Causes of sudden cardiac death in young Australians

OBJECTIVES: To determine the causes of sudden cardiac death in people aged 35 years or younger. DESIGN AND SETTING: A review of all autopsies performed between 1 January 1994 and 31 December 2002 at a major Sydney forensic medicine department serving an area with over 2 million people. MAIN OUTCOME MEASURES: Incidence of various types of cardiac disease causing sudden death in those aged 相似文献   

The cardiac pathology of sudden, unexplained nocturnal death in Southeast Asian refugees

Sudden death during sleep has occurred among previously healthy Southeast Asian male refugees, but routine autopsies have not determined the cause of death in any of these cases. We report the first systematic attempt to define the cardiac abnormalities associated with this syndrome. Among 18 hearts examined, 14 showed slight to significant cardiomegaly, characteristic of increased cardiac work load. The reasons for the cardiomegaly remain unexplained. Conduction system anomalies were present in all but one heart. These included persistent fetal dispersion of the atrioventricular node and/or bundle of His, present in 14 hearts; accessory conduction fiber connections, found in 13 cases; and congenital heart block, observed in one case. These abnormalities were associated with variations in the structure of the cardiac base, suggesting a common aberrant developmental process. Although the functional significance of these findings has not been established, the conduction system anomalies may be the substrate for sleep-related cardiac arrhythmias and sudden death.     

Sudden cardiac death in young Danes

Sudden Cardiac Death (SCD) in the young (aged 1-35 years), although presumably rare, is always a tragic and devastating event often occurring in apparently healthy persons. Through the last decades, research have been undertaken to estimate the incidence rate and underlying causes of these deaths. However, because autopsy is not always conducted, the true incidence of SCD might be underestimated. The incidence of sudden infant death syndrome (SIDS) has previously been thoroughly investigated, also in Denmark. However, data has not been precise in sudden unexpected death in infancy (SUDI) estimates. SIDS is a diagnosis of exclusion and an ICD-10 diagnosis (R95.9), but to what extent this diagnosis is being accurately applied has not been investigated in Denmark. A genetic screening for mutations in an otherwise unexplained death, might identify a likely cause of (inherited) death. It would be of great clinical interest if DNA derived from the Danish Neonatal Screening Biobank, containing DNA from all Danes born after 1981, could be used in this respect. In this thesis we provide nationwide data on SCD, SUDI and SIDS in Denmark for the period 2000-2006 by reading death certificates, autopsy reports, and registry data. We report the highest possible incidence rate of SCD in the young. We elaborate on regional differences in post-mortem investigations of sudden death cases in Denmark and validate a method for whole-genome amplification of DNA from Guthrie cards to be used in genetic screening for disease causing mutations. We found 7% of all deaths in the young could be attributed to SCD. A total of 25% of sudden unexpected death in the 1-35 years old were not autopsied. The incidence of SCD of 2.8 per 100,000 person-years--when including non-autopsied cases--was higher than previously reported. Unexplained deaths were abundant and accounted for 22% of all sudden unexpected deaths. Sudden deaths occurring during competitive sports, however, were only seen in few cases. We found that regional differences exist in the investigation of sudden unexpected deaths. Fewer deaths were medico-legally investigated by external examinations ("retsl?geligt ligsyn") in some parts of Denmark compared to other parts. The same was the case in autopsy ratios. In infant deaths we found that almost 1 in 2000 live-borns died suddenly and unexpectedly during their first year of life. The R95.9 diagnosis did not reflect the SIDS cases we identified. We were able to get DNA from the Danish Neonatal Screening Biobank on 93 cases of unexplained deaths (including SIDS). Due to the limited amount of DNA available from the dried blood spots, we performed whole-genome amplification on the DNA (wgaDNA). We investigated the use of wgaDNA for genetic screening and it completely resembled genomic DNA (gDNA). Future research will focus on the genetics substrate of sudden unexplained death. In addition, we will investigate the causes of death in the 36-49 years old, as these may also suffer from cardiac disease that can be predisposed in the family.     

