In the third match of a volleyball tournament, a 15-year-old girl jumps up for a block and collapses. Despite cardiopulmonary resuscitation, she cannot be revived. She had been healthy all her life and complained only of limited episodes of chest pain in games during the current school year. Which of the following pathologic findings of the heart is the medical examiner most likely to find?
- Haphazardly arranged hypertrophied septal myocytes
- Extensive myocardial hemosiderin deposition
- Tachyzoites within foci of myocardial necrosis and inflammation
- Mitral valvular stenosis with left atrial enlargement
- Large, friable vegetations with destruction of aortic valve cusps
Hypertrophic cardiomyopathy is the most common cause of sudden unexplained death in young athletes. There is asymmetric septal hypertrophy that reduces the ejection fraction of the left ventricle, particularly during exercise. Histologically, haphazardly arranged hypertrophic myocardial fibers are seen. Hemochromatosis gives rise to a restrictive cardiomyopathy in middle age. Tachyzoites of Toxoplasma gondii signify myocarditis, a process that may occur in immunocompromised persons. Rheumatic heart disease with chronic valvular changes would be unusual in a patient this age, and the course is most often slowly progressive. Valve destruction with vegetations is seen in infective endocarditis. This would be accompanied by signs of sepsis.
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