （14.7%） deaths, including two of heart failure and three with a non-cardiac course, during an average follow-up of （15.0±11.9） months. Forty-one ICD therapy events were recorded, including 19 （46.3%） appropriate ICD therapies in six patients and 22 （53.7%） inappropriate ICD therapies in four patients with single chamber leads. Inappropriate ICD therapies were mainly due to supraventricular tachyarrhythmias, especially atrial fibrillation. Patients with ischemic cardiomyopathy and non-ischemic cardiomyopathy did not differ in the incidence of either appropriate or inappropriate therapy.Conclusions ICD for primary prevention of sudden cardiac death in China prevents patients from arrhythmia death. Relatively high incidence of inappropriate therapies highlights the importance of an atrial lead.     

Electrocardiographical case. Asymptomatic patient with ST-segment elevation

A 46-year-old man complained of recurrent episodes of giddiness which was not associated with chest pain or breathlessness. There was no family history of sudden death. Clinical examination was unremarkable.12-lead electrocardiogram (ECG) showed ST segment elevation in the right precordial leads, with coved ST segment elevation at its J point followed by a negative T wave with no isoelectric separation, specifically in V2. These ECG features are characteristic of the Brugada syndrome. He underwent a flecanide challenge which produced further elevation of ST segment at its J point and spontaneous ventricular ectopy. Electrophysiological studies induced ventricular fibrillation with 3 extra stimuli. An implantable cardioverter-defibrillator was implanted for prevention of sudden cardiac death. The Brugada syndrome is discussed.     

24h动态心电图结合阿托品试验预测窦性心动过缓患者猝死风险

目的 对窦性心动过缓(SN)患者作24 h动态心电图(Holter)检查,结尾时连接作阿托品激发窦房结试验,分析窦房结功能以进行猝死风险预测.方法 选择近4年来因各种原因未能安装心脏永久性起博器之SN患者43例,控制心功能在Ⅱ级以内,剔除房性、交界性和室性传导阻滞、Brugada综合征、J波综合征者.经24 h Hol...     

The preparticipation physical examination for athletics: a critical review of current recommendations

The preparticipation physical examination (PPE) has become the standard of care for the millions of high school students in the United States as they prepare for athletic participation. These assessments are intended to identify medical conditions that may affect safe and effective participation in organized sports. The PPE has become an integral aspect of the athletic and sports medicine system during the last three decades. Over time, the PPE has been revised, largely based upon the recommendations of large medical organizations. Several primary and secondary goals have been presented to be accomplished through the PPE. One particular goal of these assessments is to identify individuals with underlying cardiovascular disease, a significant cause of acute sudden cardiac death in high school and college athletes. While current research continues to demonstrate that the PPE has no effect on the overall morbidity and mortality rates in athletes, other objectives may be fulfilled by these examinations. In order to improve the ability of these examinations in fulfilling their primary objectives, instruments that have better results in preventing the injuries and deaths associated with athletic participation should be developed and investigate.     

Cannabis, possible cardiac deaths and the coroner in Ireland

Background

The elevated risk of triggering a myocardial infarction by smoking cannabis is limited to the first 2?h after smoking.

Aim

To examine the possible role of cannabis in cardiac deaths.

Cases and results

From 3,193 coroners?? cases over 2?years, there were 13 cases where the clinical information was compatible with a primary cardiac cause of death. An inquest was held in three cases. Myocardial infarction was the primary cause of death in 54%. Other causes were sudden adult death syndrome, sudden death in epilepsy, and poisoning by alcohol and diazepam. Cannabis was mentioned once only on a death certificate, but not as a cause of death. Blood delta9-tetrahydrocannabinol-carboxylic acid was recorded in one case and in no case was plasma tetrahydrocannabinol (THC) measured.

Conclusions

To attribute sudden cardiac death to cannabis, plasma THC should be measured in the toxicology screen in coroners?? cases where urine cannabinoids are positive. A positive urine cannabinoids immunoassay alone is insufficient evidence in the linkage of acute cardiac death and cannabis.     

肥厚型心肌病基因突变的临床意义

肥厚型心肌病（hypertrophic cardiomyopathy,HCM）是以心肌肥厚尤其是左心室不对称性心肌肥厚、心肌纤维肥大、排列紊乱为病理特征的原发性心肌病,是目前年轻人和运动员常见的猝死原因之一。目前HCM通常被认为是一种基因突变所导致的常染色体疾病,呈显性遗传。最近研究发现心脏肌节蛋白基因以及相关的线粒体基因与修饰基因的基因突变,超过900种不同的基因突变类型与HCM发生发展以及临床表型有关。本文主要就近年来关于HCM常见的基因突变与其临床意义的研究作一综述。     

Sudden death in athletes in Trinidad and Tobago.

