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

Figures & data

Table I.  Family history and main symptoms in 162 cases of sudden cardiac death, by forensic diagnosis. Numbers in parentheses denote the number who consulted a doctor.

	Family history
	Number	Per cent	Presyncope/syncope	Chest pain	Palpitations	Dyspnoea	Fatigue	Infection	Unknown	Total
Structurally normal heart	5	12	15 (11)	0 (0)	6 (5)	1 (0)	4 (1)	3 (2)	12 (0)	41 (19)
Atherosclerosis	7	22	2 (2)	14 (7)	2 (0)	1 (0)	2 (0)	3 (0)	8 (0)	32 (9)
DCM	3	14	7 (4)	3 (1)	1 (1)	1 (1)	2 (1)	2 (0)	6 (0)	22 (8)
HCM	6	32	3 (2)	2 (2)	8 (8)	1 (0)	3 (2)	0 (0)	2 (0)	19 (14)
Myocarditis	1	5	5 (4)	0 (0)	0 (0)	1 (0)	3 (0)	5 (1)	5 (0)	19 (5)
ARVC	3	25	7 (5)	1 (1)	1 (1)	1 (1)	2 (2)	0 (0)	0 (0)	12 (10)
Valvular disease	0	0	1 (1)	1 (1)	2 (2)	0 (0)	2 (1)	0 (0)	2 (0)	8 (5)
Coronary artery anomaly	1	14	1 (1)	2 (2)	0 (0)	1 (0)	3 (0)	0 (0)	0 (0)	7 (3)
Other	0	0	1 (1)	0 (0)	0 (0)	0 (0)	1 (0)	0 (0)	0 (0)	2 (1)
Total	26	16	42 (31)	23 (14)	20 (17)	7 (2)	22 (7)	13 (3)	35 (0)	162 (74)

DCM, dilated cardiomyopathy; HCM, hypertrophic cardiomyopathy; ARVC, arrhythmogenic right ventricular cardiomyopathy; Valvular disease, valve and postoperative congenital disease.

Table II.  Clinical characteristics in 42 patients with presyncope/syncope.

