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Exercise-related death in subjects with coexistent hypertrophic cardiomyopathy and coronary artery disease. Case
Insights
Sudden cardiac death in athletes can occur due to combined coronary artery disease (CAD) and hypertrophic cardiomyopathy (HCM). Autopsies revealed these conditions in three men who died suddenly during exercise.
Area of Science:
- Cardiology
- Sports Medicine
- Pathology
Background:
- Sudden cardiac death (SCD) is a critical concern in athletes.
- Coronary artery disease (CAD) and hypertrophic cardiomyopathy (HCM) are known risk factors for SCD.
Observation:
- Autopsy findings are presented for three White men who experienced sudden death during or post-exercise.
- Two deceased were marathon runners; the third engaged in other sports.
Findings:
- All three individuals exhibited significant coronary artery disease (CAD) affecting major coronary arteries.
- Macroscopic and histological evidence confirmed hypertrophic cardiomyopathy (HCM) in all subjects.
- The co-occurrence of CAD and HCM is an uncommon but critical finding.
Implications:
- This case series highlights the potential for combined CAD and HCM to cause exercise-related SCD in athletes.
- The lack of preceding symptoms in some cases complicates antemortem diagnosis, particularly for HCM.
- Understanding these combined pathologies is crucial for athlete screening and prevention strategies.
Abstract:
Autopsy findings in 3 White men who died suddenly during or after exercise are described. Two were well conditioned marathon runners who had recently completed a 90 km ultramarathon, while the third was active in sports other than running. At autopsy all had significant coronary artery disease (CAD) involving the left anterior descending and right coronary arteries and macroscopic or histological features diagnostic of hypertrophic cardiomyopathy (HCM). Although CAD and HCM are well-established causes of sudden death in athletes, the combination is uncommon. The absence of symptoms prior to death in 2 of the subjects indicates that the possibility of antemortem diagnosis (particularly of HCM) was unlikely.