Causes of death in young Australians with type 1 diabetes: a review of coronial postmortem examinations

OBJECTIVE: To determine the causes of death in Australians with type 1 diabetes mellitus who died aged 40 years or younger. DESIGN AND SETTING: Retrospective review of autopsy reports at the Department of Forensic Medicine, Sydney, New South Wales, 1 January 1994-31 December 2006. MAIN OUTCOME MEASURE: Causes of mortality in people with type 1 diabetes aged <40 years. RESULTS: Of the 26 682 autopsy reports, 1914 were for individuals with diabetes (type 1, 400; type 2, 1514). Cardiovascular disease accounted for 51% of deaths (169/333) in people with type 1 diabetes aged >40 years, versus 13% among those aged 相似文献   

Unexpected death related to restraint for excited delirium: a retrospective study of deaths in police custody and in the community

BACKGROUND: Some people in states of excited delirium die while in police custody. Emerging evidence suggests that physical restraint in certain positions may contribute to such deaths. In this study the authors determined the frequency of physical restraint among people in a state of excited delirium who died unexpectedly. METHODS: The authors reviewed the records of 21 cases of unexpected death in people with excited delirium, which were investigated by the Office of the Chief Coroner for Ontario between 1988 and 1995. Eyewitness testimony, findings during postmortem examinations, clinical history, toxicological data and other official documents describing the events surrounding the deaths were analyzed. Specific reference was made to documented eyewitness testimony of restraint method, body position and use of capsicum oleoresin (pepper) spray. Because cocaine was detected in the blood of some of these people during the postmortem examination, the role of cocaine in excited delirium was examined by comparing the cocaine levels in these cases with levels in 2 control groups: 19 people who died from acute cocaine intoxication and 21 people who had used cocaine shortly before they died but who had died from other causes. RESULTS: In all 21 cases of unexpected death associated with excited delirium, the deaths were associated with restraint (for violent agitation and hyperactivity), with the person either in a prone position (18 people [86%]) or subjected to pressure on the neck (3 [14%]). All of those who died had suddenly lapsed into tranquillity shortly after being restrained. The excited delirium was caused by a psychiatric disorder in 12 people (57%) and by cocaine-induced psychosis in 8 (38%). Eighteen people (86%) were in police custody when they died. Four (19%) had been sprayed with capsicum oleoresin, and heart disease was found in another 4 at autopsy. The blood level of cocaine in those whose excited delirium was cocaine induced was similar to levels found in recreational cocaine users and lower than levels found in people who died from cocaine intoxication. INTERPRETATION: Restraint may contribute to the death of people in states of excited delirium, and further studies to test this hypothesis are recommended. Meanwhile, law enforcement authorities and others should bear in mind the potential for the unexpected death of people in states of excited delirium who are restrained in the prone position or with a neck hold.     

The Brugada syndrome: a recently recognised genetic disease causing sudden cardiac death

Australian doctors need to be aware of this little-known syndrome, which is a cause of sudden cardiac death. It is more common among Southeast Asian people, who make up a considerable proportion of our population. We report two cases which represent very different clinical presentations of this condition.     

心性猝死—4例主动脉瘤破裂的法医病理学鉴定

目的:探讨主动脉瘤破裂猝死的发病特点和病理学基础,为临床医师提供帮助。方法:对本系2002年12月至2006年l2月期间,所作450例法医病理检案的4例主动脉瘤破裂猝死案例进行分析研究。结果:4例主动脉瘤破裂致死占尸体解剖总数的0.89%,占SCD的4.1%,其中,DAA3例;2例DAA与AS有关。结论:主动脉瘤破裂病程短骤、凶险,是心性猝死的病因之一,早期症状与冠心病酷似,且病死率极高,因此应引起临床医师的高度重视,提高诊治水平。     

猝死尸检79例统计分析

本文分析了猝死尸检79例,男女之比为2:1,朝鲜族和汉族之间猝死发病率无差异.猝死的两个高峰年龄是21～40岁及10岁以下;12月和1月寒冷季节猝死者22例(28.1％),在22:00～6:00时间内发病者28例(35.4％).致猝死的疾病以心血管系统疾病最多,为34例(43.3％);其中在1965年以前以克山病猝死者为多,而在1966年以后以冠心病猝死者为多.尸检中不能确定死因者13例(16.5％).     

Sudden death due to ischaemic heart disease in young aboriginal sportsmen in the Northern Territory, 1982-1996.

