Death is the end of life, when all brain activity ceases permanently. We all expect to die. But in Nature, the old die before the young, parents before their children. A disruption of this normal sequence results in distress, depression and an inability to cope.
SAD victims who simply drop dead in the middle of action may have unrecognized underlying risk factors
The unexpected death of a healthy child can be the result of SIDS (Sudden Infant Death Syndrome), also known as cot death or crib death It occurs in a seemingly normal child, usually a male, under the age of one year, who goes to sleep in the night and fails to wake up in the morning.
The immature brains of children do not regulate the heart rate or breathing very efficiently, especially at night. This may be further compromised by exposure to cigarette smoke. Also, the child may be accidentally smothered when parents roll over in their sleep, or it could be that its nose and mouth get blocked by soft, fluffy sheets or pillows.
Parents are, therefore, advised to avoid sleeping in the same bed as the child and to always place the child on the back instead of the stomach. These measures appear to significantly reduce the number of SIDs.
Death in healthy young adults between the ages of 16 and 60 years may be due to accidents or violence. Some like the SIDS infants just drop dead or die during their sleep. Their death is sudden, unexpected, tragic and inexplicable.
These unexplained deaths have been grouped together and given the expressive acronym SAD (Sudden Adult Death). More men than women die this way. Some families are even considered cursed, with many economically productive young men in the family dying in the prime of their life.
Autopsies on SAD victims have shown that some of them actually did have unrecognized underlying risk factors. This is particularly true in India where we have many young undiagnosed diabetics and others with metabolic abnormalities of syndrome X (insulin resistance, hypertension, lipid abnormalities). Despite their youth, some had coronary arteries partially blocked with fatty deposits and plaques. In others, the vessels supplying the muscles of the heart arose from abnormal locations. The congenital heart diseases may have been mild enough to remain unrecognized and undiagnosed until it was too late. The efficient functioning of the heart may have been affected by a group of diseases called cardiomyopathies. Infection of the heart muscle (myocardium) with viruses and bacteria may have caused myocarditis. The infection can trigger arrhythmia and death. Some prescription drugs like terfenadine can also set off similar fatal reactions. Unfortunately, as such people appeared healthy and had no symptoms, they were never investigated for risk factors prior to the sudden death.
SAD has been in the news recently because of the discovery that many affected individuals had a long QT in their ECG (electrocardiograph). Even if the initial resting ECG is normal, the abnormality shows up on an ECG taken after exercise. These ECG changes are caused by disturbances in the electrical conduction currents of the heart and are inherited. The genetic defects causing this are of various types. The percentage of genetic carriers in the population is probably around 5 to 10 for 100,000 persons. This has lead to speculation that SID and SAD are two spectrums of the same disease.
The defects are commoner in Southeast Asia than in the western countries. The syndrome even has local names bangungutin the Philippines, pokkuri in Japan and lai tai in Thailand. It has been known for many centuries, although the precise defect was identified only recently.
About 60 per cent of people with hereditary long QT syndrome has non-specific symptoms like fainting spells or seizures during childhood and adolescence. Around 40 per cent has no symptoms at all and the condition may just present itself with sudden death. Many die in front of family and friends. Unfortunately, from the time the heart stops beating, irreversible brain damage occurs in three to six minutes, followed by coma and death. Cardio-pulmonary resuscitation (CPR) may have saved the lives of a few of these people. However, most people do not learn CPR, and others are too stunned by the occurrences to initiate it in time.
Once the long QT is picked up on an ECG, measures can be taken to prevent sudden death. Medications belonging to the beta-blocker group can be started. Certain prescription drugs that prolong the QT can be avoided. Potassium levels in blood need to be monitored as low levels can precipitate death. Some patients may need pacemakers.
Symptoms in persons with a long QT syndrome can be precipitated by physical exertion. The long QT has been implicated in the sudden death of trained Olympic-level athletes. Competitive sports, therefore, are risky and better avoided.
Exercise is good for health, well being, diabetic control and lipid abnormalities, but vigorous action should be undertaken only after medical advice in those with risk factors.
Source: The Telegraph (Kolkata, India)