Pathology of sudden death during recreational sports in Spain

Most sudden deaths during sports occur in general population practising recreational sports and according to legislation, a forensic autopsy is required. Most are sudden cardiac deaths but the incidence of specific pathologies differs in reported series according to autopsy methods or diagnostic criteria. The purpose of this work is to analyse the pathology of sports-related sudden deaths in a large forensic series from Spain studied according with cardiovascular pathology criteria.

We have reviewed the sudden deaths occurred during sports studied at our institution between 1995 and 2010 in which a complete autopsy was performed with exhaustive cardiac examination and toxicological analysis. Out of 8862 sudden deaths studied, 168 (1.8%) were related to sports; age was between 9 and 69 (average 36.6 ± 15.6 y); 163 were males and 5 females. Only 3 were professional athletes. Most frequent sports associated to sudden death were cycling (29%), soccer (25.5%), running (8.9%) and gymnastics (6.5%). In 49 cases (29.1%) there were some personal pathological antecedents or familial sudden deaths. Causes of death were: coronary atherosclerotic disease, 85 (50.5%) (74 over 35 years old); arrhythmogenic cardiomyopathy, 13 (7.7%); hypertrophic cardiomyopathy, 12 (7.1%); idiopathic left ventricular hypertrophy, 7 (4.1%); congenital coronary anomalies, 7 (4.1%); myocarditis, 6 (3.5%); aortic stenosis, 5 (2.9%); and other, 11 (6.5%). Myocardial diseases were the most frequent under 35 years old. No cause of death was found in 19 (11.3%) (all under 30 years old) what stresses the necessity of including molecular techniques in forensic autopsies.