OBJECTIVE: To estimate the incidence of sport-related sudden cardiac death due to ischaemic heart disease (IHD) in competitive young Aboriginal sportsmen. SETTING: Northern Territory (NT), 1982-1996. DESIGN: Retrospective case series with cases identified from Australian Bureau of Statistics cause-of-death listings and NT coronial autopsy records. MAIN OUTCOME MEASURES: Circumstances and incidence of sport-related sudden cardiac deaths due to IHD; autopsy findings. RESULTS: Between 1982 and 1996, there were eight sudden cardiac deaths due to IHD and related to sporting activity among Aboriginal sportsmen aged 15-37 years in the NT. Six were associated with games of Australian (rules) football. All occurred in the Top End of the NT in the wet season, and all occurred after the first half, or within an hour of, a game. Four of the players had macrosopic myocardial abnormalities (hypertrophy or previous infarcts) on autopsy. The estimated incidence of IHD-related sudden cardiac death among Aboriginal Australian football players in the NT was 19-24 per 100,000 player-years, compared with 0.54 per 100,000 player-years among Australian rules footballers of similar ages in Victoria. CONCLUSIONS: Incidence of sudden cardiac death attributable to underlying IHD was extremely high among young NT Aboriginal Australian footballers. Prevention will best be achieved by funding culturally appropriate long-term strategies to reduce the incidence of IHD. However, in the short-term, community-controlled programs with education of athletes, heat-stress reduction strategies, and cardiovascular screening should reduce the incidence of sudden cardiac death in sport.     

Snowmobile-related deaths in Ontario: a 5-year review.

OBJECTIVES: To investigate the demographic characteristics and circumstances surrounding fatal snowmobile accidents in Ontario, to examine the risk factors and to observe any fatality trends over the study period. DESIGN: Case series. PATIENTS: All 131 people who died accidentally while operating a snowmobile in Ontario from 1985-86 to 1989-90. Records were obtained from the chief coroner's office; registration data were obtained from the Ministry of Transportation. RESULTS: Although the absolute number of deaths increased each year, owing to a rapid increase in the number of registered snowmobiles, the risk of death from snowmobile accidents remained relatively constant. Deaths occurred most frequently in northeastern Ontario. Youths and men predominated among the victims. Fatal accidents occurred more often on lakes (in 66% of the cases in which this information was known) than on roads (in 26%) or trails (in 8%). Weekend fatalities predominated, and deaths occurred most often during times of suboptimal lighting (from 4 pm to 8 am). The driver was killed in 84% of the cases in which the person's role was known. Alcohol use before death was implicated in 69% of the cases, the level exceeding the Ontario legal limit in 59%. CONCLUSION: Snowmobile-related deaths result from factors that are generally avoidable. Strategies need to be instituted to reduce the rate of these events.     

47例酒后死亡尸检的法医学分析

目的 探讨酒后死亡的常见死因及法医学鉴定要点。方法通过对47例酒后死亡尸检案例的性别、年龄、简要案情、尸检情况、毒物分析情况、死亡原因等进行回顾性分析。结果死亡原因以饮酒后心脑血管疾病及其他原因引起的猝死最为多见,其次为醉酒后误吸哽死、颅脑损伤、溺死和酒精中毒等。结论系统尸体解剖和药毒物分析等检验对酒后死亡尸体的法医学鉴定有重要价值。     

Sudden Unexpected Death in Infancy: A Reassessment

Attention is drawn to the marked change in the pattern of infant mortality in Canada. The period of greatest improvement in the reduction of infant death, i.e. from the end of the first 28 days of life to the end of the first year, continues to present a challenge in the problem of sudden unexpected deaths (S.U.D.). Cases remain unexplained even after detailed autopsy examination. The principal theories of milk hypersensitivity and virus infection have been unsatisfactory, to date, in accounting for the deaths.

By enlisting the co-operation of parents and physicians, the Department of Preventive Medicine at Queen's University plans to carry out an epidemiological investigation of S.U.D. in infancy in Southeastern Ontario. Much could be added to our knowledge of S.U.D. by the examination of the sociomedical background of cases.

     

Sudden death in young Aboriginal adults with rheumatic heart disease

A retrospective review for the period 1983 to 1988 was made of all sudden deaths in young Aboriginal adults from the Darwin and East Arnhem regions who had known rheumatic heart disease. A total of five cases was identified from autopsy reports. The age range was between 16 and 35 years. All were being treated for asymptomatic heart disease (grade I). The sudden, unexpected death in each of these patients resulted in their deaths all being reported to the coroner. In all cases there was no evidence at autopsy of significant coronary artery disease or bacterial endocarditis. All had evidence of rheumatic valvular heart disease affecting either one or both mitral and aortic valves to varying degrees. No other cause of death was found. This report serves to illustrate the fact that rheumatic heart disease is still a significant contributor to morbidity and mortality in Aborigines, and that while the usual picture of progressive deterioration in exercise tolerance may be the norm, sudden death without any apparent preceding symptomatology can occur.     

