A 22-year-old athlete collapses and dies suddenly during a game. Autopsy reveals ventricular hypertrophy. What is the most likely underlying cause?

Appeared in: INI-CET EXAM -2025

Explanation

Hypertrophic Obstructive Cardiomyopathy (HOCM) is the most common cause of sudden cardiac death (SCD) in young athletes.
It is a genetic condition characterized by unexplained, often asymmetrical, left ventricular hypertrophy, which was found on the athlete's autopsy.
The hypertrophy can lead to dynamic outflow obstruction and, more critically, creates a substrate for fatal ventricular arrhythmias, especially during exercise.

Option A: While severe valvular disease (like aortic stenosis) can cause hypertrophy and sudden death, it is statistically a less frequent cause of SCD in young athletes compared to HOCM.
Option B: Chronic heart failure is a clinical syndrome and a potential consequence of long-standing HOCM, not the acute cause of sudden death. Sudden death in HOCM is typically due to an arrhythmia.
Option C: Coronary artery disease (CAD) from atherosclerosis is the leading cause of SCD in adults over 35. It is highly unlikely in a healthy 22-year-old athlete.

Visual 1: Diagram: Comparison of a normal heart and a heart with HOCM, showing the thickened interventricular septum and narrowed left ventricular outflow tract.
Visual 2: ECG Strip: Example of an ECG showing signs of left ventricular hypertrophy (LVH), such as large S waves in V1/V2 and large R waves in V5/V6, which can be a screening indicator for HOCM.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Causes of sudden cardiac death in young athletes as background academic context rather than a clinical decision trigger.
This case highlights the critical importance of pre-participation screening for athletes, which includes a detailed personal and family history (looking for syncope, chest pain, or family history of SCD/cardiomyopathy).
Nurses play a key role in identifying at-risk individuals by taking thorough histories and recognizing potential red-flag symptoms like exertional syncope.
What if? If the athlete was 45 years old instead of 22, the most likely cause would shift dramatically to coronary artery disease, and the immediate management approach for a similar living patient would focus on acute coronary syndrome.

How to Approach the Question

First, identify the key elements of the clinical scenario: a young patient (22-year-old), an athlete, a sudden death event during activity, and a key pathological finding (ventricular hypertrophy).
Consider the differential diagnosis for sudden cardiac death based on the patient's age. Recognize that causes differ significantly between young and older populations.
Evaluate the options in the context of a young athlete. Coronary artery disease is the leading cause in older adults, making it less likely here.
Connect the specific autopsy finding of 'ventricular hypertrophy' to the provided options. HOCM is defined by myocardial hypertrophy.
Conclude that HOCM is the classic and most common cause for this specific presentation, making it the most likely answer.

Concept Tested & Keywords

Concept Tested: Causes of sudden cardiac death in young athletes.
Stem keywords: 22-year-old athlete, collapses and dies suddenly, autopsy, ventricular hypertrophy
Lead-in keywords: most likely underlying cause
Clinical cues: Patient demographic (young athlete) is a key clue pointing away from typical adult cardiac pathologies like CAD.
Clinical cues: The finding of ventricular hypertrophy on autopsy is the cardinal sign to interpret.

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