Aase Wisten

Sudden cardiac death in 15-35-year olds in Sweden during 1992-99.

Abstract.  Wisten A, Forsberg H, Krantz P, Messner T (Sunderby Hospital, Luleå; National Board of Forensic Medicine, Lund; Kiruna District Hospital, Kiruna; and Umeå University Hospital, Umeå; Sweden). Sudden cardiac death in persons 15–35‐year old in Sweden, 1992–99. J Intern Med 2002; 252: 529–536.

Symptoms preceding sudden cardiac death in the young are common but often misinterpreted.

Objectives. To identify patients at risk of sudden cardiac death (SCD) by analysis of clinical history. Design. A retrospective study of the Swedish cohort of 15–35 year olds having suffered an SCD during 1992–1999 and having undergone a forensic autopsy (162 individuals). We sought information in forensic, police and medical records and from interviews with family members. Results. Syncope/presyncope, chest pain, palpitations or dyspnoea were present in 92/162, unspecific symptoms such as fatigue, influenza, headache or nightmares in 35/162. Syncope/presyncope was most common (42/162). In 74 seeking medical attention, 32 had an ECG recorded (24 pathological). In 26 subjects there was a family history of SCD. Conclusions. The patient seeking medical advice before suffering an SCD is characterized by one to three of the following: 1) cardiac-related symptoms or non-specific symptoms often after an infectious disease, 2) a pathological ECG, 3) a family history of SCD. In 6 out of 10 a cardiac diagnosis was not considered. We conclude that symptoms preceding SCD were common but often misinterpreted.

Sudden cardiac death in the young in Sweden: electrocardiogram in relation to forensic diagnosis

Objectives.  To study electrocardiogram (ECG) in relation to forensic diagnosis in young persons who suffered a sudden cardiac death (SCD) in Sweden during 1992–99.

Young Swedish patients with sudden cardiac death have a lifestyle very similar to a control population

Objectives. To study the association between lifestyle and sudden cardiac death (SCD) in the young with special respect to athletic activities. Design. We compared lifestyle factors, collected from forensic and medical reports and from interviews with family members, in the Swedish cohort of individuals 15–35 years of age who had suffered an SCD during 1992–1999, with those of the control population of the same age group, obtained from national health registries. Results. Physical activity and body mass index (BMI) in men were the same as in the controls, whilst women had a higher BMI and a lower level of physical activity in the SCD group. Twenty-three per cent (32/138) were competing athletes in the SCD group and 29% in the control group (622/2131). Death during physical activity was more common in athletes (20/32) than in non-athletes (18/106) (p < 0.001). In coronary artery disease deaths, 11/15 (73%) were smokers and BMI was significantly higher than in the controls in both sexes. Conclusions. Young Swedish persons suffering SCD were very similar to the normal population with regard to lifestyle factors.

Characteristics and outcome amongst young adults suffering from out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation is attempted.

Objectives.  Amongst patients suffering from out‐of‐hospital cardiac arrest, young adults represent a minority. However, these victims suffer from the catastrophe when they are in a very active phase of life and have a long life expectancy. This survey aims to describe young adults in Sweden who suffer from out‐of‐hospital cardiac arrest and in whom cardiopulmonary resuscitation (CPR) is attempted in terms of characteristics and outcome.

Mutation analysis of cases of sudden unexplained death, 15 years after death : Prompt genetic evaluation after resuscitation can save future lives

INTRODUCTION The aim of this study is to use genetic mutation analysis to determine the cause of sudden unexpected death in young (SUDY) persons with normal autopsy findings, and to provide relatives with an identified cardiac mutation with suitable cardiovascular prevention. METHODS We performed mutation analysis on blood samples from first-degree relatives of 25 cases with normal autopsy findings identified in the national Swedish study of sudden cardiac death in 15- to 35-year-olds from 1992 to 1999. RESULTS We found three families with long QT syndrome through mutation screening, and the mutations were verified in two of the deceased. Eight family members were found to be mutation carriers and have been provided with suitable cardiovascular prevention. Mutation screening also identified a number of common polymorphisms in the individuals screened. Clinical history revealed one family each with short QT syndrome and hypertrophic cardiomyopathy, respectively, but no mutations were found in the family members or in the deceased. Two SCDs each had occurred in two of the affected families. CONCLUSION Cardiac/genetic evaluation of relatives long after SUDY can reveal a diagnosis in 5/25 (20%) of cases. Since DNA extraction of formalin fixed paraffin embedded samples is unreliable, it is important that blood or tissue samples be stored at autopsy of such cases. This can facilitate establishing a diagnosis and thereby save lives in the future.

Sudden cardiac death among the young in Sweden from 2000 to 2010 : An autopsy-based study

Aims To study the incidence and aetiology of sudden cardiac death (SCD) in 1- to 35-year-olds in Sweden from 2000 to 2010. Methods and results We used the database of the Swedish National Board of Forensic Medicine and the Swedish Cause of Death Registry and identified SCD cases by review of forensic files and death certificates. We identified 552 individuals with SCD in 1- to 35-year-olds; 156 (28%) were women. In 393 (71%), a forensic autopsy had been performed; in 131 (24%), a clinical autopsy had been performed; in 28 (5%) with no autopsy, a cardiac disease was diagnosed before death. The incidence of SCD per 100 000 person-years was 1.3 in 1- to 35-year-olds and 1.8 in 15- to 35-year-olds. In women, the incidence rates yearly decreased during the study period by 11% (95% confidence interval 6.6-14.2). The most common aetiology in 1- to 35-year-olds was sudden arrhythmic death syndrome (31%) and coronary artery disease (15%). In cases with forensic autopsy, death occurred during daily activity (48%), sleep (38%), and physical activity (14%); death was unwitnessed in 60%. Co-morbidity in 15- to 35-year-olds, e.g. psychiatric disorder, obesity, or diabetes, was present in 93/340 (27%) (73 men). Conclusion The incidence of SCD among 1- to 35-year-olds in Sweden during 2000-10 was 1.3 per 100 000 person-years (28% women); incidence was decreasing in women. Sudden arrhythmic death syndrome was the most common diagnosis. Co-morbidity such as psychiatric disorders and obesity was common among men.