Common underlying diseases do not contribute in determining the causes of sudden unexplained death

Background  Underlying diseases have a statistically significant positive correlation to sudden death. However, sudden unexplained death (SUD) is different from sudden death, as there is no clinical evidence to support the sudden death due to the original underlying disease, nor a lethal pathological basis to be found during autopsy. In addition, SUD are more common in young, previously healthy individuals, usually without any signs of disease, with no positive lesions found after autopsy. Therefore, a causal relationship between SUD and the underlying disease needs to be further explored. This study aimed to explore the role that common underlying diseases play in patients with SUD and to reveal the correlation between them.

Methods  The medical records, history and case information of 208 patients with SUD were collected for the survey. All these SUD occurred in the emergency room of Peking University Third Hospital from January 2006 to December 2009. The patients were stratified by with and without common underlying diseases. To examine possible associations between the underlying diseases and the cause of unexplained sudden death, the chi-squared and Fisher’s exact tests were used.

Results  Among the 208 patients, 65 were diagnosed with common underlying diseases while 143 were not. Within these two groups, there were 45 patients for whom the clear cause of death was determined. However, there were no statistically significant differences or strong associations (x²=1.238, P >0.05) between the 11 patients with (16.90%) and 34 without (23.78%) common underlying disease among these 45 patients. We also found that occurrence of the common underlying diseases, such as neurological system, cardiovascular and pulmonary system diseases, are not statistically significant (P >0.05) in the diagnosis of the SUD.

Conclusion  Common underlying diseases make no obvious contributions to SUD and are not useful in diagnosing the underlying reasons for death.

     

Sudden cardiac death in Air Force recruits. A 20-year review

We reviewed the clinical and autopsy records of the 19 sudden cardiac deaths that occurred among the 1,606,167 US Air Force healthy, medically screened recruits (90% male; 17 to 28 years old) during a 42-day basic training period between 1965 and 1985. Sixteen (all male) died suddenly of underlying structural heart disease, whereas no anatomic cause of death was identified in the remaining three. Thirty-two nonsudden, noncardiac deaths occurred during the same period, and only two had structural heart disease. Strenuous physical exertion was associated with sudden death in 17 of 19 cases (0.017 deaths per 50,000 exercise-hours), and the most frequent underlying etiology was myocarditis. Sudden cardiac death, a rare event in healthy young adults, is usually associated with exertion.     

257例成年猝死患者临床分析

目的分析成年成年猝死患者的病因和猝死时间,为预防成年患者猝死提供临床依据。方法对2008年10月1日-2012年10月30日马鞍山市十七冶医院院257例成年猝死患者的临床资料进行回顾性分析。设定三餐就餐时间：早餐时间6：30—8：30,中餐时间11：00-13：00,晚餐时间18：30—20：30;根据猝死时间是否在就餐时间内分2组,并根据不同就餐时间分3组,组间进行比较;猝死年龄以60岁为界分2组,2组间率的比较采用x。检验,P〈0．05为差异有统计学意义。结果257例猝死患者60岁以上（大于60岁者）183例（71．21％）;小于等于40岁者15例（5．84％）;有冠心病者124例（48．24％）,有糖尿病者88例（34．24％）,有高血压者75例（29．18％）;有脑卒中者61例（23．74％）,不明原因者52例（20．23％）,有慢性阻塞性肺病者26例（10．12％）,有癫痫者10例（3．89％）;小于等于40岁者（总15例）以不明原因死亡者11例;60岁以上组猝死183例,其中猝死时间为就餐时间89例（48．08％）,60岁以下组猝死74例,猝死时间为就餐时间29例（39．19％）,2组间X。检验,x2=14．77,P〈0．01。结论成年猝死患者以印岁以上多见,有冠心病、高血压、糖尿病者多见;年青猝死者以不明原因死亡者多见;年老患者猝死时间以就餐时间多见,故就餐可能是猝死的诱发因素之一。     

Radium in drinking water and the risk of death from bone cancer among Ontario youths.

