Incidence and clinical manifestations of sudden death in young adults: a two-decade, nationwide, retrospective, cross-sectional study.

Sudden Death in Young Adults: An Autopsy-Based Series of a Population Undergoing Active Surveillance

Mitral valve prolapse syndrome as cause of sudden death in young adults

Background & objectives Sudden death, defined as death occurring within one hour of symptom onset in witnessed cases or within 24 h of last being seen alive in unwitnessed cases, remains a major public health concern. This study aimed to evaluate the incidence, causes, and risk factors associated with sudden death in young adults. Methods A cross-sectional study was conducted over one year at a tertiary care centre in New Delhi. Cases meeting the definition of sudden death were included, excluding trauma, suicide, homicide, and drug abuse. Each case underwent whole-body imaging, autopsy, and histopathological examination. A multidisciplinary team comprising forensic experts, pathologists, radiologists, and clinicians determined the cause of death. Comparative analysis was performed between sudden death in young adults (18-45 yr) and older adults (46-65 yr). Results Out of 2214 autopsies, 180 cases (8.1%) met the criteria for sudden death. Sudden death in young accounted for 103 (57.2%) cases. Mean age was 33.6 yr in sudden death in young (IQR=10) and 53.8 years in sudden death in old, with male predominance in both. Cardiovascular causes were most common in young (n=40, 42.6%), followed by respiratory causes (n=20, 21.3%) and sudden unexplained deaths (n=20, 21.3%), where no pathology was identified. Other causes included gastrointestinal, central nervous system, and genitourinary pathologies. Smoking and alcohol intake was equally prevalent in those who died young and at old age. Interpretation & conclusions Sudden death in young adults is a significant concern requiring targeted public health strategies. Coronary artery disease remains the leading cause. Respiratory and unexplained deaths warrant further investigation.

Sudden unexpected death in young adults of 18-35 years account for an important subset of deaths in our autopsy population. The case notes and autopsy reports in 44 subjects were analysed during the period 1985-94 at the Department of Histopathology, University College Hospital, Galway to establish the underlying cause of death. Subjects who were involved in road traffic accidents, cases of drowning, and patients with known congenital heart disease, chronic renal failure and malignancy were excluded. We found that a large proportion of sudden deaths in young adults were secondary to epilepsy and chemical/drug poisoning, accounting for 34 per cent and 31.8 per cent respectively. Sudden adult death syndrome (SADS) accounted for 9 per cent of the study population. Detailed case history, meticulous post-mortem examination and complete toxicological screening are recommended to arrive at the underlying cause of death.

BackgroundWe aim to study the profile, and pathological characteristics of sudden death in young in purpose of recommendations for prevention.MethodsWe performed a retrospective cohort study using autopsy data from the Department of Forensic Medicine of Monastir (Tunisia). A review of all autopsies performed for 28 years was done (August 1990 to December 2018). In each case, clinical information, and circumstances of death were obtained. A complete forensic autopsy and histological, and toxicological investigations were performed. We have included all sudden death in persons aged between 18 and 35 years.ResultsWe collected 137 cases of sudden death during the studied period. The mean age of the studied population was 26.47 years. Almost 72% deaths were classified as cardiac death, and was due to ischemic heart disease in 32.32%. Sudden death was attributed to a pleuropulmonary cause in 7.4%, an abdominal cause in 6%, and from a neurological origin in 4.5%. The cause of sudden death in this group was not established by 9.5%.ConclusionIn this series, sudden death in young adults occurs mainly in a smoking male, aged between 18 and 24 years old, occurring at rest, in the morning, and early in the week. It is more common, especially in summer. Sudden death is most often the first manifestation of pathologies, especially unsuspected heart diseases. The predominance of cardiovascular causes is the common denominator of almost all studies reported in the literature. Our findings suggest that prevention of sudden death among young adults under the age of 35 years should also focus on evaluation for causes not associated with structural heart disease.

To study the time relationship between the onset of coronary thrombosis and sudden unexpected cardiac death in young adults. Hearts of 11 young adults (< or = 35 years), who had died within 1h after onset of symptoms and presented with a coronary thrombotic occlusion were studied retrospectively for the type of underlying plaque complication and the time of onset of thrombus formation. In all cases tissue blocks were taken from the occluded artery and sectioned for microscopic evaluation. Of 11 culprit lesions 10 were mainly fibrocellular; only one was lipid-rich. Inflammatory cells were found in all plaques, albeit in highly variable amounts. Plaque erosion had occurred in nine; deep ruptures in two. Analysis of the plaque-related occluding thrombus revealed fresh thrombosis in three (both ruptured plaques and one erosion); the other eight, however, showed occlusion with different histological stages of organization of thrombus. Despite strict inclusion criteria for sudden death in these young adults, the majority must have had plaque instability for some time, since thrombus formation had occurred at least days to weeks prior to the acute event.

