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翻译：苗 丹妮 猫
Introduction of Sudden Death猝死介绍
Abstract摘要
Sudden death is unpredictable; it is the most serious disease of human beings. With the development of economy and society, people’s pace of work and life is accelerating, which results in long-term physical fatigue, excessive mental burden, and the accompanying bad emotions, such as depression and irritability. Due to the bad influence, the number of sudden deaths is increasing, which has brought huge disaster to the whole society and family. This chapter introduces the connotation, epidemiology, and classification of sudden death in detail.
猝死是不可预测的，它是人类最严重的疾病。随着经济和社会的发展，人们的工作和生活节奏不断加快，导致长期的身体疲劳、精神负担过重，以及伴随而来的抑郁、易怒等不良情绪。由于不良影响，猝死人数不断增加，给整个社会和家庭带来了巨大的灾难。本章详细介绍了猝死的内涵、流行病学和分类。
Keywords：
Sudden death猝死、Connotation含义、Epidemiology[ˌepɪˌdiːmiˈɑːlədʒi]]流行病学、Classification[ˌklæsɪfɪˈkeɪʃn]分类
Introduction介绍：
1.1.1 Evolution of the Concept of Sudden Death
猝死概念的演变
1.1.1.1 Death死亡
It is generally known that all lives will die. From ancient to modern times, many philosophers, writers, medical scientists, and other scholars have profoundly studied the facts of death from different angles. When people live in the world, they will eventually face death, which is judged by nature. No one can get rid of the control of fate. The deaths in life are happening at any time and in just different ways such as death, natural death, or accidental death. Death is the last link that constitutes the complete life process of people. Hegel believes that the moment of the birth of life has already buried the seeds of death, and in the process of human growth, all activities are cultivating this seed and continue to advance the process of death. The meaning and value of death is based on the existence of life, and it ensures the integrity of life. Whether the life of a person lacks life or does not achieve death, the meaning and value as well as the integrity and finiteness of life cannot be judged.
Death is originally interpreted in myth. Primitive religion is the main form of primitive culture. It often needs to be expressed by means of mythology, rituals, etc., all of which are trying to interpret death. Humans have studied the original myths of death around the world and found that the most primitive tribes refuse to recognize the fact that “death is inevitable.” With the further development of scientific practice and modern medicine, traditional death standards no longer pose a threat to death because of the wide application of heart transplants and respirators. In addition, effective techniques such as cardiac pacing, intracardiac injection, and cardiopulmonary resuscitation help some people recover their heartbeat and breathing, thus gaining new life. Medical experts have therefore explored new standards of death. The standard of modern medical death is brain death, also known as whole brain death, including irreversible death of the brain, midbrain, cerebellum, and brainstem. The concept of brain death was first proposed by French medical practitioners in 1959, and they first used the term “excessive coma.” Because the probability of a patient waking up in this state tends to zero, it can be expressed as “brain death.” The criteria for brain death in 1968 were formally proposed, that is, “the irreversibility loss of brain function.” This criterion has been recognized by many medical scientists all over the world. Today, more than 80 countries worldwide use brain death as criteria for determining death, and based on this, many European countries and the United States have established special laws and regulations for brain death criteria.
众所周知，所有的生命都会死亡。从古代到现代，许多哲学家、作家、医学家和其他学者从不同的角度深刻地研究了死亡的事实。人活在世上，最终会面临死亡，这是自然的判断。没有人能摆脱命运的控制。生命中的死亡随时都在发生，只是方式不同，如死亡、自然死亡或意外死亡。死亡是构成人的完整生命过程的最后一环。黑格尔认为，生命诞生的那一刻就已经埋下了死亡的种子，而在人类成长的过程中，一切活动都在培育这种种子并不断推进死亡的进程。死亡的意义和价值是以生命的存在为基础的，它保证了生命的完整性。一个人的生命是缺少生命还是没有达到死亡，生命的意义和价值以及完整性和有限性是无法判断的。
死亡最初在神话中被解释。原始宗教是原始文化的主要形式。往往需要通过神话、仪式等方式来表达。所有这些都试图解释死亡。人类研究了世界各地最初的死亡神话，发现最原始的部落拒绝承认“死亡是不可避免的”这一事实。随着科学实践和现代医学的进一步发展，由于心脏移植和呼吸机的广泛应用，传统的死亡标准不再对死亡构成威胁。此外，心脏起搏、心内注射和心肺复苏等有效技术帮助一些人恢复心跳和呼吸，从而获得新的生命。医学专家因此探索了新的死亡标准。现代医学死亡的标准是脑死亡，也称为全脑死亡，包括大脑、中脑、小脑和脑干的不可逆死亡。脑死亡的概念最早是由法国医生在1959年提出的，他们首次使用了“过度昏迷”这个术语因为患者在这种状态下醒来的概率趋于零，所以可以表述为“脑死亡”。1968年脑死亡的标准被正式提出，即“大脑功能丧失的不可逆性”。这一标准得到了全世界许多医学家的认可。如今，全球已有80多个国家将脑死亡作为判定死亡的标准，基于此，许多欧洲国家和美国都对脑死亡标准制定了专门的法律法规。
1.1.1.2 Sudden Death猝死
Sudden death (SD), as a special type of death, is the most serious disease of human beings. It was known to people thousand years ago. In the ancient Egypt, about more than 4000 years ago, the ancient Abbots medical book stated that the patient may die if there is pain in chest, shoulder, and back. Different literatures have different definitions of sudden death. It is scientifically defined by World Health Organization (WHO) as an unexpected death which occurs within minutes from disease for those who are healthy and seemingly healthy people.
猝死作为一种特殊的死亡类型，是人类最严重的疾病。它早在一千年前就为人们所知了。在古埃及，大约4000多年前，古代Abbots的医学书籍中写道，如果胸部、肩部和背部疼痛，患者可能会死亡。不同的文献对猝死有不同的定义。根据世界卫生组织(WHO)的科学定义，它是指那些身体健康和看似健康的人在患病后几分钟内发生的意外死亡。
At present, there is no uniform standard to decide how long exactly can be considered as sudden death from onset to death. For example, the World Health Organization (WHO) in 1970 and the International Heart Association in 1979 defined the sudden death as the immediate accidental death or 24 h after acute symptoms occur. The time from onset to death was within 1 h, 6 h, 12 h, and 24 h, and it was considered to include deaths within 48 h. Most of the deaths within 1 h were sudden cardiac death.
