A study of sudden unexpected death from cardiac causes in Nigerians, fifty cases of sudden and unexpected death from cardiac causes in individuals between the ages of 28 and 80 years are reviewed; the causes and circumstances of the deaths of these individuals are defined (Rotimi 1, Ajayi & Odesanmi, 1998). 70% were males and 44% of the deaths occurred in the 41-50 years age group. Death was due to hypertensive heart disease in 82% of the cases and only 18% were previously diagnosed. Acute left ventricular failure was the commonest (68%) cause of death. Only 4% of the total died of acute myocardial infarction from coronary artery disease.
Sudden cardiac death is the abrupt and unexpected ending of all heart activity. Breathing and blood flow stop right away, and within seconds, the person becomes unconscious and dies. Heart diseases are affecting people earlier than before. The year 2023 has had its share of shocking news about deaths related to people in their 50s.
These continuous deaths in the 50s are a concern to everyone, especially people who have heart problems. It is believed by leading specialists that sudden cardiac death is more common in males than in females. Hence, regular checkups are very important if you want to ensure your good health status even in the future.
What to know about sudden death syndrome
Sudden death syndrome (SDS) is a broad term that can describe any sudden, unexpected death from natural causes. It is not a formal condition or diagnosis and does not necessarily indicate a specific medical condition.
Sudden death syndrome (SDS) is an umbrella term for many biological scenarios leading to quick-onset and unforeseen mortality. The person involved often has little to no warning signs of illness. Even after death, an autopsy may not reveal obvious abnormalities.
This article explores what SDS is, its causes, and whether a person can prevent it. It also looks at commonly asked questions about SDS-related conditions.
SDS is not a formal diagnosis: no set criteria universally define sudden death.
However, a 2023 articleTrusted Source suggests that many experts have adopted the World Health Organization’s (WHO) definition.
It states that SDS is sudden, unexpected death from natural causes witnessed within one hour of symptom onset. If not witnessed, death occurring within 24 hours of someone seen alive and symptom-free is considered SDS.
SDS vs. sudden cardiac death (SCD)
People may use SDS interchangeably with sudden cardiac death (SCD), also known as sudden cardiac arrest (SCA).
SCD describes death caused by loss of heart function, occurring within one hourTrusted Source of any cardiovascular cause.
SDS and SCD have become synonymous. While many different diseases can result in a fatal chain reaction in the body, SCD is a common cause.
According to a 2022 comprehensive review, cardiovascular causes account for up to 73% of sudden deaths. This is compared with other conditions such as asthma, epilepsy, and intracerebral hemorrhage.
Are there symptoms or warning signs of SDS?
There is no standardized list of symptoms in SDS. Since SDS is not a single illness or disease, symptoms, if any, can vary significantly depending on the underlying cause.
For example, in the case of SCD, warning signs may be similar to any heart complication. Almost half of people report no symptoms of SCD. However, if symptoms are present, they may includeTrusted Source:
- palpitations
- dizziness
- chest discomfort
- shortness of breath
- fainting
Warning signs of other conditions that can lead to SDS may be subtle. For example, a person could mistake cerebral aneurysm symptoms for ordinary discomfort, such asTrusted Source a stiff neck or strong headache.
Numerous known and unknown processes in the body can contribute to SDS. However, cardiovascular disease plays a major role overall.
Sudden cardiac death (SCD) is the most common cause of SDS. It is a widely inclusive term that can describe a variety of cardiovascular events, such asTrusted Source:
- sudden arrhythmia death syndromes (SADS), genetic heart conditions that alter the heart’s electrical activity, potentially causing sudden cardiac arrest
- heart attack
- coronary spasm
- anomalous coronary origin, a coronary artery that has an abnormality
- Brugada syndrome, a rare, inherited condition that can lead to irregular heartbeats
- long or short QT syndrome, a condition that affects the heartbeat
- myocarditis, inflammation of the heart
- aortic stenosis, narrowed aortic valves
Coronary artery disease and SADS are among the most common underlying causes. Coronary artery disease may be responsible for as many as 80%Trusted Source of SCD deaths. According to a large-scale cohort study, SADS accounted for 53%Trusted Source of reviewed SCD cases.
