Sudden death

The threat of sudden death due to a myocardial infarct inevitably places a severe strain on the patient, who may realize the severity of his condition, on the family who are justifiably concerned about the life threatening situation the patient is in, and on the coronary care nurse who is involved in his care. Each one reacts to this stress in his own way. If the nurse can begin to understand her own reactions and the reactions of the family and patient, she will be better equipped to help them cope with this crisis situation.     

Sudden infant death

Sudden infant death [SID] is defined as the "sudden death of an infant under one year of age that remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene and the review of the clinical history". This definition, given by the National Institute of Child Health and Human Development in the USA. recognized SID as a diagnostic entity, however, SID remains a pathological diagnosis of exclusion. SID-cases are divided into three categories: group 1 in which autopsy does not reveal any cause of death, group 2 in which postmortem findings are not sufficient to be the cause of death; group 3 in which the death is adequately explained, is classified as "non-SID". The purpose of the study was to analyse the situation about SID over a 25-year period, from 1969 through 1993, looking for changes in frequency and developmental trends. The study includes 364 SID-infants which were examined according to a standard method. Histological, microbiological, virological and immunological studies were performed and data of the death scene investigation and of the clinical history were collected, 284 infants who had died due to clinical diseases served as one control group, a second group consisted of 6397 newborns of the city of Zürich. Of the SID-infants, almost every third infant [29%] was grouped in group 1, more than half of the infants [52%] with signs of mild infections in group 2, whereas almost every fifth child [19%] was grouped in group 3. With regard to epidemiological parameters the peak of mortality was found at about three months of age; the percentage of boys and twins, of third and later born infants was higher compared to the general population. SID probands were born twice as often in October as in March. The percentage of mothers of first, second and third born SID-infants at an age younger than 20, 22 and 24 years was higher compared to the general population. All these parameters were also found in group 3. The risk of familial recurrence in group 1 and group 2 was 0.8%. Between 1969 and 1993 the rate of SID deaths dropped from 1.1 to 0.9 per thousand live births, whereas SID as a percentage of postneonatal mortality increased to 34 per cent.     

Sudden death in police pursuit

A rare complication of sickle cell trait is sudden death and collapse. Military recruits, pilots, and subjects exposed to hypoxic stress such as high altitude and experiencing sudden cardiorespiratory collapse as a result of sickle cell trait have been well described. This is a case of a 13-year-old black male who collapsed after a police pursuit and was found to have sickle cell trait and microscopic evidence of asthma.     

Sudden infant death syndrome

The author looks at some of the features of the condition known as sudden infant death syndrome, the problems associated with making the diagnosis, and the possible causes. He explores the question that so many people ask, 'Why did my baby die?'     

Sudden infant death syndrome

This report is based on a review of the present situation of the sudden infant death syndrome through the presentation of four cases studied at the Unidad de Pediatría, Hospital General de México, S.S.A. All cases were in apparent good health before death. All babies were less than ten months of age. In three cases, necropsy was not performed, and the other one did not show significant abnormalities at the post-mortem examination. A complete review of the literature was made including: historical, epidemiological, genetic, clinical and pathological aspects. Special emphasis is made on the pathophysiology of the syndrome during MOR phase of sleep and muscular hypertrophy of the lungs arteriolae suggesting chronic hypoxia which are the most relevant theories in the sudden infant death syndrome. Psychological aspects and the family management by the physician and detection of possible future victims of the syndrome are finally discussed.     

Sudden death of adults in Japan

Epidemiological features, risk factors and preventive methods of sudden death (SD) derived from studies the authors have performed since 1987 together with colleagues in Niigata University School of Medicine were reviewed. When SD was defined as death occurring within 24 hours of the onset of symptoms, the annual incidence was 145/100,000 for people aged 15 years and older in Niigata Prefecture. The incidence increased sharply along with the advance of age, while the proportion of SD to natural death due to circulatory diseases was higher in younger people. Though diseases of the circulatory system made up approximately 90 percent of all causes of death, SD due to ischemic heart disease was less frequent in Japan than in western countries. SD showed various patterns in seasonal and "within-a-day" occurrences according to sex, age and cause of death. The months of the highest SD occurrence differed by occupation and matched the busiest work periods. A decrease in sleeping hours and mental stress experienced during the preceding week were related to the occurrence of both sudden death and non-fatal acute myocardial infarction. People having structural circulatory diseases were shown to be predisposed to SD when stress occurred, because fatal arrhythmia is easily induced by the above factors in such people. Health examinations were shown to have preventive effects, though limited, against SD. Differences in the resuscitated rates in cases where a witness was present and where one was not indicates that educating people about correct resuscitation methods is important to minimizing SD.     

