Sudden cardiac death among general population and sport related population in forensic experience.

PURPOSE: The goal of the study was to assess the causes and analyze the cases of sudden cardiac death (SCD) victims referred to the department of forensic medicine in Lausanne, with a particular focus on sports-related fatalities including also leisure sporting activities. To date, no such published assessment has been done nor for Switzerland nor for the central Europe. METHODS: This is a retrospective study based on autopsy records of SCD victims, from 10 to 50 years of age, performed at the University Centre of Legal Medicine in Lausanne from 1995 to 2010. The study population was divided into two groups: sport-related (SR) and not sport-related (NSR) SCDs. RESULTS: During the study period, 188 cases of SCD were recorded: 166 (88%) were NSR and 22 (12%) SR. The mean age of the 188 victims was 37.3 ± 10.1 years, with the majority of the cases being male (79%). A cause of death was established in 84%, and the pathology responsible for death varied according to the age of the victims. In the NSR group, the mean age was 38.2 ± 9.2 years and there was 82% of male. Coronary artery disease (CAD) was the main diagnosis in the victims aged 30-50 years. The majority of morphologically normal hearts were observed in the 15-29 year age range. There was no case in the 10-14 year age range. In the SR group, 91% of victims died during leisure sporting activities. In this group the mean age was 30.5 ± 13.5 years, with the majority being male (82%). The main cause of death was CAD, with 6 cases (27%) and a mean age of 40.8 ± 5.5 years. The youngest victim with CAD was 33 years old. A morphologically normal heart was observed in 5 cases (23%), with a mean age of 24.4 ± 14.9 years. The most frequently implicated sporting activities were hiking (26%) and swimming (17%). CONCLUSION: In this study, CAD was the most common cause of death in both groups. Although this pathology most often affects adults over 35 years of age, there were also some victims under 35 years of age in both groups. SCDs during sport are mostly related to leisure sporting activities, for which preventive measures are not yet usually established. This study highlights also the need to inform both athletes and non athletes of the cardiovascular risks during sport activities and the role of a forensic autopsy and registries involving forensic pathologists for SR SCD

Sudden aortic death-proposal for a comprehensive diagnostic approach in forensic and in clinical pathology practice.

Aortic rupture or dissection as immediate cause of sudden death is encountered in forensic and clinical autopsy practice. Despite a common denominator of 'sudden aortic death' (SAD), we expect that in both settings the diagnostic workup, being either primarily legal or primarily disease related, differs substantially, which may affect the eventual diagnoses. We retrospectively reviewed case records of deceased persons who fitted a diagnosis of SAD in the continuous autopsy cohorts in a forensic (Suisse) and a clinical setting (The Netherlands). Clinical characteristics, data from post-mortem imaging, tissue blocks for histological analysis and results of ancillary studies were reviewed for its presence and outcome. SAD was found in 7.7% in the forensic versus 2.2% in the clinical autopsies. In the forensic setting, autopsy was always combined with post-mortem imaging, showing variable outcome on detection of aortic disruption and/or pericardial bleeding. Histology of aorta was performed in 12/35 cases, mostly in the natural deaths. In the clinical setting, histology of the aorta was available in all cases, but post-mortem imaging in none. In both settings, underlying aortic disease was mostly cystic medial degeneration, atherosclerosis or a combination of both, with occasional rare unexpected diagnosis. Also in both, a genetic cause of aortic dissection was revealed in a minority (three cases). Sudden aortic death (SAD) is more commonly encountered in a forensic than in a clinical setting. Major differences in the approach of SAD between these settings coincide with similarities in causes of death and underlying diseases. To ensure a correct diagnosis, we recommend that the investigation of SAD includes a study of the medical history, a full autopsy with histology of major organs including aorta, and storage of material for toxicological and genetic testing. Post-mortem radiological examination, useful for documentation and screening purposes, is feasible as non-invasive alternative when autopsy is not possible, but cannot substitute a full autopsy

Sports-related sudden cardiac death in Switzerland classified by static and dynamic components of exercise.

BACKGROUND: Sports-related sudden cardiac deaths (SrSCDs) occur most frequently in highly dynamic and/or static sports. We aimed to assess the incidence and characteristics of SrSCDs in Switzerland and to compare SrSCD occurrence according to sports categories with the sports participation behaviour in the general population. METHODS: Between 1999 and 2010, forensic reports of SrSCDs in young individuals (10-39 years of age) were retrospectively reviewed and categorised based on peak static (increasing from I to III) and dynamic sports components (increasing from A to C). Data were compared to the sports participation behaviour of the Swiss population. RESULTS: Sixty-nine SrSCDs were identified. Forty-eight (69.6%) occurred during recreational sports (REC) and 21 (30.4%) during competitive sports (COMP). Incidences (per 100,000 athlete person-years) for COMP and REC were 0.90 and 0.52, respectively (p = 0.001). Most SrSCDs occurred in IC (23 cases, 33.3%), followed by IIC (13, 18.9%), IIIA and IIIC (11 each, 15.9%), IIIB (6, 8.7%), IIA (4, 5.8%) and IB sports categories (1, 1.5%). No SrSCDs were found in IA and IIB sports categories. Incidences between sports categories (IIIA 0.25, IB 0.25, IC 0.18, IIC 0.33 and IIIC 0.25) were not significantly different except to IIA (0.94, p < 0.001), due to the fact that few people were involved in this sports category. Coronary artery disease (CAD) was the most common underlying pathology of SrSCD. CONCLUSIONS: In this Swiss cohort, incidence of SrSCD was very low and similar in all sports categories classified by their static and dynamic components. However, the incidence was higher in COMP compared to REC, and CAD proved to be the most common underlying cause of SrSCD