Chest pain is a common presenting complaint in adolescent patients. Myocarditis is an important and potentially serious etiology of chest pain for clinicians who care for these patients to recognize. Myocarditis is commonly virally mediated, while extra-intestinal cardiac manifestations of bacterial enteritis, such as Campylobacter infections,are rare. Awareness of this uncommon, but potentially life-threatening pathophysiology is important for clinicians to understand. In our case, a 17-year-old male presented with chest discomfort, chest pain on inspiration, headache, myalgias, vomiting, and diarrhea. He denied recent viral illnesses or immunizations. He lived in rural Ohio, swam recently in a freshwater lake, and had eaten home-prepared deer meat. His father had diarrhea as well. Presenting vital signs were within normal limits for age. The patient was obese (BMI 48.5), with an otherwise normal physical exam, including a thorough cardiopulmonary assessment. Laboratory workup revealed leukocytosis (16.1 x 109/L) and elevated high-sensitivity troponin (15,857 ng/L, >22,000 ng/L three hours later, ref range <20).Gastrointestinal polymerase chain reaction (PCR) panel detected Campylobacter spp., and stool culture was positive for Campylobacter jejuni. ECG, echocardiography, chest X-ray, and CT angiography were normal. Cardiac MRI revealed an increased T2 signal consistent with myocarditis. The patient was treated with non-steroidal anti-inflammatory drugs (NSAIDs) and azithromycin and had complete resolution in symptoms. He was exercise-restricted for six months. Myocarditis is a potentially fatal pathology, representing a significant cause of sudden death in young adults. Myocarditis can present with a broad spectrum of signs and symptoms as well as variable clinical severity. Bacterial causes of myocarditis are uncommon, with Campylobacter among the least common. Campylobacter gastroenteritis, however, is quite common worldwide. Extra-intestinal and cardiac manifestations are rare; thus, it is important to maintain a high index of suspicion. Due in part to its rarity, treatment for Campylobacter-associated myocarditis is not well established. Treatment for myocarditis, regardless of etiology, is largely supportive in nature.Campylobacter-directed antibiotics, such as azithromycin, have been used successfully in adolescents withCampylobacter-associated myocarditis. Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used for symptom control, though their use remains controversial. Activity restriction is recommended for six months to reduce the risk of sudden cardiac death. Myocarditis is an important cause of sudden death in young adults and is a rare extra-intestinal manifestation of Campylobacter bacterial gastroenteritis. Pediatric and adult providers should be aware of this presentation and its pathophysiology. They should also utilize a multi-modal workup, aggressive supportive care, appropriate subspecialty consultation, and appropriate antibiotics for patients with diarrheal illness and a high clinical suspicion for extra-intestinal involvement, such as myocarditis.

Sudden death among military recruits is a rare but devastating occurrence. Because extensive medical data are available on this cross-sectional and diverse population, identification of the underlying causes of sudden death may promote health care policy to reduce the incidence of sudden death. To determine the causes of nontraumatic sudden death among a cohort of military recruits. Retrospective cohort study using demographic and autopsy data from the Department of Defense Recruit Mortality Registry. Basic military training. All nontraumatic sudden deaths from a monitored 6.3 million men and women age 18 to 35 years. Descriptive analysis, crude mortality rates of causes of sudden death, and frequency of events as a function of cause of death. Of 126 nontraumatic sudden deaths (rate, 13.0/100,000 recruit-years), 108 (86%) were related to exercise. The most common cause of sudden death was an identifiable cardiac abnormality (64 of 126 recruits [51%]); however, a substantial number of deaths remained unexplained (44 of 126 recruits [35%]). The predominant structural cardiac abnormalities were coronary artery abnormalities (39 of 64 recruits [61%]), myocarditis (13 of 64 recruits [20%]), and hypertrophic cardiomyopathy (8 of 64 recruits [13%]). An anomalous coronary artery accounted for one third (21 of 64 recruits) of the cases in this cohort, and, in each, the left coronary artery arose from the right (anterior) sinus of Valsalva, coursing between the pulmonary artery and aorta. This cohort underwent a preenlistment screening program that included history and physical examination; this may have altered outcomes. Cardiac abnormalities are the leading identifiable cause of sudden death among military recruits; however, more than one third of sudden deaths remain unexplained after detailed medical investigation.