现在，究竟从发病到死亡多长时间可以被认为是猝死，目前还没有统一的标准。例如，1970年世界卫生组织(WHO)和1979年国际心脏协会(International Heart Association)将猝死定义为立即意外死亡或急性症状发生后24小时。发病至死亡时间分别在1h、6h、12h、24h内，以48h内死亡为主，1h内死亡多为心源性猝死。
1.1.1.3 The Elements of Sudden Death
猝死的构成因素
The definition “sudden death due to illness” refines the three elements of them sudden death:
• Element 1: The patient has died. If the patient is not dead, he cannot be considered as sudden death. Sudden death is a final diagnosis and a conclusion. Therefore, sudden death is a disease that can only be prevented and cannot be treated. Any situation that can be treated or even cured or successfully recovered cannot be called sudden death.
• Element 2: The patient belongs to natural death, that is, death due to his own disease, and death is caused by internal factors of the patient’s body instead of the external factors or unnatural causes such as drowning, electric shock, self- destruction, poisoning, low temperature, high temperature, violence, blood loss, trauma, anesthesia, and surgery.
• Element 3: Sudden death occurs suddenly. The time of its occurrence is unpredictable. The patient does not have signs of imminent death. No one thinks that the patient will die, but death has occurred. Therefore, all expected deaths are not sudden death. The most common clinical patients are end-stage diseases, such as advanced cancer and late stage of various diseases, the patient’s life is gradually coming to an end, and the clinical manifestations are obvious to all. Once the patient leaves, this death is not sudden death.
“因病猝死”的定义细化了猝死的三个要素:
要素1:患者已经死亡。如果病人没死，不能认为是猝死。猝死是最终的诊断和结论。所以，猝死是一种只能预防，不能治疗的疾病。任何可以治疗甚至治愈或成功康复的情况都不能称为猝死。
·要素2:患者属于自然死亡，即因自身疾病死亡，死亡是患者身体内部因素引起的，而不是溺水、触电、自毁、中毒、低温、高温、暴力、失血、外伤、麻醉、手术等外部因素或非自然原因引起的。
要素3:猝死突然发生。它发生的时间是不可预测的。病人没有即将死亡的迹象。没有人认为病人会死，但死亡已经发生了。因此，所有的预期死亡都不是猝死。临床上最常见的患者是终末期疾病，如晚期癌症和各种疾病的晚期，患者的生命逐渐走到尽头，临床表现有目共睹。一旦病人离开，这种死亡就不是猝死。
1.1.2 Epidemiology of Sudden Death
猝死的流行病学
1.1.2.1 Cardiac Sudden Death
心源性猝死（SCD）
Incidence Rate发病率
About two thirds of the sudden deaths result from diseases of circulatory system. The sudden death caused by the heart is also called “Cardiac Sudden Death” [1]. Death often occurs within 1 h after the symptoms appear. If the main cause of sudden death outside the hospital is sudden cardiac death, the incidence of sudden cardiac death in the United States is between 300,000 and 450,000, but this may overestimate the incidence of sudden cardiac death [2]. If cardiac death is strictly defined as death within 1 h of symptom onset, the case of no witnesses is not included, thus underestimating the incidence of cardiac death. So to get a true rate of sudden cardiac death, you need to collect information from multiple sources.
Two prospective studies using multiple sources of information found that the incidence of sudden cardiac death was lower than previously reported, and a data- based study from first responders showed an incidence of sudden cardiac death is 40–90 per 100,000 people. The incidence of sudden death from the center of residents aged 20–75 years in Maastricht, the Netherlands, is 100 per 100,000 people. Research in Ireland shows that the annual rate of sudden death in the country is between 40 and 50 per 100,000 people [3]. The Framingham Heart Study showed that the incidence of sudden cardiac death was 6.8% of the 5000 people included in the study after more than 50 years of follow-up. A prospective study in Paris showed that the incidence of sudden cardiac death in 7000 people enrolled in the study over a 23-year period was 4.4% [4]. If we conclude from these data, the incidence of sudden death in the United States should be between 180,000 and 250,000 per year. With the advancement of primary prevention and secondary prevention of coronary heart disease in recent decades, deaths from coronary heart disease have decreased significantly. The incidence of corresponding sudden cardiac death is also decreasing. In China, through a 1-year monitoring of rural and urban residents selected in Beijing, Guangzhou and Xinjiang, according to the incidence and population of 1.3 billion, the number of sudden cardiac deaths in China is 550,000/year [5]. However, when China’s 1.3 billion population is further calculated, the total number of sudden cardiac deaths in China is 544,000, ranking first in the world. The total number of people killed in the United States is 300,000 per year, that is, one person per minute will have sudden cardiac death, and the total number of sudden deaths in China is twice that of the United States, which means that two people will have sudden cardiac death every minute. The data also suggest that with the further aging of the Chinese population, and the increase in the incidence of coronary heart disease as well as the cardiovascular disease the total number of sudden cardiac deaths in China will further increase.
Whether there are differences in epidemiology among different ethnic groups is not yet fully understood. The available data show that the proportion of sudden deaths among the black Americans is higher than that of the white Americans [6], and the rate of discharge after cardiac arrest and survival after cardiopulmonary resuscitation are lower than the white people. At present, the sudden death and risk factors of various people’s heart are still unknown.
