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

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

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

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.

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

Related Posts:

Glinge C, Jabbari R, Risgaard B, Lynge TH, Engstrøm T, Albert CM, Haunsø S, Winkel BG, & Tfelt-Hansen J (2015). Symptoms Before Sudden Arrhythmic Death Syndrome: A Nationwide Study Among the Young in Denmark. Journal of cardiovascular electrophysiology, 26 (7), 761-7 PMID: 25807988

Lynge TH, Risgaard B, Jabbari R, Glinge C, Bundgaard H, Maron B, Haunsø S, Winkel BG, & Tfelt-Hansen J (2016). Cardiac symptoms before sudden cardiac death caused by hypertrophic cardiomyopathy: a nationwide study among the young in Denmark. Europace PMID: 26823388