Sudden death and vigorous exercise--a study of 60 deaths associated with squash.

The circumstances surrounding 60 sudden deaths (59 men, one woman) associated with squash playing are described. The mean age (SD) of those who died was 46 (10.3) years (range 22-66 years). Necropsy reports were available in 51. The certified cause of death was coronary artery disease in 51 cases, valvar heart disease in four, cardiac arrhythmia in two cases, and hypertrophic cardiomyopathy in one case. There were only two deaths from non-cardiac causes. Forty five of those who died had reported prodromal symptoms, the most common of which was chest pain, and 22 were known to have had at least one medical condition related to the cardiovascular system during life, the most common of which was systemic hypertension (14 subjects). Those dying from coronary artery disease had a high frequency of risk factors. Some of these deaths might have been prevented by appropriate counselling of players after prospective medical screening, which would have detected most of the patients with overt cardiovascular disease and some of those with subclinical coronary artery disease.