Physical exercise and cardiac death due to pneumonia in male teenagers [Iznenadna smrt zbog upalće pluća za vrijeme tjelovježbe u trojice mladića]

Duraković, Zijad and Mišigoj Duraković, Marjeta and Škavić, Josip and Duraković, Lejla (2009) Physical exercise and cardiac death due to pneumonia in male teenagers [Iznenadna smrt zbog upalće pluća za vrijeme tjelovježbe u trojice mladića]. Collegium Antropologicum, 33 (2). pp. 387-390. ISSN 0350-6134

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Abstract

From 1998 to 2008 we noticed 3 cardiac deaths in male teenagers aged 18-19 during or after physical exercise. The first was working at the site recreatively, the second was engaged in soccer recreatively and the third was professional soccer player. One felt general tiredness and was exhausted of a heavily physical effort, the other after physical exercise became septic and the third was without symptoms. One died suddenly during physical exercise at the field and two died in the hospital. At the forensic autopsy the first had bilateral bacterial pneumonia, possible high-altitude non-cardiogenic pulmonary edema and cerebral edema. The second had bilateral bacterial pneumonia, adult respiratory distress syndrome, disseminated intravascular coagulation, suprarenal bleeding, cerebral edema, hypoplastic right coronary artery and myocardial fibrosis. The third had bilateral bacterial pneumonia, fibrinous pericarditis, cerebral contusion with edema, thickenning of the left ventricle 20 mm and hypoplastic ascending aorta. In Croatia the death rate among athletes reached 0.15/ 100,000, in athletes suffered of acute pneumonia 0.28/ 100,000, in others who practice exercise recreatively 0.57/ 100,000 (p = 0.0068), in all males who practice exercise recreatively 0.75/ 100,000 (p = 0.0014). Physical exercise is contraindicated in acute respiratory tract infections. Every such case has to be treated by physician. When to start with physical training after bacterial pneumonia depends on disappearing of clinical and X-ray signs of pneumonia, normalization of erythrocite sedimentation rate and of white cell count.

Abstract in Croatian

U vremenu od 1998–2008 godine suočili smo se s tri nagla i neočekivana smrtna ishoda u mladića dobi 18–19 godina. Jedan je radio na gradilištu rekreacijski, drugi se bavio nogometom rekreacijski, treći bio je profesionalni nogometaš. Jedan je osjećao opću iscrpljenost, drugi je razvio kliničku sliku sepse nakon tjelesnog napora, dok se treći nije tužio na simpotome. Jedan je naglo preminuo na gradilištu, dok su druga dvojica preminula u bolnici. Nalaz sudsko-medicinske obdukcije u prvog je upućivao na obostranu bakterijsku upalu pluća, mogući nekardiogeni edem pluća i edem mozga. U drugog nalaz je upućivao na obostranu bakterijsku upalu pluća, respiracijski distresni sindrom odraslih, diseminiranu intravaskularnu koagulopatiju, krvarenje u nadbubrežne žlijezde, hipoplastičnu desnu koronarnu arteriju i fibrozu miokarda. U trećeg nalaz je upućivao na obostranu bakterijsku upalu pluća, fibrinozni perikarditis, cerebralnu kontuziju s edemom, zadebljanje lijeve klijetke od 20 mm i hipoplastičnu uzlaznu aortu. U Hrvatskoj stopa smrtnog ishoda u tjelovježbača iznosi 0,15/100 000 godišnje, u tjelovježbača koji su bolovali od akutne upale pluća iznosi 0,28/100 000, u ostalih koji se bave rekreacijskom tjelovježbom iznosi 0,57/100 000 (p=0,0068), u svih muškaraca koji se bave tjelovježbom iznosi 0,75/100 000 (p=0,0014). Tjelovježba je kontraindicirana u onih koji boluju od akutne infekcije dišnih putova. Svaki takav slučaj treba biti liječen od liječnika. Kada nastaviti s trenažnim procesom nakon bakterijske upale pluća ovisi o nestanku kliničkog nalaza na plućima, rendgenskog nalaza infiltrata na plućima, normalizaciji laboratorijskog nalaza sedimentacije eritrocita i normalizaciji nalaza bijele krvne slike.

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