While the number of adolescents and young adults who die suddenly and unexpectedly is very low, there is evidence that the number of young people dying from sudden cardiac arrest is on the increase.
Not all sudden deaths in young, otherwise healthy adults have a cardiac cause. In those that do the term sudden cardiac death (SCD) is used. However, recently it has been agreed that the term sudden adult death syndrome (SADS) be used to cover all such unexpected deaths in young people.
The number of adolescents and young adults dying each year in the US from sudden cardiac arrest rose by 10 per cent between 1989 and 1996, according to a study carried out by the Centre for Disease Control in Atlanta. Although many more men than women aged 15-34 died over the eight-year period of the study, the rate of increase in sudden death was much higher among young women. An examination of the death certificates showed that 34 per cent had either a heart rhythm problem (arrhythmia) or a condition called cardiomyopathy.
Hypertrophic cardiomyopathy (HCM) affects one in 500 people although only a small proportion, with a serious form of the disease, are at risk of sudden death. The term HCM describes a thickening ( hypertrophy) of the heart muscle (myocardium).
Primarily affecting the main pumping chamber of the heart - the left ventricle - it also disrupts the dividing wall down the middle of the heart. This wall carries the transmission system which both triggers and spreads the normal beat throughout the heart. So as the heart muscle thickens, both its pumping efficiency and its ability to maintain a smooth heart rate is impaired.
The other principal cardiac cause for sudden death in young people is a rhythm disturbance in the heart. Since this is essentially an electrical malfunction, it cannot be found or tested for at post-mortem. Some families will have to face the additional stress of being told that no cause of death could be found. However, doctors believe that most of these are due to a sudden catastrophic malfunctioning of the heart's electrical pacemaker. Recent interest has focused on a condition called the long Q-T wave syndrome.
The sudden death of an older child or adolescent is every bit as devastating as a cot death. It must be all the more difficult to accept when the victim is an athlete at the height of his career.