engleski

Sudden Cardiac death due to physical exercise in Croatia in a 27-Year Period

In a period of 27 years: from January 1, 1984 to December 31, 2010 we noticed 69 sudden and unexpected cardiac deaths during physical exercise in Croatia. There were 6 sudden cardiac deaths in male athletes. At the autopsy, an athletic runner aged 21, had an acute myocardial infarction with normal coronaries and left ventricular wall thickened. A professional soccer player aged 17, had hypoplastic right coronary artery and narrowed ascending aorta, bacterial tonsillitis and subacute myocarditis. A student rugby player aged 29, and a school boy-basketball player aged 15, had hypertrophic cardiomyopathy. The arrhythmogenic right ventricular dysplasia was a cause of death in two athletes. The first was a short trails runner, and the second was a soccer player. The hypertrophic cardiomyopathy was a cause of death in 3 athletes and 2 persons during recreational exercise. An acute myopericarditis was a cause of death in 2 professional soccer players, and in one who died during swimming. One had subacute diffuse myopericarditis, bacterial tonsillitis and narrowed ascending aorta of 10 mm. The other had chronic myopericarditis and cardiac aneurysm of the left ventricle. The third had fibrinous pericarditis, hyperthropic cardiomyopathy, hypoplastic ascending aorta, bilateral bronchopneumonia and cerebral contusion with edema. Sudden cardiac deaths appeared in 10 school boys. Two of them had been engaged in physical exercise at school, the third was a professional soccer player, the fourth was engaged in recreational swimming, and the fifth had just finished secondary school and was working at the site recreatively. In 3 of them congenital cardiovascular diseases was found: in 2 hypoplastic coronary arteries and in 2 hypertrophic cardiomyopathy. The fourth had normal heart findings including coronaries, but had bilateral pneumonia with a non-cardiogenic pulmonary edema. The fifth had a chronic myopericarditis with an aneurysm of the left ventricle. Pneumonia was a cause of death in 3 male teenagers aged 18-19. The first was working at the site recreatively, the second was engaged in soccer recreatively and the third was professional soccer player. One died suddenly during physical exercise at the field and 2 died in the hospital. The first had bilateral bacterial pneumonia, non-cardiogenic pulmonary edema and cerebral edema. The second had bilateral bacterial pneumonia, adult respiratory distress syndrome, disseminated intravascular coagulation, cerebral edema, hypoplastic right coronary artery and myocardial fibrosis. The third had bilateral bacterial pneumonia, fibrinous pericarditis, and cerebral contusion with edema, thickening of the left ventricle 20 mm and hypoplastic ascending aorta. We noticed 5 sudden death among Croatian male physicians, during or after recreational exercise: swimming, soccer, tennis and jogging ; 3 were autopsied, and all had coronary heart disease. Two physicians who were not been autopsied, had possible an alcohol cardiomyopathy. Fifteen “elderly” men, died suddenly during exercise: 6 in swimming, 4 in playing tennis, one ridded, one was jogging, 2 bowling and one died during sexual act. At autopsy, 14 had coronary heart disease: 5 critical coronary artery stenosis, and 2 had signs of recent myocardial infarctions, 3 had left descending coronary artery occluded, and one with acute myocardial infarction of the anterior wall, 12 had myocardial scars due to previous myocardial infarctions and one signs of diffuse myocardial fibrosis. Twelve of them had left ventricular hypertrophy. In Croatia the death rate among athletes reached 0.19/100 000 yearly (p=0.00005), in the male population aged 15-40 years, engaged in sports and recreational physical exercise: 0.71/100 0000 (p=0.00001), in the total male population aged 15-64 engaged in sport and recreational exercise 0.96/100 000 (p=0.00001), in arrhythmogenic right ventricular dysplasia reached 0.06/100.000 (p=0.00000), in teenagers suffered of hypertrophic cardiomyopathy 0.10/100 000 (p=0.00000), in myopericarditis it was 0.11/100, 000 (p=0.00000), in pneumonia 0.11/100 000 (p=0.00000), in teenagers 0.37/100 000 (p=0.00226), in physician-specialists reached 24.8/100 000 (p=0.00000), in elders reached 2.99/100 000 (p=0.00001).

men ; athletes ; recreational physical exercise ; sudden death

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