大约三分之二的猝死是由循环系统疾病引起的。由心脏引起的猝死也称为“心源性猝死”[1]。死亡通常发生在症状出现后1小时内。如果院外猝死的主要原因是心脏性猝死，那么美国心脏性猝死的发生率在30万到45万之间，但这可能高估了心脏性猝死的发生率[2]。如果心源性死亡被严格定义为症状出现后1小时内死亡，则无目击者的情况不算。包括在内，因此低估了心脏性死亡的发生率。因此，要获得心源性猝死的真实比率，你需要从多个来源收集信息。
两项使用多种信息来源的前瞻性研究发现，心脏性猝死的发生率比之前报道的要低，来自急救人员的一项基于数据的研究显示，心脏性猝死的发生率为每10万人中有40-90人。在荷兰马斯特里赫特，20-75岁居民从中心猝死的发生率为每10万人中有100人猝死。爱尔兰的研究表明，该国每年的猝死率在每10万人40到50人之间[3]。弗雷明翰心脏研究显示，经过50多年的随访，在纳入该研究的5000人中，心脏性猝死的发生率为6.8%。巴黎的一项前瞻性研究显示，在23年的时间里，7000名参与研究的人发生心脏性猝死的发生率为4.4%[4]。如果我们从这些数据中得出结论，美国每年的猝死发生率应该在18万到25万之间。近几十年来，随着冠心病一级预防和二级预防工作的推进，冠心病死亡人数明显减少。相应的心脏性猝死的发生率也在下降。在中国，通过对北京、广州和新疆选取的城乡居民进行为期一年的监测，根据13亿人的发病率和人口，中国的心脏性猝死人数为55万/年[5]。然而，进一步计算中国13亿人口，中国心脏性猝死总数为54.4万人，居世界首位。美国每年的死亡总人数是30万人，也就是每分钟会有一个人发生心脏性猝死，而中国的猝死总数是美国的两倍，这意味着每分钟会有两个人发生心脏性猝死。数据还表明，随着中国人口进一步老龄化，冠心病和心血管疾病发病率的增加，中国心脏性猝死总数将进一步增加。
不同民族之间的流行病学是否存在差异尚不完全清楚。现有数据显示，美国黑人的猝死比例高于白人[6]，心脏骤停后的出院率和心肺复苏后的存活率低于白人。目前，各种人心脏的猝死和危险因素还不得而知。
Age and Gender Distribution年龄和性别分布
In the reported epidemiological studies, the incidence of adolescents and young people (<35 years old) ranged from 0.5 to 8/100,000 per year, and the incidence of those who are under 35 years old was lower. The average is 4.5/ten million and 1.4/ ten million in London of the United Kingdom and the V eneto area of Italy, respectively. The risk of sudden death of adults increases with age and coronary heart disease. Middle-aged men are four times more likely to have sudden cardiac death than women of the same age. However, this gap decreases with age and may be associated with postmenopausal women who are also susceptible to coronary heart disease. A Chinese study showed that the incidence of sudden cardiac death in middle- aged men was significantly increased, and most cases occurred in people aged 65 years or older. The annual incidence of SCD in 80-year-old males is about 7 times that of 40-year-old males; the distribution of sudden cardiac death in women is more extreme with age: the incidence in those who are over 70-year-old women is more than 40 times that in women aged 45 years or younger. Foreign studies have shown that the incidence of male SCD is 2–3 times that of women; Chinese Hua and other studies have shown that the incidence of males in rural areas is twice that of urban males, about three times that of females. The overall incidence rates of male and female in China were 44.6/100,000 and 39.0/100,000, respectively, and the difference was not statistically significant. In the young population, SCD is predominantly male, with a gender ratio of 1.5 to 3.6:1; the risk of SCD in middle-aged men is four times that of women of the same age, but the difference decreases with age, which may be due to women. The prevalence of postmenopausal CHD is gradually increasing, while CHD is the primary risk factor for SCD.
在报告的流行病学研究中，青少年(< 35岁)的发病率在每年0.5/10万至8/10万之间，35岁以下的发病率较低。英国伦敦和意大利维尼托地区的平均值分别为4.5/千万和1.4/千万。成年人猝死的风险随着年龄和冠心病的增加而增加。中年男性发生心源性猝死的可能性是同龄女性的四倍。然而，这种差距随着年龄的增长而减小，可能与绝经后妇女也易患冠心病有关中国的一项研究表明，中年男性心脏性猝死的发生率明显增加，大多数病例发生在65岁以上的人群中。80岁男性SCD年发病率约为40岁男性的7倍；心脏性猝死在女性中的分布随着年龄的增长更加极端:70岁以上女性的发病率是45岁及以下女性的40多倍。国外研究表明，男性SCD的发病率是女性的2-3倍；中国华等研究表明，农村地区男性发病率是城市男性的两倍，约为女性的三倍。我国男女总体发病率分别为44.6/10万和39.0/10万，差异无统计学意义。在年轻人口中，SCD主要是男性，性别比为1.5至3.6:1；中年男性患SCD的风险是同龄女性的4倍，但这种差异随着年龄的增长而减小，这可能是女性的原因。绝经后冠心病的患病率逐渐增加，而冠心病是SCD的主要危险因素。
1.1.3 Classification of Sudden Death
猝死的分类
1.1.3.1 Cardiac Death心源性死亡
Sudden death due to heart disease is the most common cause心脏病导致的猝死是最常见的原因
1. Acute coronary syndrome (ACS). Acute coronary syndrome (ACS) includes plaque rupture, vascular endothelial damage, various inflammatory factors platelet aggregation, and thrombosis after coronary atherosclerosis, causing coronary artery stenosis or even obstruction [7]. With the occurrence of clinical syndrome of insufficient blood supply, subsequent myocardial hypoxic necrosis, the most dangerous type of CHD may occur. In recent years, its morbidity, lethality, and disability rate have been increasing year by year, and it is often accompanied by risks such as malignant arrhythmia, heart failure, sudden cardiac death, and sudden cardiac arrest. In clinical work, it is the most common reason for death. ACS mainly includes ST segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction (NSTEMI), and unstable angina pectoris (UAP). The first two are collectively called acute myocardial infarction (AMI) [8]. ACS, a serious acute cardiovascular disease, has the characteristics of rapid onset, rapid change of condition, and high mortality. It threatens human health and survival. The Global Acute Coronary Artery Events Registry (GRACE) shows that the mortality rate of ACS patients is about 15% after 1 year and that the cumulative mortality rate is about 20% after 5 years. Bougouin and his team reported the 5-year follow-up results of 3670 patients with acute myocardial infarction. The hospital mortality rate was 5.6%, and the all-cause mortality rate of surviving patients within 5 years was 25.6% [9]. Since 2004, cardiovascular disease (CVD) deaths have been the leading cause of death for urban and rural residents in China and are higher than tumors and other diseases, accounting for more than 40% of deaths from residents. According to the “2017 Chinese Cardiovascular Disease Report,” the number of AMI patients in China is about 2.5 million, and the mortality rate of AMI generally shows an upward trend. The Taiwan ACS full-spectrum registration form shows that among the 183 ACS patients registered, STEMI, NSTEMI, and UAP mortality rates after 1 year were 6.1%, 10.1%, and 6.2%, respectively. Such a high fatality rate not only causes a heavy financial burden on patients, families, and society, but also significantly reduces the quality of life of patients, which shows the urgency and importance of prevention and treatment of ACS.
