Sudden death in young athletes

Sudden death in young athletes is always a sensitive issue. Various causes have been described in literature, though by and large hypertrophic cardiomyopathy predominates the picture, contributing about one fourth of the cases. Commotio cordis is an important cause especially in contact sports and contributes about one fifth of the cases. Coronary anomalies may contribute to a little over one tenth of the cases. Other causes would include myocarditis, rupture of aortic aneurysm in Marfan’s syndrome, arrhythmogenic right ventricular cardiomyopathy, aortic stenosis, dilated cardiomyopathy, long QT syndrome, trauma involving cardiac injury or contusio cordis, heat stroke and even drug abuse. Among the coronary anomalies, one in which the left coronary artery has a course between the aorta and pulmonary artery is important since it gets compressed and causes myocardial ischemia.
In the case of commotio cordis, the non compressible balls are more likely to cause it and has been reported with baseball and ice hockey. The mechanical stimulation is thought to produce ventricular arrhythmias by an R on T phenomenon – ectopy induced by the mechanical impact occurring in vulnerable period of repolarization triggering fatal arrhythmias. The role of an automated external defibrillator (AED) available in the field has bee high lighted in this situation.