Beyond the finish line: unraveling the causes, prevention, and postmortem diagnostics of sudden death in sports

Sudden death in sports was investigated from a medico-legal perspective, focusing on pathophysiology, prevention strategies, and postmortem diagnostics procedures. A literature review was conducted, searching databases including PubMed, Medline, Scopus, and Google Scholar using keywords related to sports and sudden death. All peer-reviewed articles from the last 10 years were considered, focusing on the pathophysiology, prevention, and postmortem procedures of sudden death in sports. The cardiological causes of sudden death differ significantly by age. In older athletes, ischemic heart disease is prevalent, while younger athletes more commonly suffer from genetic conditions such as cardiomyopathies and channelopathies. Non-cardiological causes include sudden unexpected death in epilepsy and intracranial hemorrhage. Additionally, doping in sports poses a significant risk. Postmortem diagnostics are challenging due to the lack of characteristic symptoms, requiring thorough analysis of the circumstances of death and the patient’s medical history. Essential postmortem studies include heart examinations, as well as histopathological, genetic, and toxicological analyses, tailored to the specifics of various sports disciplines. Sudden death in sports underscores the necessity for both primary and secondary prevention measures to ensure athlete safety. Implementing regular screenings and educational programs on the risks associated with physical activity and rigorous postmortem diagnostic procedures are crucial steps in mitigating these risks.