Sudden Cardiac Death in Young Adults: An Audit of Coronial Autopsy Findings
A Treacy, A Roy, R Margey, JC O'Keane, J Galvin, A Fabre. Mater Misericordiae University Hospital, Dublin, Ireland
Background: Sudden adult cardiac death is in most cases attributable to atheromatous coronary artery disease. Non-atheromatous causes of cardiac death include congenital heart diseases, cardiomyopathies (CM) and valvular heart disease. In recent years the advent of sudden adult cardiac death with a morphologically normal heart (sudden adult death syndrome, SADS) has generated much debate and led to the establishment of registries to investigate these deaths further.
Design: A list of suspected sudden cardiac deaths among young adults (16 – 45 years) was compiled using data from the Central Statistics Office in Ireland from 2004 to 2009. The pathologists and coroners involved in each case were contacted and a copy of the autopsy report requested. The autopsy reports were audited using agreed dataset criteria including demographic factors, toxicology, detailed cardiac parameters, histology and toxicology. The findings were reviewed with regard to cause of death, cardiac pathology and diagnosis of sudden cardiac death.
Results: 90 autopsy reports were received and audited, 16 cases were excluded due to age criteria (≤ 16 years). There were 74 adults, 27 women (36%) and 47 men (64%). The mean age at death was 27.7 years (range 17 – 41 years). The breakdown of the cause of death was as follows: 47 cardiac deaths, 22 non-cardiac deaths, 3 SUDEP and 2 SADS. Coronary artery disease (CAD) was identified in 24 patients (32.4%), however only 26% of these had evidence of IHD. CAD was seen in association with CM in 5 and SADS in 2. Overall, 23 patients (33%) had an enlarged heart (weight > 400g women and 500g men), for which the causes of death included hypertrophic cardiomyopathy (HCM, n=4), dilated cardiomyopathy (DCM, n=3), left ventricular hypertrophy (LVH, n=5), myocarditis (n=1) and valvular disease (n=3) and ischaemic heart disease (IHD, n= 5). Causes of death with a normal heart weight included DCM in 2, ARVD in 1, myocarditis in 2, IHD in 10, and SADS in 8. LVH was seen in that group in 3 cases, but death not attributed to it.
Conclusions: Sudden adult death is a diagnosis of exclusion with important consequences for the living relatives, in the era of molecular diagnosis of genetic cardiomyopathies and channelopathies. Thourough exmination of the heart at autopsy is mandatory in cases of sudden adult death, as SADS is a diagnosis of exclusion, and some cardiomyopathies may present with an apparently normal heart.
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 8, Monday Morning