Re: Sudden Death

Posted By CCF Cardio MD- SGM on August 26, 1997 at 13:31:06:

In Reply to: Sudden Death posted by Dianne Walker on August 21, 1997 at 22:18:05:







: We had a 26 year old male friend and his fiance visiting with us one
evening. He never complained of any symptoms or distress of any kind.
He ate supper and even went after seconds! He acted normally all evening.
He told his fiance that he needed to head for home as he had to work early
in the morning. He said see you all later and walked out the door. His
fiance said a few words to me and went out less than a minute later. She
walked out and found him lying on the ground about 20 feet from the house.
At first she thought he was playing around and said he sounded like he was
snoring. When she went over to him, she started to turn his head her way
and it limply rolled toward her and he was clammy and sweating and then
appeared to not be breathing. She screamed for help and I and my husband
went out immediately and began CPR when he appeared not to be breathing and
we could not find a pulse. We kept at this and enlisted the help of a
neighbor as I needed to help calm the fiance. He would take a couple of
labored breath and then quit again. They got a pulse and then they'd lose it
CPR was administered until emergency help arrived. They shocked him several
times at the scene as well as continuing CPR. They began an IV(of what I am
not sure) and took him to the nearest hospital. They continued to shock him and
administered several cardiac drugs with no success. We overheard that they could
not keep the heart in regular rythym nor was there blood flow to the heart.
Within approximately 45 minutes they pronounced him dead. Before leaving the
hospital we viewed the body and he was extremely mottled with lips bluish-purple. His
abdomen was extremely distended
(he looked as if he were 8 months pregnant!)He did not look that way before he
left our yard. The coroner did an autopsy the following day saying that there was no obvious
signs of a cause of death. We then heard later
that there was a possiblity of an enlarged heart and that the sac around the
heart may have burst.
My questions are these:
What could/would cause the abdominal distension?
Can one be defibrilated too often?
Can one die this quickly if the sac around the heart ruptures?
What symptoms, if any, could one have if they had an enlarged heart?
If this sac ruptures, is there any surgical procedures that can be employed
to rectify the rupture?
Is any surgery available to rectify an enlarged heart?
Are any medications available to help someone with an enlarged heart?
Thanks in advance for helping me understand what happened to this young man.






____
Any case of sudden death, especially that of a young man, is emotionally traumatic
and usually unexpected.  You ask numerous questions, and I will respond to several
of them as time and space allow.  The most common cause of sudden death is heart-
related, often secondary to a rhythm disturbance causing disorganized or chaotic
electrical activity with consequent ineffective pumping of the heart.  Rhythm
disturbances(such as ventricular tachycardia and ventricular fibrillation), especially
in young people, may present as the first sign of underlying cardiac structural
diseases.  These diseases include, but are not limited to, hypertrophic cardiomyopathy,
arrhythmogenic right ventricular dysplasia, and idiopathic dilated cardiomyopathy.
An enlarged heart, as you describe in the autopsy report, speaks to the third condition
I noted above, namely dilated cardiomyopathy. This denotes a progressive loss of cardiac
pumping function due to disease of the heart muscle itself, which inevitably progresses
to dilation of the left ventricle.  There are specific reasons(toxins, viral infection,
etc.) which may lead to dilated cardiomyopathy, but in its purest form, no clear reason
is ever discovered.  Dilated cardiomyopathy and the other conditions above can lead
to arrhythmias that may herald sudden cardiac death.
In answer to your specific questions, I do not believe that a rupturing of the sac around
the heart(the pericardium) had any direct relationship to this young man's death.
Abdominal distention is an inevitable consequence of cardiopulmonary resuscitation
(CPR) since air intended for the lungs tends to fill the belly, distending it.
The protocols for utilizing cardiac defibrillation are quite clear, and I do not
believe that "too many defibrillations" is a common problem with resuscitative efforts.
Regarding the issue of an enlarged heart(congestive heart failure or the cardiomyopathy
that I mentioned above), there are effective treatments including water-pills and
medications known as ACE inhibitors. This is a serious condition without a cure at
present, despite active research and investigation.  Symptoms of heart failure
include shortness of breath, swelling of the ankles, easy fatiguability, and
difficulty laying flat.
I hope this response has been of assistance.