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The incidence of sudden cardiac death in the young is
estimated to be 1 in 100,000 per life year. This number is
likely to be an under-estimate in UK, due to several important reason.
There is lack of national systemic registry for sudden death in the
young, and most of the reports are derived from deaths of high profile
athletes, media reports etc. Also, not all the post mortem
examinations are carried out by expert pathologists with a special
interested in sudden death in the young. Hence, some of the
uncommon conditions are easily missed. Finally, some of the disorders
which affect channels in the heart (such as congenital Long QT
syndrome, Brugada syndrome,etc) have structurally normal hearts, and
hence cannot be diagnosed during autopsy.
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It is estimated, approximately 80%
of all non-traumatic sudden deaths in young competitive athletes are
due to inherited/ congenital structural or functional
cardiovascular abnormalities. HCM accounts for 40-50% of all such
deaths (Shama et al, Br J Sports
Med).
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The majority of young sudden cardiac deaths are due to inherited forms of
heart muscle disorder and irregular heart beat. Hypertrophic
Cardiomyopathy is the most common of these conditions. Recent research
in the USA by Dr Barry Maron shows that 1 in 500 people have
Hypertrophic Cardiomyopathy( Maron, 1995, Circulation)
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In the UK unexplained "sudden death," where there is no
cause identified, is frequently classified as due to natural causes.
Experts believe that the majority of these deaths are due to Sudden
Death Syndrome or Sudden Cardiac Death. Until the law is changed and coroners have to refer
hearts on to specialists we cannot find the true statistics.
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A national programme for systematic
pre-participation screening of all young competitive athletes has been in
place in Italy since 1971. Recent Research there confirms that ECG Testing
is the most cost effective way to test for cardiac abnormalities (Corrado
et al, 1998, New England Journal of Medicine August 6 1998). A competitive athlete was defined as a
participant in an organised sports programme requiring regular training
and competition. (Thus school children would be
included in the programme)
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Italian law requires every athlete to have an annual "Fitness
Certificate" before they are permitted to participate in any
event. Sports Clubs and Schools have to take responsibility for their
students fitness to participate. One pathologist, Gaetano Thiene,
resolutely collated all statistical data on sudden death in young
people in the Veneto region of Northern Italy, and as a result of his
research he discovered that cardiovascular screening was effective in
identifying individuals at risk. (Corrado
et al, 1998, New England Journal of Medicine August 6 1998)
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Those sufferers with symptoms are considered to be the
"lucky" ones, as once cardiac conditions are recognised,
precautions can be taken, and much can be done to prevent
complications and sudden death.
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