Sudden Cardiac Death in Young Military Recruits: Guarding the Heart of a Soldier

Sudden unexpected death is always tragic, but especially so when it occurs in soldiers. Death in combat is devastating, but it is an inherent risk of an occupation that calls for individuals to put their life at risk for others. Sudden cardiac death during basic military training should raise concern because it implies failures at many levels: a potentially fatal cardiovascular abnormality that fails to generate symptoms or signs of the underlying disorder; the patient's failure to recognize and report unusual symptoms; the physician's failure to recognize nonspecific symptoms that may represent a serious underlying cardiovascular condition; routine screening methods that fail to detect obscure cardiovascular abnormalities; and, finally, resuscitation efforts that fail to restore spontaneous circulation. However, most of these “failures” do not invoke blame; rather, they present a challenge to the medical and scientific community to prolong life by reducing the occurrence of sudden unexpected death.

In this issue, Eckart and colleagues (1) take another step toward a better understanding of sudden death by providing more evidence that certain cardiovascular conditions account for most sudden deaths in military recruits. The identification of these conditions raises the possibility that their subsequent improved detection could reduce the incidence of sudden cardiac death. This retrospective cohort study included 6.3 million U.S. military recruits over a 25-year period (1977–2001). All recruits, who were enlisted in all branches of military service, underwent a pre-enlistment screening evaluation that consisted of a personal history and physical examination. Each death that occurred at a military site before the completion of initial training led to a thorough investigation and an autopsy. Of those who died, 90% were men, and the median …