OBJECTIVE: To determine whether residents of Ontario who are exposed to radium 226 naturally occurring in drinking water are at increased risk of bone cancer. DESIGN: A population-based case-control study of records from death and birth registries. Water samples were obtained from residences at the time of birth and of death. SETTING: Ontario. PARTICIPANTS: All Ontario-born people under the age of 26 years who died of bone cancer between 1950 and 1983. Control subjects were those who died of any other disease matched by age, sex and year of death. OUTCOME MEASURES: Radium exposure distributions and estimation of risk. RESULTS: An association was found between death from bone cancer and exposure to radium at the birthplace residence in concentrations of 7.0 mBq/L or more (odds ratio 1.58, 90% confidence interval [CI] 1.01 to 2.50; p = 0.047). There was a statistically significant exposure-response relation (p = 0.045). The increase in risk was similar for the main types of childhood bone cancer: osteosarcoma, Ewing's sarcoma and chondrosarcoma. CONCLUSIONS: The estimated risk at these exposure levels is much higher than would be predicted. The association may be spurious, the point estimates of risk may be too high, or risk factors derived from other exposure circumstances may not be valid for exposure to radium beginning in the prenatal period. Should the findings be confirmed, consideration might be given to removing radium from drinking-water sources.     

AIDS in Haitian immigrants and in a Caucasian woman closely associated with Haitians.

In Montreal the acquired immune deficiency syndrome (AIDS) was seen in eight Haitian immigrants and one Caucasian woman who had lived with Haitian immigrants for 3 years before the onset of her illness. AIDS was characterized by opportunistic infections alone in seven patients, by opportunistic infection and Kaposi's sarcoma in one patient and by chronic generalized lymphadenopathy in one patient. Five of the patients had presented with Mycobacterium tuberculosis infections 1 to 12 months before the onset of opportunistic infections. All nine patients were found to have recall anergy by skin testing for delayed hypersensitivity. Enumeration of the lymphocyte subpopulations in three patients showed a marked inversion of the ratio of helper to suppressor T lymphocytes. Six of the patients died as a result of the opportunistic infections; autopsies showed no recognizable causes of immunodeficiency. Thus, there is in Montreal a third clustering of AIDS cases in North America related to Haitian immigrants.     

攀枝花地区126例尸体解剖资料分析

目的总结攀枝花地区20年尸体解剖资料的病理学特点。方法对攀枝花市126例尸体解剖的年龄、性别、死因等临床病理资料进行回顾性分析。结果126例尸检中最小者为围产儿,最大者75岁,其中男85例、女41例;阳性解剖111例,阴性解剖15例;95例是涉及医疗纠纷病例;病理性死亡103例,非病理性死亡23例,猝死40例;临床诊断与病理诊断比较,总的误诊率为37．9％;病理性死亡原因中呼吸系统疾病居首位,其余依次为心血管系统、消化系统、神经系统疾病及其他疾病。结论科学准确的尸体解剖不但能够明确死亡原因,为解决医疗纠纷提供医学依据,而且对提高临床诊治水平也是有重要意义。     

Tuberculosis among immigrants: interval from arrival in Canada to diagnosis. A 5-year study in southern Alberta

OBJECTIVE: To examine the pattern of tuberculosis (TB) occurring among immigrants and the interval from arrival in Canada to diagnosis of the disease. DESIGN: Study of all cases of TB diagnosed in foreign-born residents of southern Alberta during the 5-year period 1990-1994. SETTING: A centre for the diagnosis, management and control of all cases of TB in the southern half of the province of Alberta. METHODS: All foreign-born patients in whom TB was newly diagnosed between January 1990 and December 1994 were included in the study. The interval from their arrival in Canada to diagnosis, their country of birth and the site of their disease were documented. RESULTS: Immigrants to Canada accounted for 248 (70.6%) of the 351 cases of TB diagnosed in southern Alberta during the 5-year period. The majority of these immigrants (182/248 [73.4%]) were of Asian origin. Extrapulmonary TB accounted for 111 (61.0%) of the 182 cases of the disease in Asian immigrants. The mean period between immigration and diagnosis was 11.2 years (standard deviation [SD] 13.9 years). Half of the patients presented within 7 years of their arrival in Canada. The time to presentation was shortest for patients with superficial lymph node disease (mean 7.6 years [SD 6.9] after arrival), intermediate among those with extrapulmonary disease, excluding superficial disease of the lymph node (10.1 years [SD 12.1]), and longest for those with pulmonary disease (14.2 years [SD 17.2]). TB developed sooner after arrival in Canada among immigrants from Asian countries (mean 9.1 years) than among those from other countries (17.2 years) (p = 0.01). CONCLUSIONS: Given the low annual incidence of TB in Canada (7.1 per 100,000), it is probable that TB occurring among immigrants reflects infection acquired before arrival in Canada. Health care professionals need to be aware that immigrants from countries with a relatively high prevalence of TB remain at risk for the disease (often at an extrapulmonary site) for many years after they immigrate to low-prevalence countries.