Chest
Volume 87, Issue 4, April 1985, Pages 476-482
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Pathologic Features of Sudden Death in Children, Adolescents, and Young Adults

https://doi.org/10.1378/chest.87.4.476Get rights and content

Pathologic investigation of 50 children, adolescents, and young adults who died suddenly and unexpectedly revealed that the most frequently encountered cardiovascular diseases were mitral valve prolapse (12 cases), myocarditis (12 cases), hypertrophic cardiomyopathy (six cases), and anomalous origin of a coronary artery from the aorta (two cases). Five subjects had no evidence of cardiac abnormalities. A striking family history of sudden death was encountered among eight subjects, of whom three had mitral valve prolapse and three had normal hearts. Assessing the circumstances surrounding sudden death, it was found that at the time of collapse, 32 subjects were engaged in regular activity, eight subjects were engaged in active athletics, and ten were found dead in bed. A relationship of the terminal event to emotional stress was reported in three subjects.

Section snippets

DEFINITION

The definition of sudden death as used herein is an unexpected natural phenomenon in which loss of all vital functions occurs instantaneously or within six hours of the onset of symptoms or collapse. There were no cases with a past history of successful cardiopulmonary resuscitation following an episode of collapse. To ensure that death was unexpected, we included in the study only those subjects who were not hospitalized at the time of onset of acute symptoms or collapse. No patient who had

RESULTS

The cardiac abnormalities which accounted for sudden death in this series are presented in order of decreasing frequency in the following tabulation:

Mitral valve prolapse12
Myocarditis12
Hypertrophic cardiomyopathy6
Coronary arterial diseases:5
Congenital2
Acquired obstructive:
Atherosclerotic1
Dissecting aneurysm1
Myxomatous intimai thickening1
Coexisting conditions3
Aortic stenosis2
Pulmonary hypertension1
Degenerative changes in bundle of His1
Cardiac tumor1
Normal heart5
Undetermined2
TOTAL50

DISCUSSION

We conducted this study on sudden death of children, adolescents, and young adults based on clearly defined criteria in order to determine the causes and circumstances of death in this particular age group. Published data of sudden death in children and young adults are sparse. An international study on this issue3 included 254 subjects, and there was wide range in the degree to which death could be identified as unexpected. Only 5 percent of the subjects in that study had no previously known

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    Supported by research grant 5 RO1 HL05694 from the National Heart, Lung, and Blood Institute.

    Manuscript received February 20; revision accepted November 7.

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