1.急性冠脉综合征(ACS)。急性冠脉综合征(ACS)包括斑块破裂、血管内皮损伤、各种炎症因子、血小板聚集、冠状动脉粥样硬化后血栓形成，导致冠状动脉狭窄甚至梗阻[7]。随着临床出现供血不足综合征，继发心肌缺氧性坏死，最危险的类型冠心病可能发生。近年来，其发病率、致死率、致残率呈逐年上升趋势，常伴有恶性心律失常、心力衰竭、心脏性猝死、心脏骤停等危险。在临床工作中，它是最常见的死亡原因。ACS主要包括ST段抬高心肌梗死(STEMI)、非ST段抬高心肌梗死(NSTEMI)和不稳定型心绞痛(UAP)。前两者统称为急性心肌梗死(AMI)[8]。急性冠脉综合征(ACS)是一种严重的急性心血管疾病，具有发病快、病情变化快、病死率高的特点。它威胁着人类的健康和生存。全球急性冠状动脉事件登记处(GRACE)显示，ACS患者1年后的死亡率约为15%，5年后的累计死亡率约为20%。Bougouin和他的团队报告了3670名急性心肌梗死患者的5年随访结果。住院死亡率为5.6%，5年内存活患者全因死亡率为25.6%[9]。自2004年以来，心血管疾病(CVD)死亡一直是中国城乡居民的头号死因，并高于肿瘤和其他疾病，占居民死亡的40%以上。根据“2017中国人心血管疾病报告”：我国AMI患者约为250万，AMI死亡率总体呈上升趋势。台湾ACS全谱登记表显示，在登记的183名ACS患者中，STEMI、NSTEMI和UAP的1年后死亡率分别为6.1%、10.1%和6.2%。如此高的病死率不仅给患者、家庭和社会造成了沉重的经济负担，而且显著降低了患者的生活质量，可见防治ACS的紧迫性和重要性。
2. Stress and sudden death. Patients can induce myocardial ischemia under mental and psychological stress, which is different from myocardial ischemia caused by exercise and drug load as inducing factors. This is called mental stress–induced myocardial ischemia (MSIM) [10]. It is closely related to characters and weight. People in a more obvious state of anger and personality traits are more likely to have myocardial ischemia. A rise in weight index leads to increased risk of MSIMI in patients with coronary heart disease, which can be used as an independent risk factor for myocardial ischemia under mental stress. This may have nothing to do with coronary artery stenosis and coronary artery calcification, and may be related to patients’ depression and anxiety [11]. Mental stress is different from exercise/drug stress–induced myocardial ischemia. Mental stress mainly increases diastolic blood pressure, the symptoms are concealed, and there are fewer changes in electrocardiogram; while exercise/drug stress increases systolic blood pressure and heart rate. ECG changes. However, this is not conclusive. A study included 34 patients with coronary heart disease and heart failure. The stress test and the drug adenosine test were used to evaluate the myocardial ischemia of the patients by PET examination. The results showed that the stress test and adenosine have the same effect on myocardial ischemia [12].
2.压力和猝死。患者在精神和心理应激下可诱发心肌缺血，不同于运动和药物负荷作为诱发因素引起的心肌缺血。这被称为精神压力诱发的心肌缺血(MSIM) [10]。它与性格和体重密切相关。处于更明显的愤怒状态和性格特征的人更容易出现心肌缺血。体重指数升高导致冠心病患者MSIMI风险增加，可作为精神压力下心肌缺血的独立危险因素。这可能与冠状动脉狭窄和冠状动脉钙化无关，可能与患者的抑郁和焦虑有关[11]。精神压力不同于运动/药物压力诱发的心肌缺血。精神压力主要增加舒张压，症状隐匿，心电图改变较少；而运动/药物压力会增加收缩压和心率。心电图改变。然而，这并不是决定性的。一项研究包括34名患有冠心病和心力衰竭的患者。应用负荷试验和药物腺苷试验评价患者的心肌缺血情况。结果表明，应激试验和腺苷对心肌缺血有相同的作用[12]。
Most research results on gender and MSIMI show that MSIMI has gender differences. The incidence of MSIMI in young women after myocardial infarction is twice that of men. There is no clear relationship between the gender differences of MSIMI and psychosocial factors and clinical risk factors. Peripheral arterial tension (PA T) index and reactive hyperemia index cannot explain this difference, but can be used as a predictor of MSIMI in women. Female patients with angina symptoms have a higher incidence of MSIMI, and young women are more likely to develop MSIMI than men and older women. For every 10 years of decline in female age, the total reversibility severity score under mental stress increased by 9.6 points, and the incidence of MSIMI in women was 82.6% higher than that in men [13]. However, Y ork et al. included 154 patients with coronary heart disease, including 61 women and 93 men. Myocardial ischemia was used to diagnose myocardial ischemia. There was no gender difference in the incidence of MSIMI, and there was no difference in hemodynamics and myocardial perfusion.
大多数关于性别和MSIMI｛心肌缺血(myocardial ischemia)｝的研究结果表明，MSIMI存在性别差异。年轻女性心肌梗死后MSIMI的发病率是男性的两倍。MSIMI的性别差异与心理社会因素和临床危险因素之间没有明显的关系。外周动脉压(PAT)指数和反应性充血指数不能解释这种差异，但可以作为预测女性MSIMI的指标。有心绞痛症状的女性患者患MSIMI的几率更高，年轻女性比男性和老年女性更容易患上MSIMI。女性年龄每下降10年，精神应激状态下的可逆性严重程度总分增加9.6分，女性MSIMI的发生率比男性高82.6%[13]。然而，York等人。包括154名冠心病患者，包括61名女性和93名男性。心肌缺血用于诊断心肌缺血。MSIMI的发生率没有性别差异，在血流动力学和心肌灌注方面也没有差异。
A meta-analysis included five clinical studies, a total of 555 patients with coronary heart disease (85% of the patients were male), a follow-up period of 35 days to 8.8 years and a total of 117 events [14]. A comprehensive analysis showed that MSIMI makes the end point (event or total mortality), and the risk of occurrence increases by a factor of 2. Indicators that reflect cardiac function, such as ventricular wall motor function, LVEF, mitral annulus movement, and hemodynamic indicators, can help predict the relationship between MSIMI and cardiac adverse events. The REMIT study has different results for the study of LVEF. The study shows that the continuous variables of mental stress–induced LVEF changes are significantly related to the end events. For every 5% decrease in LVEF caused by mental stress, patients have significant adverse cardiovascular during the average follow-up period. The probability of occurrence increased by 5%, and after 6 years of follow-up, a significant adverse cardiovascular event increased by 20%. Babyak et al. found that changes in LVEF during mental stress were related to clinical events through 5.9 years of follow-up [15]. For every 4% decrease in LVEF during the stress test compared to resting, the risk of clinical events increased by 1.7 times.
