The association between pro-arrhythmic agents and aortic stenosis in young adults: is it sufficient to clarify the sudden unexpected deaths?
Most young patients with mild-to-moderate aortic stenosis show no symptoms, and sudden death appears only occasionally. We hypothesised that malignant ventricular arrhythmias could be responsible for the high incidence of sudden death in such patients. If multiple factors such as asymptomatic aortic stenosis in association with arrhythmia-provoking agents are involved, could it be sufficient to account for sudden unexpected death? In this study, eight cases of sudden death in young adults, with ages ranging from 22 to 36 years, who had never reported any symptoms that could be related to aortic stenosis, were investigated. Full autopsies were performed, and congenital aortic stenosis in all eight cases was confirmed. DNA testing for channelopathies was negative. Comprehensive toxicological analyses found an electrolyte imbalance, or non-toxic concentrations of amitriptyline, terfenadine, caffeine, and ethanol. Collectively, these results suggest that congenital asymptomatic aortic stenosis without cardiac hypertrophy in young adults is not sufficient to cause sudden death merely on its own; rather, an additional provoking factor is necessary. According to our findings, the provoking factor may be a state of physical or emotional stress, a state of electrolyte imbalance, or even taking a therapeutic dose of a particular drug.
1Institute of Forensic Medicine "Milovan Milovanovic",School of Medicine,University of Belgrade,Belgrade,Serbia.
Bojana
B
Radnic
2Department of Forensic Medicine,Clinical Centre of Montenegro,Podgorica,Montenegro.
Nemanja
N
Radojevic
3Department of Pathology,Centre for Pathology and Forensic Medicine,Clinical Centre of Montenegro,Podgorica,Montenegro.
Jelena
J
Vucinic
4Department of Pharmacology and Clinical Pharmacology,School of Medicine, University of Montenegro,Podgorica,Montenegro.
Natasa
N
Duborija-Kovacevic
D000328:Adult; D000639:Amitriptyline / Q000097:blood; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000235:genetics; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001344:Autopsy; D002110:Caffeine / Q000097:blood; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D000431:Ethanol / Q000097:blood; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000235:genetics; D006801:Humans; D015994:Incidence; D008297:Male; D054548:Montenegro / Q000453:epidemiology; D012307:Risk Factors; D016593:Terfenadine / Q000097:blood; D055815:Young Adult
D000639:Amitriptyline; D002110:Caffeine; D000431:Ethanol; D016593:Terfenadine
Aortic stenosis; pro-arrhythmic agents; sudden death; young adults