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Sudden Death From Myocarditis in Young Athletes

1986; Elsevier BV; Volume: 61; Issue: 3 Linguagem: Inglês

10.1016/s0025-6196(12)61858-8

1942-5546

Daniel R. Neuspiel,

Cardiac electrophysiology and arrhythmias

In his Cardiovascular Clinics contribution in the December 1985 issue of the Proceedings (pages 867 through 873), Driscoll makes an important contribution to the understanding of the importance and conduct of preparticipation sports evaluations in children and adolescents. In his review of the cardiovascular causes of sudden nontraumatic death in this age group, how ever, he omits myocarditis, which may be the most common cardiovascular cause of this unfortunate event. Several studies have noted the frequency and importance of myocarditis in sudden and unexpected natural death in childhood and adolescence.1Neuspiel DR Kuller LH Sudden and unexpected natural death in childhood and adolescence.JAMA. 1985; 254: 1321-1325Crossref PubMed Scopus (207) Google Scholar, 2Wentworth P Jentz LA Croal AE Analysis of sudden unexpected death in southern Ontario, with emphasis on myocarditis.Can Med Assoc J. 1979; 120: 676-680PubMed Google Scholar, 3Molander N Sudden natural death in later childhood and adolescence.Arch Dis Child. 1982; 57: 572-576Crossref PubMed Scopus (82) Google Scholar, 4Topaz O Edwards JE Pathologic features of sudden death in children, adolescents, and young adults.Chest. 1985; 87: 476-482Crossref PubMed Scopus (157) Google Scholar Clinicians may be unaware of this abrupt manifestation of myocarditis, because most of these patients have nonspecific prodromes and are not referred to a cardiologist. These young patients usually die in their own community, and their lesions are detected at autopsies supervised by coroners or medical examiners.1Neuspiel DR Kuller LH Sudden and unexpected natural death in childhood and adolescence.JAMA. 1985; 254: 1321-1325Crossref PubMed Scopus (207) Google Scholar The diagnosis of myocarditis would be unlikely during an examination before participation in sports. The association of viral symptoms with sudden unexpected death in young athletes, however, suggests that subclinical viral myocardial infection may occur and that strenuous physical activity might be unwise during and for some period after acute viral illnesses.5Kocnar K Rous J Preventive approach to sudden cardiac deaths at sports performance.Br J Sports Med. 1973; 7: 166-167Google Scholar, 6Tunstall-Pedoe D Exercise and sudden death.Br J Sports Med. 1979; 12: 215-219Crossref Google Scholar Also, some medications with cardioactive properties, such as decongestants and bronchodilators, may have adverse effects during systemic viral infections and may generate life-threatening dysrhythmias. The incidence of subclinical myocarditis has not been adequately investigated, and further study of this condition is needed to prevent sudden death from myocarditis. Sudden Death From Myocarditis in Young Athletes: Dr. Driscoll repliesMayo Clinic ProceedingsVol. 61Issue 3PreviewI appreciate Dr. Neuspiel's letter and concur with his addition of myocarditis to the list of causes of sudden unexpected death among young athletes. His comments should alert clinicians to the possible occurrence of subclinical myocarditis in this age group. Full-Text PDF