Sudden cardiac death in the young in Sweden: electrocardiogram in relation to forensic diagnosis

• Published in: Journal of internal medicine Vol. 255; no. 2; pp. 213 - 220
• Main Authors: Wisten, A., Andersson, S., Forsberg, H., Krantz, P., Messner, T.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.02.2004; Blackwell Science; Blackwell Publishing Ltd
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arrhythmia/complications; Arrhythmias, Cardiac - complications; Biological and medical sciences; death; Death, Sudden, Cardiac - etiology; electrocardiogram; Electrocardiography; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Female; forensic diagnosis; General aspects; Health Care Service and Management, Health Policy and Services and Health Economy; Health Science; Health Sciences; Heart Block - complications; Humans; Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi; Hälsovetenskap; Intensive care medicine; Male; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Minnesota code; Registries; Risk Factors; Sex Factors; sudden cardiac; sudden cardiac death; Sweden; young; Sweden; Minnesota; United States; North America; Europe; America; Medicine; Electrodiagnosis; Sweden; electrocardiogram; young; Sudden death; forensic diagnosis; Electrocardiography; Minnesota code; Diagnosis; sudden cardiac death; Code; Death; Cardiac/etiology; Sudden
• ISSN: 0954-6820; 1365-2796; 1365-2796
• DOI: 10.1046/j.1365-2796.2003.01277.x

. Objectives.  To study electrocardiogram (ECG) in relation to forensic diagnosis in young persons who suffered a sudden cardiac death (SCD) in Sweden during 1992–99. Design.  A register study of a national database of forensic medicine in Sweden, selecting all cases of SCD 15–35 years of age. In this group, 12‐lead ECGs and clinical data were searched for in military conscription and medical records. The ECGs were re‐analysed and classified according to the Minnesota code criteria. Setting.  The whole nation of Sweden. Subjects.  Sudden cardiac death victims (66 individuals), 15–35 years of age, where it was possible to obtain an ECG recording. Results.  We observed major or minor ECG abnormalities in 82% of the subjects. The most common changes were T wave abnormalities (35%), ST segment changes (32%) and conduction defects (20%). The ECGs were evaluated as pathological in 50% of the cases, more often in arrhythmogenic right ventricular cardiomyopathy (88%) and hypertrophic cardiomyopathy (82%). Cardiac‐related symptoms were seen in 76% of the total group and there was a family history of a similar cardiac condition in 18%. Conclusions.  Pathological ECGs were common in young SCD victims, in spite of being taken many years before death. An ECG could help identify prospective victims of SCD, and should always be taken in cases with possible cardiac‐related symptoms or a family history of SCD. The pathological ECGs were often found in connection with routine screening at military enlistment for men, which raises the question of a routine screening in the young, including women.