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Sudden unexpected death in young athletes: reconsidering "hypertrophic cardiomyopathy"

Thomas Rowland1

  • 1Department of Pediatrics, Baystate Medical Center, Springfield, MA 01199, USA. thomas.rowland@bhs.org

Pediatrics
|April 2, 2009
PubMed

Insights

Sudden cardiac death in young athletes may not always be hypertrophic cardiomyopathy. Exaggerated athletic training may cause extreme hypertrophy, leading to electrical instability and cardiac events.

Area of Science:

  • Sports Cardiology
  • Cardiovascular Pathology
  • Exercise Physiology

Background:

  • Sudden unexpected cardiac death (SUCD) in young athletes is often attributed to hypertrophic cardiomyopathy (HCM).
  • Observed demographic features in some SUCD cases are inconsistent with typical HCM diagnoses.
  • These inconsistencies suggest alternative explanations for cardiac events in elite athletes.

Purpose of the Study:

  • To critically review the evidence linking ventricular hypertrophy in athletes to sudden cardiac death.
  • To propose an alternative hypothesis for SUCD in athletes with extreme myocardial hypertrophy.
  • To explore the concept of electrical stability in athletes with training-induced cardiac remodeling.

Main Methods:

  • Literature review of studies on sudden cardiac death in athletes.
  • Analysis of demographic data and autopsy findings in young athletes.
  • Examination of physiological responses to intense sports training on cardiac structure.

Main Results:

  • Certain demographic patterns in SUCD cases do not align with classic HCM.
  • A common feature across these cases is significant ventricular hypertrophy.
  • This hypertrophy may be an adaptive response to extreme training, potentially leading to electrical instability.

Conclusions:

  • The diagnosis of hypertrophic cardiomyopathy may be overemphasized in certain athlete SUCD cases.
  • Extreme, training-induced myocardial hypertrophy could be a distinct entity predisposing to cardiac events.
  • Further research is needed to differentiate between pathological HCM and physiological hypertrophy in athletes.

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