Sudden cardiac death during sport and recreational activities in Israel

doi:10.1054/jcfm.2000.0374

Journal of Clinical Forensic Medicine

Volume 7, Issue 2, June 2000, Pages 88-91

https://doi.org/10.1054/jcfm.2000.0374 Get rights and content

Sudden unexpected death of healthy individuals during strenuous physical activity is rarely encountered. In the present study, 36 cases of death during physical exercise over the past 19 years were examined at the Israel National Center of Forensic Medicine.

The victims' ages ranged from 13–62 years; none of them had a pre-existing history of a cardio-vascular condition. Atherosclerotic cardiovascular disease (ASCVD) was the cause of death in most of the older participants in sport activities (35 years of age and over), while younger individuals died mainly as a result of diseases of the myocardium.

More than half of the deceased had been found fit to participate in active sports following basic medical examination.

We conclude that more detailed medical screening tests should be utilized to detect potentially hazardous cardiovascular diseases in all those engaged in strenuous physical activity.

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Cited by (15)

Preparticipation Evaluation
2020, Primary Care - Clinics in Office Practice
Citation Excerpt :
Screening for predisposing conditions is difficult and limited by several coexisting issues: the low prevalence of cardiovascular diseases responsible for sudden death (SD) in the young population, the low risk of SD among those with the diseases, the large sizes of the populations proposed for screening, and the imperfection of the 12-lead ECG as a screening or diagnostic tool in this setting.65 A valid concern with ECG screening is the potential for costly second-tier follow-up testing (eg, ECHOs and MRI) while only detecting rare true-positive results.38,87–89 However, even if ECGs with false-positive results could be reduced to only 5% in the course of screening 10 million individuals (the estimated number of US competitive athletes), screening ECGs would nevertheless identify a formidable obstacle of 500,000 people who required further testing to exclude underlying heart disease and resolve eligibility for sports participants.
Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age): A scientific statement from the american heart association and the american college of cardiology
2014, Journal of the American College of Cardiology
Citation Excerpt :
In terms of HCM, the single most common cause of athletic field deaths (1,2,6,117,122,125a,127), there is particular concern about relying on a single screening ECG obtained at a single point in time to exclude this disease, given the distinct possibility of left ventricular remodeling and changes in pattern in the ECGs in young patients (108,119). This is a potential source for false-negative diagnoses (15,93,185,189,190). Similar to many tests, the ECG is subject to issues related to consistency, reproducibility, and interobserver variability in interpretation.
Pathology of sudden death during recreational sports in Spain
2013, Forensic Science International
Citation Excerpt :
This percentage may be even minor because although we do not study all SDs occurring in Spain, we do study most sport-related SDs because of the social impact they have. Mean age of SD differs depending on the population analysed: in competitive athletes is around twenties [7,11,16,24,25] (Table 3) whereas in general population sport-related SDs are significantly more frequent in middle-aged men [1–6,13,15,17–19] (Table 4). In our series, mean age was 36.6 ± 15.6 years with two peaks at 16–20 and 41–45 years old (Fig. 1) probably associated to high-intensity exercise practice in the youngest group and the progression of the CAD in the oldest [23].
Most sudden deaths during sports occur in general population practising recreational sports and according to legislation, a forensic autopsy is required. Most are sudden cardiac deaths but the incidence of specific pathologies differs in reported series according to autopsy methods or diagnostic criteria. The purpose of this work is to analyse the pathology of sports-related sudden deaths in a large forensic series from Spain studied according with cardiovascular pathology criteria.
We have reviewed the sudden deaths occurred during sports studied at our institution between 1995 and 2010 in which a complete autopsy was performed with exhaustive cardiac examination and toxicological analysis. Out of 8862 sudden deaths studied, 168 (1.8%) were related to sports; age was between 9 and 69 (average 36.6 ± 15.6 y); 163 were males and 5 females. Only 3 were professional athletes. Most frequent sports associated to sudden death were cycling (29%), soccer (25.5%), running (8.9%) and gymnastics (6.5%). In 49 cases (29.1%) there were some personal pathological antecedents or familial sudden deaths. Causes of death were: coronary atherosclerotic disease, 85 (50.5%) (74 over 35 years old); arrhythmogenic cardiomyopathy, 13 (7.7%); hypertrophic cardiomyopathy, 12 (7.1%); idiopathic left ventricular hypertrophy, 7 (4.1%); congenital coronary anomalies, 7 (4.1%); myocarditis, 6 (3.5%); aortic stenosis, 5 (2.9%); and other, 11 (6.5%). Myocardial diseases were the most frequent under 35 years old. No cause of death was found in 19 (11.3%) (all under 30 years old) what stresses the necessity of including molecular techniques in forensic autopsies.
Media reporting bias affects reported sudden death rates
2011, Journal of the American College of Cardiology
Reply
2011, Journal of the American College of Cardiology
Mitral valve prolapse syndrome as cause of sudden death in young adults
2007, Forensic Science International
Citation Excerpt :
While the clinical diagnosis of MVPS can be established in even very young patients [26], fatal cases during childhood represent rarities [24]. Cases of unexpected death have been reported to occur during sport activities [27] and as perioperative death [28]. This points at the fact that there is controversy, whether bodily strain might promote the occurrence of arrhythmias in patients with MVPS [29].
Mitral valve prolapse syndrome (MVPS) is a relatively common disorder of the mitral valve and most cases take a benign clinical course. Only a subset of patients develop severe clinical symptoms such as arrhythmia, insufficiency of the mitral valve or infective endocarditis. As a consequence, sudden death might occur in these patients, thought to be caused by an arrhythmogenic event. By presenting six cases of sudden unexpected death in young female adults, we point at clinical and pathological data from the literature, which are of interest from the viewpoint of legal medicine. The incidence of MVPS in autopsy series has been reported to be about 4–5%, while clinical data hint at an incidence of about 2.5%. The presented cases suggest that even clinically benign cases of MVPS in young adults might result in sudden unexpected death. Such cases are not included in hospital based studies on the topic. This might lead to an underestimation of the fatal risk associated with the disease, even if sudden death might be a rare event in MVPS.

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Regular ArticleSudden cardiac death during sport and recreational activities in Israel

Am J Cardiol

Chest

J Am Coll Cardiol

The 10 leading causes of death

Sudden death in young competitive athletes. Clinical, demographic and pathological profiles

JAMA

Cardiovascular evaluation of the athlete. Issues regarding performance screening and sudden cardiac death

Sports Med

Screening for hypertrophic cardiomyopathy in young athletes

N Engl J Med

Regular Article
Sudden cardiac death during sport and recreational activities in Israel