Pathological wave dynamics: a postulate for sudden cardiac death in athletes

Sudden death (SD) in young athletes is a shocking and disturbing event with significant societal impact. Previous studies have demonstrated that sudden cardiac death (SCD) is the leading medical cause of SD in athletes. Various structural and pathological cardiovascular abnormalities have identified as the underlying causes of SCD in young athletes. However, there have been reported cases of SCD in athletes with no structural or pathological cardiovascular disorders. Our proposed hypothesis in this article is that abnormalities in aortic wave dynamics and coronary wave dynamics may be responsible for SCD in these athletes. These abnormal waves-pathological waves-can act as a trigger toward cardiac death in the presence of cardiovascular diseases. These waves may initiate SCD in the absence of apparent cardiovascular abnormalities. In summary, when the aortic and coronary wave dynamics are abnormal, the myocardial oxygen demand can exceed the oxygen delivery during exercise, hence creating acute ischemia which leads to death. It is explained in this article how increased oxygen demand may be the result of pathological aortic waves while reduced oxygen delivery is mainly due to pathological coronary waves. Additionally, our pathological wave hypothesis is able to provide a plausible explanation for Commotio Cordis.