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Exercise Related Sudden Cardiac Death: The Experience of a Tertiary Referral Pathology Centre in the United Kingdom
  1. Sofia V de Noronha
  1. National Heart and Lung Institute, Imperial College, London, United Kingdom
    1. Sanjay Sharma (ssharma21{at}hotmail.com)
    1. King's College Hospital Foundation Trust and University Hospital Lewisham NHS Trust. London, United Kingdom
      1. Michael Papadakis
      1. King's College Hospital Foundation Trust, United Kingdom
        1. Saral Desai
        1. Royal Brompton and Harefield NHS Trust, United Kingdom
          1. Gregory Whyte
          1. Liverpool John Moores University, Liverpool, United Kingdom
            1. Mary N. Sheppard (m.sheppard{at}rbht.nhs.uk)
            1. National Heart and Lung Institute, Imperial College, London, United Kingdom

              Abstract

              Objective: To characterise the demographics and aetiology of sudden cardiac death (SCD) in athletes referred to a tertiary cardiac pathology centre in the UK.

              Design: Retrospective non-case controlled analysis.

              Setting: Cardiac pathology centre at the National Heart and Lung Institute and Royal Brompton Hospital.

              Subjects: Between 1996-2008, the hearts of 118 athletes were referred for pathological assessment to ascertain the precise aetiology of SCD.

              Results: The majority of athletes (n=113; 96%) were male and most (107; 91%) were amateurs participating predominantly in football, rugby and running. The mean age of death was 28 ± 12 years old (range 7-59 years old); 75% athletes were aged < 35 years of age. Most deaths (81%) occurred during or immediately after exercise. Antecedent symptoms of cardiac disease were reported in 18% and 17% had a family history or premature cardiovascular disease or SCD. Twenty one per cent of athletes had relevant past medical history which included a known history of cardiac disease. Cardiomyopathy was the commonest cause of death and accounted for 62% of all the SCDs. A significantly high proportion of athletes (23%) exhibited a morphologically normal heart. Atherosclerotic coronary disease accounted for only 3% of cases and was confined to athletes aged > 35 years old.

              Conclusions: Sudden cardiac death in sport is largely due to clinically silent cardiomyopathies or primary electrical disorders (morphologically normal heart). Antecedent symptoms and family history are absent in over 80% of cases, therefore clinical screening with health questionnaires will fail to identify most athletes with potentially sinister cardiac disorders.

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