SDS is not limited to cardiovascular events. Examples of non-cardiac conditions that can also lead to sudden death include:
- epilepsy
- asthma
- pulmonary embolism, a blockage in the pulmonary arteries
- brain hemorrhage
- sudden infant death syndrome (SIDS)
- stroke
- brain aneurysm
- anaphylaxis, a severe allergic reaction
- hypertensive crisis, a sudden and severe increase in blood pressure
- cerebral abscesses, an abscess in the brain
- meningitis, inflammation of the lining that surrounds the brain and spinal cord
In many cases, the causes of SDS can never be explained. When this happens in adults, it may be referred to as sudden adult death syndrome. Similarly, unexplained infant mortality is referred to as sudden infant death syndrome.
What are the risk factors for SDS?
Due to the number of conditions that can lead to SDS, individual risk factors vary significantly.
Because SCD is the most common cause of SDS, its risk factors are among the most well-known. These include the general risk factors for adverse cardiac events, such as:Trusted Source
- heavy alcohol consumption
- tobacco use
- physical inactivity
- obesity
- high blood pressure
- living with a chronic disease, such as diabetes or kidney disease
- a family history of SCD
- substance misuse
Some causes of SDS can be heritable, or passed down through families. SADS, for example, are conditions passed down from parent to child. If a parent lives with a SADS condition, each child has a 50% chance of inheriting that condition.
The heart, kidneys, brain and lungs
Balfour in an interesting volume on the senile heart, says ‘age must be measured by tissue changes and not by years because those tissue changes which mark the progress of development from the cradle to the grave intensify after middle life all the danger of acute disease and by accentuating any latent organic weakness or structural defects inherent or acquired often cause those to die from age who have scarcely began to think themselves old’.
The four principal organs in order of their frequency by which they cause sudden death and those, which I shall consider in this article, are the heart, kidneys, brain and lungs.
Cause of sudden death from diseased heart
Among the immediate causes revealed at an autopsy may be found rupture of the heart walls-principally the left ventricle, the contributing causes being fatty or fibroid degeneration, circumscribed myocarditis, necrosis following thrombosis or embolism of the coronary arteries; rupture of an aneurism of the arch of the aorta, perforating into either auricle or thoracic cavity, rupture of coronary arteries, due to atheroma, filling the pericardial cavity with blood ; adherent pericardium, due to old attacks of pericarditis; a chronic valvular disease, due to endocarditis and certain congenital malformations of the heart, which have gone on to middle life before producing sudden death.
Cause of sudden death from diseased kidneys
Recently, we know enough about renal disease to include it in the organs that cause sudden death. After cardiac lesions, the kidneys are next to reveal illness post-mortem.
Sir George Johnson made the remark, which today’s leading doctors agree with, that cirrhotic kidneys are common in overeaters and drinkers.
Apoplexy, convulsions, coma, and larynx edema may cause mortality, but renal examination reveals the main cause or disease.
Most often, cirrhotic or contracted kidneys cause abrupt mortality in chronic Bright’s disease. According to Paris-based Death and Sudden Death author Brouardel, gout-related sudden death invariably has a kidney cause.
In gouty individuals, unexpected renal function changes due to circulatory system degeneration may indicate approaching danger. The patient may first suspect this mild, deceiving sickness when a robber in the night or a highwayman kills them. Business and professional men have seen colleagues fall like the enemy in ambush. The clergyman attributes it to Providence, but the physician suspects ignorance or avarice. A thorough medical checkup may have detected the sickness and prevented the approaching disaster. Chronic diffuse nephritis is the most sneaky disease after middle age. Not covered early, it kills quickly.
Apoplexy, pneumonia, or Bright’s disease usually causes death beyond 50. Buffalo statistics demonstrate their frequency closeness. 91 apoplexy, 44 Bright’s disease, 46 pneumonia in 1894. In 1895, 89 apoplexy, 59 Bright’s disease, and 59 pneumonia. In 1896, apoplexy (98), Bright’s disease (76), and pneumonia (72). 103 apoplexy, 107 pneumonia, 102 Bright’s illness in 1897.
Many life insurance applicants have been instructed to get rid of an unknown illness before being accepted.
Cause of sudden death from brain disease
The brain causes numerous problems in other vital organs, yet it is the most powerless in protecting itself after they degrade. Due to its location and blood supply, the brain was designed to be the last organ to degrade or lose function. The brain rarely gets sick, although emboli from other organs cut off its nutrition and cause uremias and toxemias.
