Elsevier

Heart Rhythm

Volume 2, Issue 12, December 2005, Pages 1277-1282
Heart Rhythm

Original-clinical
Sudden death in the young

https://doi.org/10.1016/j.hrthm.2005.09.008Get rights and content

Background

Sudden death is rare in young people, but it has a disproportionate impact on the community.

Objectives

The purpose of this study was to determine the causes of sudden, natural death in persons aged 5–35 years.

Methods

All autopsies conducted at a forensic medicine facility in the years 1995–2004 (inclusive) were reviewed. This facility serves more than 2.5 million people in the eastern part of Sydney, Australia. Data collected included subject age, height, weight, gender, circumstances of death, and pathologic findings at autopsy. Deaths caused by trauma, accidental causes, drowning, and drug toxicity were excluded from analysis.

Results

There were 427 nontraumatic, sudden deaths in the 10-year period (70.7% male). Cardiac causes accounted for 56.4%, noncardiac causes 39.3%, and undetermined cause 4.3%. The most common cardiac cause of sudden death was presumed arrhythmia in those with no or minimal structural heart disease (29.0%). Other cardiac causes were acute myocardial infarction (24.5%), myocarditis (11.6%), hypertrophic cardiomyopathy (5.8%), aortic dissection (5.4%), and dilated cardiomyopathy (5.4%). More than two thirds of deaths caused by acute myocardial infarction occurred in the age group from 30–35 years. Sudden cardiac death occurred during physical activity in 10.8% of cases. Sudden cardiac death was reported in a first-degree relative in 4.5% of decedents. The most common noncardiac causes of sudden death were epilepsy (23.8%), intracerebral hemorrhage (23.8%), asthma (16.1%), and pulmonary embolism (12.5%).

Conclusion

Presumed cardiac arrhythmia is the most common cause of sudden, natural death in the young. There was no reported history of sudden death among the relatives of most decedents.

Introduction

Sudden death is rare in young people, but it has a disproportionate impact on the community. Each year 300,000 sudden deaths occur in the United States,1, 2 and a similar number occur in Europe. Liberthson3 estimated that several thousand Americans younger than 20 years die suddenly from cardiac disorders each year in the United States. Most sudden deaths in middle-aged and elderly individuals in developed countries are caused by coronary artery disease, but there is a paucity of data on the causes of sudden death in the young.4, 5, 6, 7, 8, 9, 10, 11 The aim of the current study was to determine the causes of sudden death in persons aged 5–35 years who had undergone postmortem examination.

Section snippets

Methods

All autopsies conducted at the Department of Forensic Medicine, Central Sydney Laboratory Service over a 10-year period were reviewed. This facility serves a population of more than 2.5 million people in the eastern part of Sydney, Australia. This population is demographically stable and representative of the urban Australian population. The New South Wales Coroners Act stipulates that all sudden unexpected deaths for which the cause is unknown must be referred for medicolegal investigation.12

Results

From 1995–2004, there were 427 sudden, nontraumatic deaths. Cardiac and noncardiac causes accounted for 56.4% and 39.3% of cases, respectively. The cause was undetermined in 4.3% of cases. Mean age was 26.3 ± 7.1 years, and BMI was 26.9 ± 8.4 kg/m2. Males accounted for 70.7% of subjects. Figure 1, Figure 2 illustrate the most frequent diagnoses in the cardiac and noncardiac categories, respectively.

Discussion

Sudden death in the young is relatively uncommon but has tragic consequences. The reported causes of sudden death vary among populations. This finding may reflect differences in data collection or autopsy technique, or it may be a consequence of genetic diversity.

Previous studies such as the National English Survey by Bowker et al17 attributed the majority of sudden cardiac deaths (93.4%) to structural heart disease. In our study, the heart was normal or near-normal to careful examination in

Dedication

In memory of Dr. Tim Radvan, Royal Prince Alfred Hospital Resident Medical Officer.

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  • Cited by (0)

    Dr. Puranik is supported by a postgraduate research scholarship from the National Heart Foundation of Australia.

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