Pulmonary pathology is the third most requent cause of sudden death in young adults, usually associated with asthma, thrombembolism, infectious respiratory disorders, or rheumatoid disorders. Many cardiovascular pathologies leading to sudden cardiac death are known to be associated with unspecific pulmonary changes. In this study we aimed to analyze the morphologic appearance of the lungs in cases of sudden death with a blank autopsy. Material and method: 89 sudden death cases with blank autopsies were selected from the National Institute of Legal Medicine database; from each a total number of 59 parameters were selected and analyzed. Results: Significant correlations were found between pulmonary fibrosis and renal glomerular fibrosis, pulmonary edema and renal interstitial fibrosis, pulmonary stasis and myocardial lipomatosis, and pulmonary fibrosis and hypoxic cardiomyocytes. Very significant correlations new identified between pulmonary and renal stasis, pulmonary edema and renal glomerular sclerosis, pulmonary fibrosis and renal interstitial fibrosis, myocardial stasis and myocardial hemorrhages. Conclusion: unspecific fibrotic pulmonary changes were found and were positively correlated with renal fibrosis. This may suggest a possible role of angiotensin pathway in some sudden deaths where the autopsy is blank or unspecific. Further studies must be conducted in this area in order to confirm this hypothesis.

Electrocardiographic diagnosis of Brugada syndrome: Medico-legal implications

Life-threatening hobbies in the youth?: Two autoptic cases suggesting arrhythmogenic right ventricular cardiomyopathy

Background. Hypertrophic cardiomyopathy (HCM) is one of the most common cardiac genetic disorders. The prevalence of this disease is 1 in 500 live births. It is stated to be the most frequent cause of sudden death in young adults. Therefore, some guidelines recommend to restrict physical activity and exercise. On the contrary, latest data show that active lifestyle and exercise in HCM patient provide significant benefits in cardiovascular function with no significant adverse reactions. Following to that, some experts might be reveal that its benefits might be outweigh risks.&#x0D; Summary. There is a paucity of studies that examine the effectiveness of exercise for HCM. American Heart Association (AHA) and (European Society of Cardiology) ESC established exercise recommendations for HCM individuals based on discussion and consensus of experts. We found three studies that investigate the efficacy of exercise in HCM individuals. Outcomes of our interest were differences in cardiovascular function, quality of life and safety issues. All studies found positive significant differences in main outcomes measure in which the HCM subjects on exercise had better or improved outcomes. None reported adverse reaction such as fatal arrhythmia or sudden death related to exercise.&#x0D; Brief Conclusion. Old belief regarding exercise restrictions on HCM need to be reconsidered, given that at present exercise have been shown to provide significant benefits for reducing cardiovascular risk factors. Nevertheless, exercise in patients with HCM must be specifically considered regarding the risk and benefit. Practicing active lifestyle and exercise on HCM individual is an exciting possibility that need further study.&#x0D; Keywords: hypertrophic cardiomyopathy, exercise training, risks and benefit, physical activity

Hot and humid: A bad combination for you, me, and patients with arrhythmogenic right ventricular dysplasia/cardiomyopathyCalkins

Sudden cardiac death in younger adults: autopsy diagnosis as a tool for preventive medicine

Summary Long QT syndrome is a genetically determined clinical condition that can lead to sudden cardiac death, life–threatening arrhythmias, typically ventricular tachycardia – Torsades de Pointes in young, otherwise healthy, adults and children. Congenital long QT syndrome is the most common cause of sudden death in young adults with structurally normal heart. There are several studies, which introduce us to gene mutation types, responsible for this disease. At this point 17 types of LQTS gene mutations are recognized, most patients present with the first 3 LQTS gene mutations: KCNQ1, KCNH2, and SCN5A. Secondary factors like electrolyte disbalance, dietary restrictions, and specific drugs may also cause QT interval prolongation. It is important to rule out avoidable causes, before further evaluation of congenital disease. Several treatment options are used in daily practice, which also includes a surgical approach. Although not so often used and seen, surgical technique has positive results – recognized by both doctors and patients.