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Medico-legal perspectives on sudden cardiac death in young athletes

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Abstract

Sudden cardiac death (SCD) in a young athlete represents a dramatic event, and an increasing number of medico-legal cases have addressed this topic. In addition to representing an ethical and medico-legal responsibility, prevention of SCD is directly correlated with accurate eligibility/disqualification decisions, with an inappropriate pronouncement in either direction potentially leading to legal controversy. This review summarizes the common causes of SCD in young athletes, divided into structural (hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, congenital coronary artery anomalies, etc.), electrical (Brugada, congenital LQT, Wolf-Parkinson-White syndrome, etc.), and acquired cardiac abnormalities (myocarditis, etc.). In addition, the roles of hereditary cardiac anomalies in SCD in athletes and the effects of a positive result on them and their families are discussed. The medico-legal relevance of pre-participation screening is analyzed, and recommendations from the American Heart Association and European Society of Cardiology are compared. Finally, the main issues concerning the differentiation between physiologic cardiac adaptation in athletes and pathologic findings and, thereby, definition of the so-called gray zone, which is based on exact knowledge of the mechanism of cardiac remodeling including structural or functional adaptions, will be addressed.

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    Authors and Affiliations

    1. Institute of Public Health, Section of Legal Medicine, Catholic University, School of Medicine, Largo Francesco Vito 1, 00168, Rome, Italy

      Antonio Oliva, Vincenzo M. Grassi, Sara Partemi & Vincenzo L. Pascali

    2. Cardiovascular Genetics Center, Gencardio Institut d’Investigacions Biomèdiques de Girona (IDIBGI), Girona, Spain

      Oscar Campuzano, Monica Coll & Ramon Brugada

    3. Grupo de Xenética de enfermidades cardiovasculares e oftalmolóxicas, IDIS, RIC Santiago de Compostela, Santiago de Compostela, Spain

      Maria Brion & Angel Carracedo

    4. Fundación Pública Galega de Medicina Xenómica, SERGAS, Santiago de Compostela, Spain

      Maria Brion & Angel Carracedo

    5. Institute of Pathological Anatomy, Catholic University, School of Medicine, Rome, Italy

      Vincenzo Arena

    6. Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain

      Josep Brugada

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    1. Antonio Oliva
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    Correspondence to Antonio Oliva.

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    Angel Carracedo and Ramon Brugada are co-senior authors.

    Antonio Oliva, Vincenzo M. Grassi and Oscar Campuzano contributed equally to this work.

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    Oliva, A., Grassi, V.M., Campuzano, O. et al. Medico-legal perspectives on sudden cardiac death in young athletes. Int J Legal Med 131, 393–409 (2017). https://doi.org/10.1007/s00414-016-1452-y

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