Age	Sex	Forensic diagnosis	Activity at syncope	Other symptoms	MD	Hospitalized	Clinical diagnosis	Time^a	Activity at death
23	m	“Normal” heart	Daily	No	Yes	No	Syncope	2 years	Sleep
22	m	“Normal” heart	Daily	Palpitation	Yes	No	Asthma	1 week	Daily
18	m	“Normal” heart	Exertion	Fatigue	No	No	None	1 month	Exertion
27	m	“Normal” heart	Daily^b	Dizziness	No	No	None	2 months	Sleep
28	m	“Normal” heart	Daily^b	No	Yes	Yes	Observation seizures	5 months	Sleep
27	m	“Normal” heart^c	Daily	Headache	Yes	No	None	6 years	Sleep
26	m	“Normal” heart	Daily	Dizziness	Yes	No	Gastroenteritis	3 weeks	Sleep
21	m	“Normal” heart	Daily	Dizziness	Yes	No	Depression	1 year	Daily
18	m	“Normal” heart	Sleep	Upper resp. tract infection	Yes	No	None	6 months	Sleep
17	f	“Normal” heart	Sleep	Nightmares	No	No	None	1 week	Sleep
34	f	“Normal” heart	Daily	Fatigue	No	No	None	10 months	Daily
22	f	“Normal” heart	Daily^d	Dizziness	Yes	Yes	Suspected seizures	2 days	Daily
24	f	“Normal” heart	Daily	Palpitations	Yes	No	Stress-related	4 months	Daily
24	m	“Normal” heart	Sleep^d	Dyspnoea, headache	Yes	No	Stress, sleep apne	3 days	Sleep
23	f	“Normal” heart^c	Exertion^b	Fatigue	Yes	Yes	Long QT syndrome	1 year	Daily
15	m	DCM	Sleep	Nightmares	No	No	None	7 months	Daily
25	m	DCM	Daily^b	None	Yes	No	None	5 months	Daily
22	f	DCM	Daily	Dizziness	No	No	None	4 weeks	Daily
20	m	DCM	Daily^b	Palpitations	Yes	No	None	10 months	Daily
33	f	DCM	Daily^d	None	Yes	No	Suspected seizures	3 days	Daily
19	m	DCM	Exertion	Fatigue	Yes	Yes	Syncope	2 years	Exertion
33	f	DCM	Daily	Fatigue	No	No	None	1 year	Daily
28	m	ARVC	Exertion	Dizziness	No	No	None	2 weeks	Exertion
20	m	ARVC	Exertion	Palpitations	Yes	Yes	Suspected ARVC	10 months	Exertion
30	f	ARVC	Daily	None	Yes	No	Suspected seizures	5 months	Daily
23	m	ARVC	Exertion^b	None	Yes	Yes	Ventricular tachycardia	1 year	Exertion
16	f	ARVC	Daily	None	Yes	No	None	1 year	Exertion
20	m	ARVC	Daily	Headache	Yes	No	None	8 months	Sleep
28	f	ARVC	Exertion^b	Thoracal pain	Yes	No	RBBB, VES	2 years	Exertion
27	m	Myocarditis	Exertion	Palpitations	Yes	No	Arrhythmia	2 months	Exertion
26	f	Myocarditis	Daily	Palpitations	Yes	No	None	1 week	Daily
19	m	Myocarditis	Exertion	Palpitations, nightmares	Yes	Yes	VES, Wenchebach at night	5 months	Exertion
25	m	Myocarditis	Daily	Palpitations	Yes	Yes	Atrial flimmer	4 years	Daily
35	m	Myocarditis	Daily	Fever	No	No	None	6 hours	Sleep
21	m	HCM	Daily	Palpitations	Yes	Yes	Observation arrhythmia	2 months	Sleep
27	m	HCM	Daily	Fatigue	No	No	None	1 week	Sleep
32	m	HCM	Daily	Fatigue	Yes	Yes	WPW syndrome	3 days	Sleep
17	m	Atherosclerosis	Exertion	None	Yes	No	Syncope	6 months	Exertion
30	m	Atherosclerosis	Exertion	None	Yes	No	Dehydration	5 months	Exertion
23	f	ASD	Daily	Palpitations	Yes	No	Syncope, postop. ASD	1 year	Sleep
19	f	Cor. anomaly	Daily	Upper resp. tract infection	Yes	No	Upper resp. tract infection	4 months	Exertion
26	f	Myocard. bridge	Exertion^b	Dizziness	Yes	Yes	Syncope	6 months	Exertion

^aTime between symptom and death.

^bTwo to three syncopal attacks.

^cFamily history of sudden cardiac death (SCD) or condition related to SCD.

^dGreater than three syncopal attacks.

DCM, dilated cardiomyopathy; ARVC, arrhythmogenic right ventricular cardiomyopathy; HCM, hypertrophic cardiomyopathy; ASD, atrial septal defect.

Table III.  Activity at death in 162 patients who suffered a sudden cardiac death, by diagnosis.

Diagnosis	Physical activity	Daily activity	Sleep	Unknown activity
Structurally normal heart (%)	6 (15)	15 (37)	18 (44)	2 (5)
Atherosclerosis (%)	7 (22)	18 (56)	6 (19)	1 (3)
Dilated cardiomyopathy (%)	5 (23)	14 (64)	3 (14)	0 (0)
Hypertrophic cardiomyopathy (%)	5 (26)	8 (42)	6 (32)	0 (0)
Myocarditis (%)	6 (32)	8 (42)	4 (21)	1 (5)
Arrhythmogenic right ventricular cardiomyopathy (%)	8 (67)	2 (17)	2 (17)	0 (0)
Valve and postoperative congenital disease (%)	1 (13)	4 (50)	2 (25)	1 (13)
Coronary artery anomaly (%)	2 (29)	2 (29)	2 (29)	1 (14)
Other (%)	1 (50)	0	1 (50)	0 (0)

Figure 1. Main symptoms in 115 men and 47 women 15–35 years old who suffered a sudden cardiac death in the period 1992–1999 in Sweden. Only one symptom (the main symptom) was counted in each individual.