Chronic endocarditis and arteriosclerosis contribute to cerebral blood vessel thrombosis and embolism, which are more common than brain tumors and abscesses. Aneurism, endarteritis, alcoholism, and syphilis may produce apoplexy and cerebral bleeding immediately. An example of a common urban medico-legal case: In a prizefight, social combat, or arrest, a man dies from a head or face hit; the other is charged with murder. The autopsy shows that the person had syphilis, chronic pachymeningitis with dura-mater adhesion, endarteritis, and military aneurism of the cerebral arteries. They may also have been drunk all the time or had syphilis.
The Erie County postmortem examiner heard this case in 1890. As indicated above, the autopsy showed damaged cerebral arteries and generalized hemorrhage into the corpus striatum, optic thalami, and ventricles. Death was unintentional and natural. Any major emotional emotion or physical effort may have caused abrupt death under those physical conditions. Under such conditions, any intracranial pressure increase would likely kill. Circumstantial evidence alone should not be used to try this case.
Cause of death from organs of respiration
-Pulmonary apoplexy, edema of the larynx, pneumonia, pneumothorax, hydrothorax and hematothorax, are some of the fatal lesions.
It was reported that a physician while under treatment for rheumatism at the Warsaw sanitarium, three years ago, died suddenly of edema of the larynx. He had been troubled with rheumatism for some time. A woman under care died of pneumothorax, which was the result of septicemia.
Infarction of the lung with a following pneumonia commonly occurs in acute or chronic diseased conditions of the endocardium. Hydrothorax may be one of the fatal complications of kidney lesions with inflammation of the pleura and other serious surfaces. Pathologic conditions of the respiratory organs, causing sudden death, are largely dependent upon heart and renal disease, e.g., pneumonia and pulmonary congestion due to diseased heart and pulmonary edema, due to diseased kidneys.
Bottomline
Men after fifty should ponder on Herbert Spencer’s definition of life, as it will guide them in adopting preventive measures wthatare reliable. He speaks of life as ‘‘ the continuous adjustment of internal relations with external relations.” When men and women after fifty years of age have been informed (findeth wisdom) that some previous illness, e.g., typhoid fever or other infectious disease, pneumonia or rheumatism has altered the function and structure of the heart or kidneys, they should be moderate in eating and drinking, avoid violent effort-both physical and mental-secure the advice of the family physician and then “length of-days will be in their right hand, and in their left, riches and honor.”
While low-degenerative changes in the vital tissues of the body may not be cured, they can easily be alleviated and frequently arrested.
Premonitory symptoms referable to the heart.
Precordial anxiety or uneasiness, bradycardia, tachycardia arrhythmia and angina pectoris are among the earlier symptoms and when associated with organic changes, such as fibrous and fatty degeneration of the myocardium, coronary sclerosis, dilatation and hypertrophy, are premonitions of danger, and the prognosis is based on the response which these conditions give to proper treatment. Angina pectoris is more commonly found in males, because arteriosclerosis is more frequent and the first attack may prove fatal. Balfour states that ” the essential lesion of the senile heart is a weakened myocardium and dilatation is the first stage of cardiac change. ”
The only safety for the captain of such a vessel is to consult the weather bureau or the doctor.
Premonitory symptoms referable to the kidneys.-The signs of distress and danger will be noticed in the slow, continued headache, occasional dizziness, dimness of vision (neuro-retinitis), sleeplessness, difficulty in breathing, muscular twitching and gastric disturbances. A closer examination reveals the urine diminished in quantity, of low specific gravity, usually a trace of albumin, casts may or may not be present, dilatation and hypertrophy of the heart.
While hypertrophy of the left ventricle of the heart and cirrhotic kidney are co-incident, Gull and Sutton deny any direct casual connection between the two, but hold that the two conditions are the result of one general affection of the arterial system, which they call arteriocapillary-fibrosis that this condition primarily affects the arterioles and invades the other organs–heart, kidneys, lungs, brain, spinal cord and so forth-as a wide spread cachexia, which has its base in the vascular system.
As in the earlier stages of chronic Bright’s disease, so in the senile degeneration of the heart and arteries, there may be no pathognomonic symptom until the action of the heart is altered or the secretion of the urine changed in quantity and quality.
References
Sidney Dunham (1897). The cause and prevention of Sudden death after fifty
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