荟萃分析包括5项临床研究，总共555名冠心病患者(85%的患者是男性)，随访35天到8.8年，总共117个事件[14]。综合分析表明，MSIMI是终点(事件或总死亡率)，其风险反映心脏功能的指标，如室壁运动功能、LVEF、二尖瓣环运动和血流动力学指标，可以帮助预测MSIMI和心脏不良事件之间的关系。REMIT研究对LVEF的研究有不同的结果。研究表明，心理应激引起的LVEF变化的连续变量与终点事件显著相关。精神压力引起的LVEF每下降5%，患者在平均随访期内就会有显著的心血管不良反应。发生的概率增加了5%，经过6年的随访，重大不良心血管事件增加了20%。Babyak等人。通过5.9年的随访发现，精神应激期间LVEF的变化与临床事件有关[15]。与静息相比，压力测试期间LVEF每下降4%，发生临床事件的风险就增加1.7倍。
Changes in myocardial valve ring motion caused by mental stress are independent predictors of the prognosis of adverse cardiovascular events in patients with stable coronary heart disease. Changes in myocardial valve ring motion caused by mental stress in early diastole and systole are important predictors of major adverse cardiovascular events, while late diastolic changes are marginal. Cardiac annulus motion measurement relationship model shows that early diastolic and/or systolic phases are significantly reduced, and major adverse cardiovascular events are more likely to occur. Late diastolic changes and marginal adverse cardiovascular events are marginal, but have the same trend.
精神压力引起的心肌瓣环运动改变是稳定型冠心病患者不良心血管事件预后的独立预测因素。舒张早期和收缩期精神压力引起的心肌瓣环运动变化是主要不良心血管事件的重要预测因素，而舒张晚期的变化是边缘性的。心脏环运动测量关系模型显示，早期舒张期和/或收缩期明显减少，更容易发生重大不良心血管事件。舒张末期改变和边缘性心血管不良事件是边缘性的，但有相同的趋势。
Mental stress increases myocardial oxygen consumption requirements. Physiological responses to mental stress include increased heart rate, peripheral vasoconstrictor response, and increased left ventricular afterload. Mental pressure has an effect on cardiac output and is related to a decrease in LVEF. There is a clear relationship between the changes of neurohormones and the mechanism of MSIMI when coping with mental stress. The heart has its own endocrine function, which affects microcirculation and endothelial signal changes. At the same time, it activates the hypothalamic–pituitary–adrenal axis, promotes the release of cortisol and corticotropin-releasing hormone, and has a systemic effect on inflammation, cardiac function, microcirculation, platelet function, and hemodynamics.
精神压力增加心肌耗氧量需求。对精神压力的生理反应包括心率加快、外周血管收缩反应和左心室后负荷增加。精神压力对心输出量有影响，并且与LVEF减少有关。在应对精神压力时，神经激素的变化与MSIMI的机制之间有明确的关系。心脏有自己的内分泌功能，影响微循环和内皮信号变化。同时，它激活下丘脑-垂体-肾上腺轴，促进皮质醇和促肾上腺皮质激素释放激素的释放，对炎症、心功能、微循环、血小板功能和血流动力学有全身作用。
3. Cardiomyopathy (dilated, hypertrophic) is another important disease contributing to ventricular arrhythmia and sudden death. Sustained or induced sustained ventricular tachycardia, mean signal electrocardiogram positive, and right heart involvement are risky patients of sudden death [16–18]. Right ventricular cardiomyopathy can contribute to right ventricular tachycardia and sudden death [19– 21]. Myocarditis intrigued by virus leads to the sudden death in children and young people.
3.心肌病(扩张型、肥厚型)是导致室性心律失常和猝死的另一种重要疾病。持续或诱发的持续室性心动过速、平均信号心电图阳性和右心受累是猝死的高危患者[16–18]。右心室心肌病可导致右心室心动过速和猝死[19–21]。病毒引起的心肌炎会导致儿童和年轻人的猝死。
4. Congenital heart disease. In patients with Faure’s quadruple syndrome, the incidence of sudden death after repair was 6%. Two flap prolapses with complicated ventricular tachyarrhythmia, high-risk patients with sudden death, family history of sudden death, syncope history, and prolonged Q-T interval. Aortic stenosis, regurgitation, and pulmonary stenosis can also occur sudden death [22–24].
4.先天性心脏病。在Faure’s四联征患者中，修复后猝死的发生率为6%。2例皮瓣脱垂合并复杂室性快速性心律失常、高危猝死患者、猝死家族史、晕厥史、Q-T间期延长。主动脉狭窄、返流和肺动脉狭窄也可能发生猝死[22-24]。
5. Arrhythmia. Long Q-T interval prolongation syndrome includes congenital and acquired two major categories. Congenital Q-T interval prolongation syndrome, corrected Q-T interval over 500 ms, and the risk of sudden death in families with sudden death [25, 26]. Pre-excitation syndrome combined with short-term refractory forward conduction has a rapid ventricular rate of atrial fibrillation, which has a certain risk of sudden death. Brugada syndrome refers to “idiopathic” ventricular fibrillation (IVF) in the absence of structural heart disease [27, 28], electrocardiogram with right bundle branch block, V1 to V3 lead ST segment elevation, and sudden death with a group of symptoms [29].
5.心律不齐。长Q-T间期延长综合征包括先天性和获得性两大类。先天性Q-T间期延长综合征、校正后超过500 ms的Q-T间期以及猝死家庭的猝死风险[25，26]。预激综合征合并短期难治性前向传导有快速心室率房颤，有一定猝死风险。Brugada综合征是指在没有结构性心脏病的情况下出现的“特发性”心室颤动(IVF)[27，28]，心电图伴右束支传导阻滞，V1至V3导联ST段抬高，以及猝死伴发的一组症状[29]。
6. Atrial myxoma [30–33]. A benign tumor originating from the endocardial primitive interstitial cells grows to a certain extent. Under the influence of blood flow, it can block the position of the mitral valve. In severe cases, it may cause sudden death. It should be detected early and operated as soon as possible.
6.心房粘液瘤[30–33]。起源于心内膜原始间质细胞的良性肿瘤生长到一定程度。在血流的影响下，可以阻断二尖瓣的位置。在严重的情况下，它可能会导致猝死。应及早发现，尽早手术。
7. Viral myocarditis [34, 35]. Many viruses can cause myocarditis, leading to myocardial interstitial hyperplasia, edema, and congestion. The clinical manifestations vary greatly in severity and can be completely symptom-free or sudden death.
7.病毒性心肌炎[34，35]。许多病毒会引起心肌炎，导致心肌间质增生、水肿和充血。临床表现的严重程度差异很大，可以完全无症状或猝死。
8. Heart shock sudden death syndrome [36]. Refers to the heart area in front of a healthy chest, suddenly hit by some reason and drowned.
