84 How do I investigate the relatives of a patient
with sudden cardiac death?
Niall G Mahon and W McKenna
In patients aged over 30 years by far the commonest cause of
sudden cardiac death is coronary disease (80%). In patients
younger than this, inherited disorders play a major role, with
hypertrophic cardiomyopathy accounting for approximately 50%
of these deaths. Although perhaps not entirely representative of the
general population, the most systematically collected data on
sudden death in young people comes from athletes. Common
causes of sudden death in young athletes are shown in table 84.1.
Aortic root dissection and arrhythmias due to accessory pathways
and long QT syndromes may also be causative. A specific diagnosis
in the deceased should be pursued by means of expert examination
of the postmortem heart if available and attempts to obtain ante-
mortem electrocardiograms and other investigations.
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Hypertrophic cardiomyopathy 51
Anomalous coronary artery 17
Other coronary disease 9
Myocarditis 5
Dilated cardiomyopathy 4
Ruptured aortic aneurysm 3
Aortic valve stenosis 3
Arrhythmogenic right ventricular cardiomyopathy 2
Mitral valve prolapse 2
From Basilico FC. Cardiovascular disease in athletes. Am J Sports Med1999; 2277 :
108–21.