Northcote et al evaluated 60 patients who died suddenly while playing squash. They identified prodromal symptoms in 75% of the patients. A patient with prodromal symptoms should be evaluated prior to undertaking vigorous exercise, especially if the person has multiple risk factors for coronary artery disease.


Most common prodromal symptoms:

(1) chest pain or angina

(2) increasing fatigue

(3) indigestion, heartburn or other gastrointestinal symptoms


Less common symptoms:

(1) excessive breathlessness

(2) ear or neck pain

(3) vague malaise

(4) upper respiratory tract infection

(5) dizziness and/or palpitation

(6) severe headache (associated with intracranial hemorrhage)


Risk factors for coronary artery disease in the patients:

(1) cigarette smoking

(2) family history of early myocardial infarction

(3) hypertension

(4) history of angina or previous myocardial infarction

(5) hypercholesterolemia

(6) diabetes mellitus



• Obesity is not listed in Table 4 (Northcote page 201), but seems reasonable to include.


Conditions found at autopsy:

(1) coronary artery disease

(2) valvular heart disease

(3) cardiac arrhythmia

(4) hypertrophic cardiomyopathy

(5) intracranial hemorrhage


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