8.心源性休克猝死综合征[36]。指健康胸部前面的心脏区域，突然被某种原因击中而淹死。
1.1.3.2 Non-cardiac Sudden Death
非心脏性猝死
Arrhythmia Drugs and Cardiotoxic Drugs心律失常药物和心脏毒性药物
It can cause severe arrhythmia and sudden cardiac death. Certain drugs and serum preparations may cause cardiac arrest due to severe allergic reactions.
它会导致严重的心律失常和心源性猝死。某些药物和血清制剂可能会因为严重的过敏反应而导致心脏骤停。
Drowning溺水
Drowning refers to the fact that people are drowning in the water, often due to accidents when they fall into the water or swim. Because the respiratory tract is blocked by water, sludge, algae, etc. (90% of wet sudden death) or by the reflex spasm of the head of the throat and trachea (dry drowning accounts for 10%), it causes suffocation and hypoxia and even causes the stop of breathing and heartbeat, even death. The drowning process is very fast, which can cause death if the rescue does not take place in 4–6 min. The study pointed out that the drowning person’s 6–9 min mortality rate reached 65%. It can cause serious sequelae and even death if the rescue does not take place in 25 min. However, if the rescue is obtained within 1–2 min, the success rate of salvage can reach 100%. Therefore, weak water first aid must be obtained in time. The early death in drowning is mainly caused by water, sludge, algae, etc. entering the mouth, nose, trachea, and lungs which obstructs the respiratory tract. The death can also be caused by obstruction of throat, trachea, and bronchospasm due to inhaling water, panic, cold, etc. Dilution of blood in fresh water, hemolysis, and ventricular fibrillation can cause elevated blood potassium and cardiac arrest. Electrolyte imbalance of seawater sputum and acute pulmonary edema lead to heart failure and death. When diving, head impact or wood piles can cause craniocerebral trauma, coma, and death in the water. The basic pathological changes of sputum are brain and heart function damage caused by asphyxia and hypoxia,myocardial hypoxia, degeneration and necrosis, and circulatory failure. Pulmonary dysfunction caused by hydronephrosis in the lungs and hypoxia in the body can lead to metabolic acidosis. The environment and duration of drowning determine the severity of the illness after asphyxia. Generally, respiratory arrest occurs first, followed by cardiac arrest.
溺水是指人在水中溺水，往往是由于落水或游泳时发生意外。因为呼吸道被水、污泥、藻类等堵塞。(90%的湿猝死)或由头部咽喉和气管的反射性痉挛(干溺水占10%)，引起窒息缺氧甚至引起呼吸心跳停止，甚至死亡。溺水过程非常快，如果在4–6分钟内没有进行救援，可能会导致死亡。研究指出，溺水人员的6-9分钟死亡率达到65%。如果25分钟内不进行抢救，会造成严重的后遗症甚至死亡。但是，如果在1–2分钟内获得救助，救助成功率可达100%。因此，必须及时进行弱水急救。溺水早期死亡主要由水、污泥、藻类等引起。进入口、鼻、气管和肺部，阻塞呼吸道。死亡也可能是由于吸入水、恐慌、寒冷等引起的喉咙、气管阻塞和支气管痉挛引起的。血液在淡水中稀释、溶血和心室颤动会导致血钾升高和心脏骤停。海水痰电解质失衡和急性肺水肿导致心力衰竭和死亡。潜水时，头部撞击或木桩会造成颅脑损伤、昏迷，并在水中死亡。痰液的基本病理变化是窒息缺氧引起的脑、心功能损害，心肌缺氧、变性坏死和循环衰竭。肺部积水和体内缺氧引起的肺功能障碍可导致代谢性酸中毒。溺水的环境和持续时间决定了窒息后病情的严重程度。一般先出现呼吸骤停，再出现心脏骤停。
Electric Shock触电
Electric shock refers to the local and systemic injury or dysfunction caused by a certain amount of current passing through the human body. In severe cases, cardiac arrest and respiratory arrest can occur. Whether it is current or static current, it can cause electric shock. It is mostly due to a lack of attention to the safety regulations of the electric industry, especially in rural areas. People are lacking in knowledge of safe electricity use and install wire without permit or rescue electric shockers directly by hand. When people work in high-temperature, high-humidity workplaces or corrosive chemical workshops, especially in the rainy season, their electrical insulation performance is reduced, and the body’s resistance to skin contact points is significantly reduced due to sweating and skin moisture, causing injury through the human body. At low voltage (220–380 V) electric shock, current through the heart can cause ion disturbance in the myocardial cells and cause fatal ventricular fibrillation, which is life-threatening. At high voltage >1 kV electric shock, the most common is severe electrical burns, or respiratory numbness caused by high- voltage electric injury in the respiratory center, respiratory muscle tonic contraction caused by apnea and asphyxia, secondary cardiac arrest, or ventricular fibrillation. Muscles contract strongly during an electric shock, causing limb fractures or joint dislocation. Especially falling from high altitude can cause serious combined injuries, such as craniocerebral trauma, chest and abdominal visceral rupture, and so on.
电击是指一定量的电流通过人体引起的局部和全身的损伤或功能障碍。在严重的情况下，可能会出现心脏骤停和呼吸骤停。无论是电流还是静态电流，都会引起触电。这主要是由于缺乏对电力行业安全法规的关注，尤其是在农村地区。人们缺乏安全用电知识，私自安装电线或用手直接抢救触电者。当人们在高温、高湿的工作场所或有腐蚀性的化工车间工作时，尤其是在雨季，其电气绝缘性能降低，身体对皮肤接触点的抵抗力因出汗和皮肤潮湿而显著降低，通过人体造成伤害。在低电压(220–380伏)电击下，流经心脏的电流会导致心肌细胞中的离子紊乱，并导致致命的心室颤动，危及生命。在高压> 1 kV电击时，最常见的是严重的电烧伤，或呼吸中枢高压电击伤引起的呼吸麻木，呼吸暂停和窒息引起的呼吸肌强直性收缩，继发性心脏骤停，或心室颤动。电击时肌肉会强烈收缩，导致肢体骨折或关节脱位。特别是从高空坠落会造成严重的复合伤，如颅脑外伤、胸腹部内脏破裂等。
Obstetric Death产科死亡
Obstetric death accounts for about 5% of diagnosed deaths [37–39]. Sudden death during pregnancy is mainly caused by sudden deterioration of the original disease, more common heart disease combined with pregnancy, or sudden changes in pregnancy complications, such as eclampsia died of asphyxia, cerebrovascular accident, HELLP syndrome, and DIC. During childbirth, sudden accidents are common, such as amniotic fluid embolism and postpartum hemorrhage. During the puerperium period, the original disease is aggravated during the puerperium, such as pulmonary embolism, dielectric disorder, and puerperal infection.
