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Sudden unexpected death in persons <40 years of age

  • Yaacov Drory
    Correspondence
    Address for reprints: Yaacov Drory, MD, Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel.
    Affiliations
    From the Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel

    From the Department of Ophthalmology, Assaf Harofe Hospital, Zrifin, Israel

    From the Institute of Forensic Medicine, Tel Aviv, Israel

    From the Department of Internal Medicine “B,” Chaim Sheba Medical Center, Tel Hashomer, Israel

    From the Department of Internal Medicine “T,” Ichilov Hospital, Tel Aviv, Israel

    From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    From the Pulmonary Department, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
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  • Yoseph Turetz
    Affiliations
    From the Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel

    From the Department of Ophthalmology, Assaf Harofe Hospital, Zrifin, Israel

    From the Institute of Forensic Medicine, Tel Aviv, Israel

    From the Department of Internal Medicine “B,” Chaim Sheba Medical Center, Tel Hashomer, Israel

    From the Department of Internal Medicine “T,” Ichilov Hospital, Tel Aviv, Israel

    From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    From the Pulmonary Department, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
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  • Yehuda Hiss
    Affiliations
    From the Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel

    From the Department of Ophthalmology, Assaf Harofe Hospital, Zrifin, Israel

    From the Institute of Forensic Medicine, Tel Aviv, Israel

    From the Department of Internal Medicine “B,” Chaim Sheba Medical Center, Tel Hashomer, Israel

    From the Department of Internal Medicine “T,” Ichilov Hospital, Tel Aviv, Israel

    From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    From the Pulmonary Department, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
    Search for articles by this author
  • Boaz Lev
    Affiliations
    From the Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel

    From the Department of Ophthalmology, Assaf Harofe Hospital, Zrifin, Israel

    From the Institute of Forensic Medicine, Tel Aviv, Israel

    From the Department of Internal Medicine “B,” Chaim Sheba Medical Center, Tel Hashomer, Israel

    From the Department of Internal Medicine “T,” Ichilov Hospital, Tel Aviv, Israel

    From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    From the Pulmonary Department, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
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  • Enrique Z. Fisman
    Affiliations
    From the Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel

    From the Department of Ophthalmology, Assaf Harofe Hospital, Zrifin, Israel

    From the Institute of Forensic Medicine, Tel Aviv, Israel

    From the Department of Internal Medicine “B,” Chaim Sheba Medical Center, Tel Hashomer, Israel

    From the Department of Internal Medicine “T,” Ichilov Hospital, Tel Aviv, Israel

    From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    From the Pulmonary Department, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
    Search for articles by this author
  • Amos Pines
    Affiliations
    From the Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel

    From the Department of Ophthalmology, Assaf Harofe Hospital, Zrifin, Israel

    From the Institute of Forensic Medicine, Tel Aviv, Israel

    From the Department of Internal Medicine “B,” Chaim Sheba Medical Center, Tel Hashomer, Israel

    From the Department of Internal Medicine “T,” Ichilov Hospital, Tel Aviv, Israel

    From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    From the Pulmonary Department, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
    Search for articles by this author
  • Mordechai R. Kramer
    Affiliations
    From the Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel

    From the Department of Ophthalmology, Assaf Harofe Hospital, Zrifin, Israel

    From the Institute of Forensic Medicine, Tel Aviv, Israel

    From the Department of Internal Medicine “B,” Chaim Sheba Medical Center, Tel Hashomer, Israel

    From the Department of Internal Medicine “T,” Ichilov Hospital, Tel Aviv, Israel

    From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    From the Pulmonary Department, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
    Search for articles by this author
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      Abstract

      This study retrospectively assesses the underlying causes of sudden unexpected death and the occurrence of prodromal symptoms in 162 subjects (aged 9 to 39 years) over a 10-year period (1976 to 1985). Underlying cardiac diseases accounted for sudden death in 73% and noncardiac causes in 15% of subjects. In 12% of subjects, the causes were unidentifiable. Myocarditis (22%), hypertrophic cardiomyopathy (22%) and conduction system abnormalities (13%) were the major causes in 32 subjects aged <20 years. Major causes of 46 deaths in subjects 20 to 29 years were atherosclerotic coronary artery disease (24%), myocarditis (22%) and hypertrophic cardiomyopathy (13%). The largest number of deaths in 84 subjects aged ≥30 years was attributed to coronary artery disease (58%), followed by myocarditis (11%). Among noncardiac causes of sudden death, intracranial hemorrhage was the most frequent (5%), followed by infectious disease (4%). Prodromal symptoms were reported by 54% of subjects; most frequent were chest pain (25%) in subjects aged ≥20 years, and dizziness (16%) in those aged <20. Sudden death, which occurred during routine daily activity in 49% and during sleep in 23% of subjects, was related to physical exercise in 23% and emotional upset in 6%. Sudden unexpected death in the young is still an unresolved medical problem. The early recognition of prodromal symptoms could be crucial in the prevention of sudden death, specifically when exercise-related.
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