Unsuspected coronary artery abnormalities are a common cause of exercise-related sudden death in young athletes. Proponents of precautionary screening would have us believe that such deaths are preventable. But a disturbing case report from America suggests that this is not necessarily the case.

Cardiologist Dr Paul Thompson, of Hartford Hospital in Connecticut, describes the case of a 14-year-old boy with no previous abnormal medical history, who suffered a cardiac arrest while running and could not be resuscitated.

Autopsy revealed an acute angle take-off of the left main coronary artery and a transverse slit-like opening with a fibrous cushion, which created a kink near the origin of the artery.

So far, so tragic. Even worse, though, was the fact that two weeks earlier the boy had collapsed during soccer practice, and an extensive subsequent cardiac workup had failed to reveal any abnormalities.

The author points out that in patients with congenital coronary artery anomalies, sudden cardiac death is usually due to an arrhythmia (disturbance in the heart’s normal rhythm) triggered by myocardial ischaemia (lack of blood) induced during exercise.

He adds that identifying such subtle abnormalities before death is difficult. Moreover, identifying them does not necessarily imply that they are the cause of cardiac symptoms in young athletes, since these abnormalities are apparent in post-mortem examinations of a significant proportion of patients dying from other causes.

Nevertheless, he concludes that: ‘This case report illustrates the importance of considering unusual coronary anomalies in exercise-induced [collapse] and the potentially fatal consequences when such abnormalities are not identified in symptomatic subjects.’

Med Sci Sports Exerc, vol 36, no 2, pp180-182