产科死亡约占诊断死亡的5%[37–39]。孕期猝死主要是由于原发病突然恶化，比较常见的心脏病合并妊娠，或妊娠并发症突然变化，如子痫死于窒息、脑血管意外、HELLP综合征，以及DIC。分娩时，突发意外很常见，如羊水栓塞、产后出血等。产褥期，原发病在产褥期加重，如肺栓塞、介电障碍、产褥感染等。
Sudden Death of the Respiratory System呼吸系统猝死
1. Acute laryngeal embolism. Acute tonsillitis (occlusion of airway, acute asphyxia, septic shock); posterior pharyngeal abscess (compression obstruction of the throat, pus into the airway, acute asphyxia); acute laryngitis with glottic edema (laryngeal obstruction, suffocation death); glottic fistula, edema (inflammation, allergies, infectious diseases, etc.); throat tumors (polyps, papilloma, fibroids, cancer, obstructive asphyxia, etc.); inhalation injury (hot air, liquid, toxic or irritant gas inhalation).
1.急性喉梗阻。急性扁桃体炎(气道阻塞、急性窒息、感染性休克)；咽后脓肿(咽喉压迫性梗阻，脓液进入气道，急性窒息)；急性喉炎伴声门水肿(喉梗阻、窒息死亡)；声门瘘、水肿(炎症、过敏、传染病等。);咽喉肿瘤(息肉、乳头状瘤、纤维瘤、癌症、梗阻性窒息等。);吸入性损伤(吸入热空气、液体、有毒或刺激性气体)。
2. Bronchial asthma [40]. Pulmonary allergic disease, characterized by bronchospasm, is considered a special type of chronic obstructive bronchitis. Bronchial asthma causes asphyxia (occlusion, spasm, spontaneous pneumothorax, respiratory failure) and right heart failure (severe ventilatory disorders, myocardial hypoxia, increased resistance to pulmonary circulation) causing sudden death.
2.支气管哮喘[40]。以支气管痉挛为特征的肺过敏性疾病被认为是慢性阻塞性支气管炎的一种特殊类型。支气管哮喘引起窒息(闭塞、痉挛、自发性气胸、呼吸衰竭)和右心衰竭(严重通气障碍、心肌缺氧、肺循环阻力增加)导致猝死。
3. Pneumonia [41]. Pneumonia is a frequently occurring disease of the respiratory system. Most people do not die, and some types of pneumonia or those who are infirm can die suddenly.
3.肺炎[41]。肺炎是呼吸系统的常见疾病。大多数人不会死，某些类型的肺炎或体弱者会突然死亡。
4. Pulmonary embolism [42]. Pulmonary embolism is a pathological process in which a loose thrombus or other substance blocks the pulmonary artery or its branches. It is often a complication. A patient with pulmonary tissue necrosis after vascular occlusion is called a pulmonary infarction. Clinical symptoms include dyspnea, severe chest pain, hemoptysis, and fever. Acute pulmonary embolism is a clinical and pathophysiological syndrome caused by endogenous or exogenous emboli to block pulmonary circulatory trunk or branch. Its morbidity is second only to coronary heart disease and hypertension. Pulmonary artery trunk or large branch embolization can cause pulmonary artery resistance to suddenly increase, pressure rise, leading to acute right heart failure and sudden death, while pulmonary embolism can cause pulmonary artery, coronary artery, and bronchial artery spasm through lung-heart vagus nerve reflex, or 5-serotonin is released in large amounts, causing pulmonary vasospasm to cause acute heart failure and sudden death.
4.肺栓塞[42]。肺栓塞是一种病理过程，其中松散的血栓或其他物质阻塞肺动脉或其分支。这往往是一个复杂的问题。血管闭塞后肺组织坏死的患者称为肺梗死。临床症状包括呼吸困难、剧烈胸痛、咯血和发热。急性肺栓塞是由内源性或外源性栓子阻塞肺循环干或支引起的临床和病理生理综合征。其发病率仅次于冠心病和高血压。肺动脉干或大支栓塞可引起肺动脉阻力突然增加，压力升高，导致急性右心衰竭而猝死，而肺栓塞可通过肺-心迷走神经反射引起肺动脉、冠状动脉、支气管动脉痉挛，或大量释放5-羟色胺，引起肺血管痉挛而引起急性心力衰竭而猝死。
Sudden Death Due to Digestive System Disease消化系统疾病猝死
1. Acute gastrointestinal bleeding [43–45]. Stomach and duodenal ulcer complicated by massive hemorrhage, cirrhosis complicated with esophageal varices bleeding, acute gastric mucosal hemorrhagic erosion and ulcer, hemorrhage of longitudinal mucosal laceration in the lower esophagus or gastric cardia. Mechanism—hemorrhagic shock.
2. Acute diffuse peritonitis [46]. Appendicitis, gastroduodenal ulcer, enteric typhoid, ulcerative colitis, intestinal tuberculosis, intestinal amebiasis and other perforations, liver abscess, and pancreatic abscess rupture. Sudden death mechanism—ulcer perforation (toxic shock, neurological shock).
3. Acute necrotizing pancreatitis [47–49]. Acute hemorrhagic necrotic pancreatitis is a type of acute pancreatitis that is caused by the continued development of acute edematous pancreatitis, which include pancreatic acinar, fat, large blood vessels necrosis, pancreatic tissue edema, volume increase, extensive hemorrhage, and necrosis. A large amount of bloody exudate in the retroperitoneal space. The omentum and mesangial tissue are digested by the exuded trypsin. This type of pancreatitis is a serious condition with many complications, and high mortality. Pancreatic juice stimulates peritoneal plexus-induced neurogenic shock; massive exudation of sputum, decreased body fluid caused by vomiting, hypovolemia caused by insufficient circulating blood volume; pancreatic tissue necrosis, increased absorption of inflammation and protein breakdown products,toxic shock; pancreatic juice stimulation, abdominal plexus, nerve reflex caused by sudden cardiac arrest and sudden death.
