Symptoms before sudden arrhythmic death syndrome: A nationwide study among the young in Demark.
Glinge C, Jabbari R, Rigsgaard B, Lynge TH, Engstrom T, Albert CM, Haunso S, Winkel BG, and Tfelt-Hansen J. J Cardiovasc Electrophysiol. 2015. 26(7):761-7.
Cardiac symptoms before sudden cardiac death caused by hypertrophic cardiomyopathy: a nationwide study among the young in Denmark.
Lynge TH, Risgaard B, Jabbari R, Glinge C, Bundgaard H, Maron B4 Haunsø S, Winkel BG, Tfelt-Hansen J. Europace. 2016 Jan 27. pii: euv403. [Epub ahead of print]
Take Home Message: Patients who suffered sudden cardiac death reported experiencing more cardiac symptoms prior to death compared with control patients.
Sudden cardiac death is a major cause of death among the young individuals. Hypertrophic cardiomyopathy is a leading cause of sudden cardiac death in athletes and sudden arrhythmic death syndrome (SADS) is defined as a sudden cardiac death that remains unexplained. If more is understood about the signs and symptoms that precede these deaths, then it could help clinicians educate patients and recognize patients at risk for death. Therefore, Glinge and Lynge and colleagues completed two studies to investigate and describe the medical history and symptoms that precede sudden cardiac death due to hypertrophic cardiomyopathy and SADS. In both studies the authors identified all cases of sudden cardiac death in Denmark during set number of years among individuals 1 to 35 years of age based on detailed death certificates and autopsies. This enabled the authors to identify those who had hypertrophic cardiomyopathy (38 people) and those who had SADS (136 people). Each study had a set of control patients in the same age range that died of other causes (for example, motor vehicle accident). Medical history was extracted from patient registries, and the authors obtained symptoms reported by relatives or other medical professionals from their death certificates. Overall, 60% and 89% of SADS and hypertrophic cardiomyopathy cases were male, respectively. Forty-eight (35%) SADS patients experienced at least 1 cardiac symptom of which presyncope/syncope was the most common (23 people, 17%). Other symptoms that were reported were dyspnea, chest pain, and aborted sudden cardiac death. For sudden death attributable to hypertrophic cardiomyopathy, 55% of the cases reported cardiac symptoms more than an hour prior to death were, and 42% sought medical attention. Within an hour of death 34% of people with hypertrophic cardiomyopathy reported symptoms. Overall, the most common cardiac symptom for this group was chest pain (34%) and dyspnea (29%). For both groups of patients these cardiac symptom findings were much less common among the control cases of death.
Overall, the current studies present an interesting first look at symptoms experienced by two groups of patients with sudden cardiac death. It is important for clinicians to focus on the methodology of this study. The symptoms, which were reported were extracted by conversations with the patient’s family members or with other medical professionals who may had seen the patient prior to death. While this is limiting, it highlights how difficult gathering data about sudden cardiac deaths can be. It also underlines the number of cases where there were warning signs that could have been detected if we knew what to look for. Clinically, the data presented in this study should encourage clinicians to be conscious of all cardiac symptoms as well as immediately refer patients experiencing these symptoms to other members of the sports medicine team.
Questions for Discussion: Do you, as a clinician, feel comfortable with identifying cardiac symptoms? If so, how often do you refer patients to other members of your sports medicine team regarding cardiac symptoms?
Written by: Kyle Harris and Jeffrey Driban
Reviewed by: Jane McDevitt
Screening for Sudden Cardiac Death Before Participation in High School and Collegiate Sports: American College of Preventive Medicine Position Statement on Preventive Practice