Fatal Arrhythmia in a Juvenile Athlete due to Myocardial Hypertrophy and Infarction

This report is a case history of a 16-year-old highly trained athlete who suffered from ventricular fibrillation during exhaustive physical activity. After resuscitation and admission into hospital ECG revealed posterior wall infarction. Thrombolytic therapy was advised and ST-segment elevation reversed. Within 48 h cerebral edema evolved due to hypoxic brain damage and the subject deceased after 16 days despite prolonged maximum antiedematous therapy. Autopsy confirmed the diagnosis of concentric myocardial hypertrophy (total heart weight 568 g) without signs of coronary artery disease. Systemic inflammatory diseases and drug abuse were ruled out by lab studies, evidence for viral infection was not found. Thus, relative coronary insufficiency in regard to myocardial hypertrophy during excessive athletic activity must be viewed as cause for the fatal arrhythmia.

Key words:

Sudden cardiac death, athlete's heart, myocardial infarction, left ventricular hypertrophy, rhabdomyolysis.

References

• 1 Bharati S, Lev M. The conduction system findings in sudden cardiac death.  J Cardiovasc Electrophysiol. 1994;  5 356-366
• 2 Burke A P, Farb A, Virmani R. Causes of sudden death in athletes.  Cardiol Clin. 1992;  10 303-317
• 3 Burke A P, Farb A, Virmani R, Goddin J E, Smialek J E. Sports-related and non-sports-related sudden cardiac death in young adults.  Am Heart J. 1991;  121 568-575
• 4 Corrado D, Thiene G, Nava A, Rossi L, Pennelli N. Sudden death in young competitive athletes: clinicopathologic correlations in 22 cases.  Am J Med. 1990;  89 588-596
• 5 Craven C M. Sudden death in a young athlete. A case report.  Am J Sports Med. 1992;  20 621-623
• 6 Dickhuth H H, Röcker K, Hipp A, Heitkamp H C, Keul J. Echocardiographic findings in endurance athletes with hypertrophic non-obstructive cardiomyopathy (HNCM) compared to non-athletes with HNCM and to physiological hypertrophy (athlete's heart).  Int J Sports Med. 1994;  15 273-277
• 7 Fuller C M, McNulty C M, Spring D A, Arger K M, Bruce S S, Chryssos B E, Drummer E M, Kelley F P, Newmark M J, Whipple G H. Prospective screening of 5,616 high school athletes for risk of sudden cardiac death.  Med Sci Sports Exerc. 1997;  29 1131-1138
• 8 Hergenroeder A C, Bricker J T. Preseason cardiovascular examination: a review.  J Adolesc Health Care. 1990;  11 379-386
• 9 Maron B J. Structural features of the athlete heart as defined by echocardiography.  J Am Coll Cardiol. 1986;  7 190-203
• 10 Maron B J, Bonow R O, Cannon R O, Leon M B, Epstein S E. Hypertrophic cardiomyopathy: interrelations of clinical manifestations, pathophysiology, and therapy (II).  N Engl J Med. 1987;  316 844-852
• 11 Maron B J, Pelliccia A, Spirito P. Cardiac disease in young trained athletes. Insights into methods for distinguishing athlete's heart from structural heart disease, with particular emphasis on hypertrophic cardiomyopathy.  Circulation. 1995;  91 1591-1601
• 12 Maron B J, Roberts W C, McAllister H A, Rosing D R, Epstein S E. Sudden death in young athletes.  Circulation. 1980;  62 218-229
• 13 Maron B J, Shirani J, Poliac L C, Mathenge R, Roberts W C, Mueller F O. Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles.  J Am Med Ass. 1996;  276 199-204
• 14 Mills J D, Moore G E, Thompson P D. The athlete's heart.  Clin Sports Med. 1997;  16 725-737
• 15 Pelliccia A. Outer limits of physiologic hypertrophy and relevance to the diagnosis of primary cardiac disease.  Cardiol Clin. 1992;  10 267-279
• 16 Rossi L. Structural and non-structural disease underlying high-risk cardiac arrhythmias relevant to sports medicine.  J Sports Med Phys Fitness. 1995;  35 79-86
• 17 Rost R. The athlete's heart. Historical perspectives.  Cardiol Clin. 1992;  10 197-207
• 18 Rost R. The athlete's heart. Historical perspectives - solved and unsolved problems.  Cardiol Clin. 1997;  15 493-512
• 19 Shephard R J. The athlete's heart: is big beautiful?.  Br J Sports Med. 1996;  30 5-10
• 20 Thiene G, Nava A, Corrado D, Rossi L, Pennelli N. Right ventricular cardiomyopathy and sudden death in young people.  N Engl J Med. 1988;  318 129-133
• 21 Wight J N Jr, Salem D. Sudden cardiac death and the “athlete's heart”.  Arch Intern Med. 1995;  155 1473-1480