Sudden death related to exercise activity is a well-recognized clinical syndrome. Although the incidence is low, it is always an agonizing experience to all concerned when a young, relatively healthy individual dies suddenly. Over the last four years, we have had six proven cases of sudden death in athletes. The cause varied from congenital to acquired pathology of the heart, and there was one case of heat stroke. From this study, we were able to analyse some of the risk factors and, from a review of the literature, we are able to determine (1) the feasibility of a screening programme, and (2) the design of such a programme as would be suitable for our environment.     

The Brugada syndrome: a recently recognised genetic disease causing sudden cardiac death

Australian doctors need to be aware of this little-known syndrome, which is a cause of sudden cardiac death. It is more common among Southeast Asian people, who make up a considerable proportion of our population. We report two cases which represent very different clinical presentations of this condition.     

Sudden cardiac death in young Danes

Sudden Cardiac Death (SCD) in the young (aged 1-35 years), although presumably rare, is always a tragic and devastating event often occurring in apparently healthy persons. Through the last decades, research have been undertaken to estimate the incidence rate and underlying causes of these deaths. However, because autopsy is not always conducted, the true incidence of SCD might be underestimated. The incidence of sudden infant death syndrome (SIDS) has previously been thoroughly investigated, also in Denmark. However, data has not been precise in sudden unexpected death in infancy (SUDI) estimates. SIDS is a diagnosis of exclusion and an ICD-10 diagnosis (R95.9), but to what extent this diagnosis is being accurately applied has not been investigated in Denmark. A genetic screening for mutations in an otherwise unexplained death, might identify a likely cause of (inherited) death. It would be of great clinical interest if DNA derived from the Danish Neonatal Screening Biobank, containing DNA from all Danes born after 1981, could be used in this respect. In this thesis we provide nationwide data on SCD, SUDI and SIDS in Denmark for the period 2000-2006 by reading death certificates, autopsy reports, and registry data. We report the highest possible incidence rate of SCD in the young. We elaborate on regional differences in post-mortem investigations of sudden death cases in Denmark and validate a method for whole-genome amplification of DNA from Guthrie cards to be used in genetic screening for disease causing mutations. We found 7% of all deaths in the young could be attributed to SCD. A total of 25% of sudden unexpected death in the 1-35 years old were not autopsied. The incidence of SCD of 2.8 per 100,000 person-years--when including non-autopsied cases--was higher than previously reported. Unexplained deaths were abundant and accounted for 22% of all sudden unexpected deaths. Sudden deaths occurring during competitive sports, however, were only seen in few cases. We found that regional differences exist in the investigation of sudden unexpected deaths. Fewer deaths were medico-legally investigated by external examinations ("retsl?geligt ligsyn") in some parts of Denmark compared to other parts. The same was the case in autopsy ratios. In infant deaths we found that almost 1 in 2000 live-borns died suddenly and unexpectedly during their first year of life. The R95.9 diagnosis did not reflect the SIDS cases we identified. We were able to get DNA from the Danish Neonatal Screening Biobank on 93 cases of unexplained deaths (including SIDS). Due to the limited amount of DNA available from the dried blood spots, we performed whole-genome amplification on the DNA (wgaDNA). We investigated the use of wgaDNA for genetic screening and it completely resembled genomic DNA (gDNA). Future research will focus on the genetics substrate of sudden unexplained death. In addition, we will investigate the causes of death in the 36-49 years old, as these may also suffer from cardiac disease that can be predisposed in the family.     

The cardiac pathology of sudden, unexplained nocturnal death in Southeast Asian refugees

Sudden death during sleep has occurred among previously healthy Southeast Asian male refugees, but routine autopsies have not determined the cause of death in any of these cases. We report the first systematic attempt to define the cardiac abnormalities associated with this syndrome. Among 18 hearts examined, 14 showed slight to significant cardiomegaly, characteristic of increased cardiac work load. The reasons for the cardiomegaly remain unexplained. Conduction system anomalies were present in all but one heart. These included persistent fetal dispersion of the atrioventricular node and/or bundle of His, present in 14 hearts; accessory conduction fiber connections, found in 13 cases; and congenital heart block, observed in one case. These abnormalities were associated with variations in the structure of the cardiac base, suggesting a common aberrant developmental process. Although the functional significance of these findings has not been established, the conduction system anomalies may be the substrate for sleep-related cardiac arrhythmias and sudden death.