Miscellaneous
Sudden unexpected death in persons <40 years of age

https://doi.org/10.1016/0002-9149(91)90251-FGet rights and content

Abstract

This study retrospectively assesses the underlying causes of sudden unexpected death and the occurrence of prodromal symptoms in 162 subjects (aged 9 to 39 years) over a 10-year period (1976 to 1985). Underlying cardiac diseases accounted for sudden death in 73% and noncardiac causes in 15% of subjects. In 12% of subjects, the causes were unidentifiable. Myocarditis (22%), hypertrophic cardiomyopathy (22%) and conduction system abnormalities (13%) were the major causes in 32 subjects aged <20 years. Major causes of 46 deaths in subjects 20 to 29 years were atherosclerotic coronary artery disease (24%), myocarditis (22%) and hypertrophic cardiomyopathy (13%). The largest number of deaths in 84 subjects aged ≥30 years was attributed to coronary artery disease (58%), followed by myocarditis (11%). Among noncardiac causes of sudden death, intracranial hemorrhage was the most frequent (5%), followed by infectious disease (4%). Prodromal symptoms were reported by 54% of subjects; most frequent were chest pain (25%) in subjects aged ≥20 years, and dizziness (16%) in those aged <20. Sudden death, which occurred during routine daily activity in 49% and during sleep in 23% of subjects, was related to physical exercise in 23% and emotional upset in 6%. Sudden unexpected death in the young is still an unresolved medical problem. The early recognition of prodromal symptoms could be crucial in the prevention of sudden death, specifically when exercise-related.

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      The methods used to ascertain the symptoms have varied. Retrieving information from medical records, autopsy records, questionnaires as well as interviews with family and/or eye witnesses of cardiac arrest, has proven useful in retrospective studies of symptoms prior to SCD [1,2,11,13,14,18,20–22,24,25,27,29]. Numerous studies on SCD mortality are primarily based on coroner and/or police reports, which is used to determine cause of death [18,20,28,29].

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    This study was supported by grants from Yaacov and Celia Michunik, the Phoenix Insurance Company and the Israeli Association of Insurance Companies, Tel Aviv, Israel.

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