Sudden cardiac death in the aged

The problem of sudden cardiac death (SCD) in the aged impends on 14% of the adult population in the Slovak Republic and it often involves people who are still effectively active. It is now generally known that a person ill with his heart is never too old to benefit from the stratification of his/her cardiovascular risk. In clinical practice it is possible to suggest to use the combination of non-invasive methods as the first step in basic stratification of risk in the aged (Holter ECG monitoring, echocardiographically assessed ejection fraction of the left ventricle, ergometric test). Regarding the prevention of SCD it is necessary to teach the patients at risk to distinguish the symptoms of the impending collapse/SCD. After myocardial infarction, also in the aged, the therapy by acetylosalicylic acid, Beta-blockers and ACE inhibitors is indicated. There are fewer contraindications to this therapy than it has been presented until now. Antiarrhythmic drugs class I are not to be used. Also in the aged, regarding the prevention of tachycardiac SCD, the most prospective antiarrhythmic drugs are amiodaron and sotalol. The attention should be paid also to other factors in coincidence with sudden cardiac death that can be influenced by therapy (consequential antiischaemic therapy, homeostasis of the internal environment, early cardiostimulatory therapy of bradycardiac disturbances of rhythm, optimal timing of surgical therapy of valvular defects if indicated, prevention of pulmonary embolism, etc.). In the aged it is necessary to create a wider space in the field of invasive cardiological therapy. In general it is possible to state that the knowledge on etiopathogenetic stratification and specific characteristics of prevention and therapy of SCD in the aged are limited. This fact only emphasizes the inevitability to concentrate on the research in this area.     

Sudden death in hypertrophic myocardiopathy]

Hypertrophic cardiomyopathy is the most common cause of sudden death in young individuals who are otherwise healthy. Risk of sudden death is highest in patients who are between 14 and 35 years old. Several mechanisms are involved in sudden death: ventricular arrhythmias, supraventricular arrhythmias leading to cardiac collapse, bradycardias and severe ischemia. Many studies have analyzed how to identify high risk patients. The factors that best identify high risk patients are: previous history of sudden death or syncope, induction in adults of sustained ventricular arrhythmias, the presence of non-sustained ventricular tachycardia in symptomatic patients, the presence of ischemia associated with hypotension in children, the presence of mutations in the beta-myosin heavy chain together with a family history of sudden death and a poor left ventricular ejection fraction. Risk stratification should be done on an individualized basis. In those patients in whom a high risk for sudden arrhythmic death is suspected, the only current effective treatment is the implantable defibrillator.     

Sudden unexplained death syndrome in north-east Thailand

N-dodecylimidazole is a compound which acquires detergent properties under acidic conditions and might be useful in killing selectively cells in those regions of solid tumours which have a reduced extracellular pH (pHe). We have therefore studied the effects of N-dodecylimidazole against malignant cells in tissue culture. N-dodecylimidazole displayed pHe-dependent cytotoxicity against EMT-6 and MGH U1 cells; cell killing was dose dependent and was 100-fold greater at pHe 6.0 than pHe 7.0. Reduced toxicity of N-dodecylimidazole was observed at higher cell concentrations (> 10(6) cells ml-1), and only minor effects were observed against multicellular tumour spheroids. Potential mechanisms of action of N-dodecylimidazole include detergent-mediated lysis of the cell membrane at low pHe, and selective uptake into lysosomes where detergent activity leads to rupture of the lysosomal membrane and release of cytolytic enzymes. Inhibition of activity of cysteine proteases by the inhibitor E-64 did not protect cells against the toxicity of N-dodecylimidazole, suggesting that these lysosomal enzymes do not play a major role in the mechanism of action of this compound. Lysis of erythrocytes (which contain no lysosomes) was observed with low concentrations of N-dodecylimidazole. Dependence of cell lysis on cell concentration was similar to that observed for two other detergents that act on the plasma membrane, Triton X-100 and sodium dodecyl sulfate. We conclude that N-dodecylimidazole causes pHe dependent cell killing in two cultured tumour cell lines, and that its mechanism of action is probably due to acid mediated production of detergent activity which acts primarily on the cell plasma membrane.     

Sudden death in sheep associated with Clostridium sordellii

Clostridium sordellii was isolated from 37 sheep, in 29 flocks, which died suddenly between 1993 and 1995. The sheep were of all ages, but the most severe gross lesions affected lambs four to 10 weeks of age. In older weaned lambs and ewes the gross changes were less marked and more variable. Thirty sheep suffering from a variety of other conditions were examined and C sordellii was not isolated. The isolation of C sordellii has been reported only twice before from sheep in Britain, and on both occasions no detailed investigations were described. The evidence from this study indicates that C sordellii should be considered when investigating the cause of sudden death in sheep of all ages in Britain.