1.急性消化道出血[43–45]。胃及十二指肠溃疡并发大出血，肝硬化并发食管静脉曲张出血，急性胃黏膜出血性糜烂及溃疡，食管下段或贲门纵行黏膜撕裂出血。机制——失血性休克。
2.急性弥漫性腹膜炎[46]。阑尾炎、胃十二指肠溃疡、肠伤寒、溃疡性结肠炎、肠结核、肠阿米巴病和其他穿孔、肝脓肿和胰腺脓肿破裂。猝死机制——溃疡穿孔(中毒性休克、神经性休克)。
3.急性坏死性胰腺炎[47–49]。急性出血坏死性胰腺炎是由急性水肿性胰腺炎持续发展引起的一种急性胰腺炎，包括胰腺腺泡、脂肪、大血管坏死、胰腺组织水肿、体积增大、广泛出血和坏死。腹膜后间隙有大量血性渗出物。网膜和系膜组织被分泌的胰蛋白酶消化。这种类型的胰腺炎病情严重，并发症多，死亡率高。胰液刺激腹腔神经丛诱发的神经源性休克；痰大量渗出，呕吐引起体液减少，循环血容量不足引起低血容量；胰腺组织坏死，炎症和蛋白质分解产物吸收增加，中毒性休克；胰液刺激、腹腔神经丛、神经反射引起的心脏骤停和猝死。
Brain Hernia脑疝
When there is a space-occupying lesion in a certain cavity in the skull, the pressure of the sub-chamber is greater than the pressure of the adjacent sub-chamber, and the brain tissue is displaced from the high-pressure area to the low-pressure area, resulting in a series of serious clinical signs and symptoms when sometimes squeezed into the interdural space or in the diverticulum, which is called brain hernia. V arious intracranial hematoma is caused by common cause damage, such as acute epidural hematoma, subdural hematoma, and intracerebral hematoma; various intracranial tumors, especially tumors located in one side of the cerebral hemisphere and posterior fossa tumor; intracranial abscess; intracranial parasitic diseases and various other chronic granulomas; congenital factors such as cerebellar tonsil malformation. In addition, if the intracranial pressure is increased, lumbar puncture releases too much cerebrospinal fluid, which leads to an increase in the pressure difference between the intracranial segments, which can promote the formation of cerebral palsy. It can be divided into cerebellar incision, occipital foramen, and cerebral palsy. Among them, the cerebellum incision is the most serious manifestation of changes in blood pressure, pulse, respiration, and body temperature. In severe cases, the blood pressure is high and low, the breathing is fast and slow, sometimes the face is flushed, sweating, sometimes turning pale, and sweaty, the body temperature can be as high as 41 °C or higher, but can be as low as 35 °C or less, and finally breath and blood pressure drop, causing heart arrest and death.
当颅骨某个腔内有占位性病变时，分腔的压力大于相邻分腔的压力，脑组织由高压区向低压区移位，有时被挤入耳间间隙或憩室时，会出现一系列严重的临床体征和症状，称为脑疝。各种颅内血肿是由常见的原因损害引起的，如急性硬膜外血肿、硬膜下血肿和脑内血肿；各种颅内肿瘤，尤其是位于大脑半球一侧的肿瘤和后颅窝肿瘤；颅内脓肿；颅内寄生虫病和各种其他慢性肉芽肿；先天性因素如小脑扁桃体畸形。此外，如果颅内压升高，腰椎穿刺释放的脑脊液过多，导致颅内各节段压差增大，可促进脑瘫的形成。分为小脑切口、枕骨孔、脑瘫。其中，小脑切口是血压、脉搏、呼吸和体温变化最严重的表现。严重者血压忽高忽低，呼吸忽快忽慢，有时面红耳赤，大汗淋漓，有时脸色发白，大汗淋漓，体温可高达41°C或更高，但可低至35°C或更低，最后呼吸和血压下降，导致心脏骤停和死亡。
Other Causes of Sudden Death猝死的其他原因
1. Cardiac catheterization and treatment, bronchoscopy, anesthesia, etc. lead to autonomic nervous instability and arrhythmia caused by cardiac arrest.
1.心导管插入术及治疗、支气管镜检查、麻醉等。导致心脏骤停引起自主神经不稳定和心律失常。
2. Sudden death from sports [50–52]: Athletes and those who do physical exercise with or without symptoms accidentally die within or after 24 h of exercise. It is mainly due to sudden loss of consciousness, the disappearance of aorta beat, and the breathing stops after 20–30 s of sigh-like breathing. Chest pain and shortness of breath may occur before sudden death, and they may occur suddenly without any warning. The ratio of male to female sports death is 7.2:1, which may be due to the low incidence of ischemic heart disease in women with low exercise load, and difficulty in tolerating fatigue or other excessive overload. The study reported that the average age of sudden death in sports was 30.8 ± 17.9 years old. The data suggest that sudden death may also be affected by the time, but it is not clear. There are a wide range of people involved in sports death, including athletes, coaches, physical education teachers, teachers, cadres, workers, and middle school students aged from 9 to 67 years. Studies have shown that sudden death in sports occurs in projects with high intensity or competition, but some projects with smaller intensity also account for a considerable proportion. Common causes of sudden death in sports are coronary heart disease (SCD is the most common, accounting for 73%–95%, the most common cause of people aged over 40 years), Marfan syndrome (the most common cause of people under 40 years), hypertrophic cardiomyopathy, coronary artery malformation, idiopathic left ventricular hypertrophy, myocarditis, pre-excitation syndrome, QT syndrome, concussion, and Brugada syndrome.
运动猝死[50–52]:运动员和有症状或无症状的体育锻炼者在运动后24小时内或之后意外死亡。主要是由于意识突然丧失，主动脉搏动消失，20-30秒的叹息式呼吸后呼吸停止。猝死前可能会出现胸痛和气短，也可能会在没有任何征兆的情况下突然出现。男女运动死亡比例为7.2:1，可能是由于女性运动负荷低，缺血性心脏病发病率低，难以耐受疲劳或其他过度负荷所致。研究报告显示，运动猝死的平均年龄为30.8±17.9岁。数据显示，猝死也可能受到时间的影响，但目前还不清楚。运动死亡涉及的人群非常广泛，包括运动员、教练员、体育教师、教师、干部、工人，以及9岁至67岁的中学生。研究表明，运动猝死多发生在高强度项目或比赛中，但一些强度较小的项目也占相当比例。运动猝死的常见原因是冠心病(SCD最常见，占73%–95%，是老年人最常见的原因40岁以上)、马凡综合征(40岁以下人群最常见的病因)、肥厚型心肌病、冠状动脉畸形、特发性左心室肥厚、心肌炎、预激综合征、QT综合征、脑震荡和Brugada综合征。
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