Log in to MyACC
Toxicology Screening in Sports-Related Sudden Cardiac Death
Quick Takes
- Among sports-related sudden cardiac death (SrSCD), toxicology screenings rarely detect SCD-associated substances and seem to have a lesser role in evaluating the cause of death than among non-SrSCD victims.
Study Questions:
What are the post-mortem toxicology findings in a cohort of young sports-related sudden cardiac death (SrSCD) victims?
Methods:
Sudden cardiac death (SCD) victims aged 12-49 years with a complete post-mortem were included. Post-mortem findings were compared between SrSCD and non-SrSCD, and toxicology findings in SrSCD were assessed.
Results:
There were 3,189 SCD victims, of which 219 (7%) were sports-related. SrSCD victims were younger, of male predominance, and death was more often caused by structural cardiac disease. Positive toxicology screenings were significantly less likely among SrSCD than non-SrSCD (12% vs. 43%, p < 0.001), corresponding to 82% lower odds of a positive toxicology screening in SrSCD. Patient characteristics were similar between SrSCD, but deaths were more often unexplained (59 vs. 34%). Non-opioid analgesics were the most common finding (3%), and SCD-associated drugs were detected in 6% of SrSCD.
Conclusions:
The authors conclude that SrSCD mainly occurred in younger males with structural heart disease. They had a significantly lower prevalence of a positive toxicology screening compared to non-SrSCD, and detection of SCD-associated drugs was rare.
Perspective:
Strenuous exercise is a known trigger of ventricular arrhythmia due to increased sympathetic tone, electrolyte abnormalities, plaque vulnerability, and many other factors. The current manuscript shows that SrSCD occurs mainly in younger males, and that structural heart disease is often found in these cases. Drugs detected included over-the-counter, prescription, and illicit drugs. They were detected in 12% of the SrSCD—almost three-fold less likely than among non-SrSCD. Non-opioid analgesics were the most commonly detected drug. Drugs associated with SCD were found in 6% of SrSCDs, but they accounted for 50% of all drugs detected. Further research is needed to evaluate the arrhythmogenic risk of dietary supplements and energy drinks containing ephedra derivatives, caffeine, and others.
Clinical Topics: Arrhythmias and Clinical EP, Sports and Exercise Cardiology, SCD/Ventricular Arrhythmias
Keywords: Death, Sudden, Cardiac, Sports, Toxicology
< Back to Listings
