Sudden death in the young: mechanisms, screening and prevention

Philip Saul
Professor of Cell Biology and Anatomy, Medical University of South CarolinaProfessor of Pediatrics, Medical University of South Carolina
Charleston, USA

Sudden cardiac death (SCD) in the athlete or young person is a relatively rare event, that is unlikely in the absence of identified heart disease. However SCD in a young person has a devastating impact when it occurs, precisely because it is so unexpected and because it often occurs in what seems to be an otherwise healthy individual. SCD can be “aborted” when resuscitation successfully restores spontaneous circulation. Most SCD in young people has an arrhythmic origin, but circulatory collapse can occur when an organized rhythm is present, typically with congestive heart failure or cerebral vascular events. The causes of SCD and their relative frequency in young people are varied, but by far the most common etiology in the U.S. is hypertrophic cardiomyopathy. Coronary artery anomalies are the second most common cause, followed by a variety of relatively rare conditions leading to primary arrhythmias. Each of the conditions causing SCD in the young has specific therapy once identified, but it is often difficult to find the susceptible population in advance. The surface 12-lead ECG is abnormal in some of the conditions leading to SCD, but many cannot be consistently identified with ECG screening, and false positives are very common. Consequently, prevention must include increasing the likelihood of immediate resuscitation, by increasing both the prevalence of CPR training in the general population and the availability of automatic external defibrillators (AED).