title: Medico-legal perspectives on sudden cardiac death in young athletes.
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.
authors.affiliation: Institute of Public Health, Section of Legal Medicine, Catholic University, School of Medicine, Largo Francesco Vito 1, 00168, Rome, Italy. antonio.oliva@unicatt.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Oliva
authors.affiliation: Institute of Public Health, Section of Legal Medicine, Catholic University, School of Medicine, Largo Francesco Vito 1, 00168, Rome, Italy.
authors.forename: Vincenzo M
authors.initials: VM
authors.lastname: Grassi
authors.affiliation: Cardiovascular Genetics Center, Gencardio Institut d'Investigacions Biomèdiques de Girona (IDIBGI), Girona, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Campuzano
authors.affiliation: Grupo de Xenética de enfermidades cardiovasculares e oftalmolóxicas, IDIS, RIC Santiago de Compostela, Santiago de Compostela, Spain.|Fundación Pública Galega de Medicina Xenómica, SERGAS, Santiago de Compostela, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Brion
authors.affiliation: Institute of Pathological Anatomy, Catholic University, School of Medicine, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Arena
authors.affiliation: Institute of Public Health, Section of Legal Medicine, Catholic University, School of Medicine, Largo Francesco Vito 1, 00168, Rome, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Partemi
authors.affiliation: Cardiovascular Genetics Center, Gencardio Institut d'Investigacions Biomèdiques de Girona (IDIBGI), Girona, Spain.
authors.forename: Monica
authors.initials: M
authors.lastname: Coll
authors.affiliation: Institute of Public Health, Section of Legal Medicine, Catholic University, School of Medicine, Largo Francesco Vito 1, 00168, Rome, Italy.
authors.forename: Vincenzo L
authors.initials: VL
authors.lastname: Pascali
authors.affiliation: Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.affiliation: Grupo de Xenética de enfermidades cardiovasculares e oftalmolóxicas, IDIS, RIC Santiago de Compostela, Santiago de Compostela, Spain.|Fundación Pública Galega de Medicina Xenómica, SERGAS, Santiago de Compostela, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Carracedo
authors.affiliation: Cardiovascular Genetics Center, Gencardio Institut d'Investigacions Biomèdiques de Girona (IDIBGI), Girona, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Brugada
mesh_terms: D056352:Athletes; D016757:Death, Sudden, Cardiac / Q000209:etiology* / Q000517:prevention & control; D004452:Echocardiography; D004562:Electrocardiography; D006331:Heart Diseases / Q000150:complications / Q000235:genetics / Q000473:pathology; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence; D016365:Liability, Legal; D008403:Mass Screening / Q000331:legislation & jurisprudence; D008487:Medical History Taking; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D018570:Risk Assessment
keywords: Athletes; Death; Forensic; Medical malpractice; Pre-participation screening; Sudden