SUDDEN DEATH

Sudden death is the one that occurs unexpectedly both in sick and healthy people. It happens between the onset of symptoms and the moment the individual is confirmed dead. Notice that death is considered sudden only if no signs of violence or trauma are found.

If the individual is found dead within the first 24 hours after the last time he/she was seen alive, that´s also considered sudden death.

Sudden death occurs both in newly born infants and adults. In infants, it is more common within the first three months and is rare after the sixth month of life. It is probably related to inherited genetic factors, being more frequent in smoking mothers´ children.

In young and adult individuals, either sedentary or athletic, a vast majority of sudden death cases occur due to heart diseases. Whether or not they´re known by their sufferers or relatives and friends, they may be congenital, degenerative, inflammatory, infectious, caused by nervous reflexes, toxic, or caused by excessively straining physical activities. Sometimes a sum of these factors is found to be the cause of death.

In the past, the unexpected passing of a person considered healthy was regarded as a sudden death. These were unexplainable deaths.

With the broadening of medical knowledge, the improvement of diagnostic resources, and the examination of the bodies of people who died suddenly, the range of diagnoses elucidating these deaths has been widened.

Seventy-five per cent of sudden death victims have ischemic heart disease due to arteriosclerosis. We don´t know why most of these individuals die within the first morning hours.

If we had the chance to watch someone´s sudden death, we could observe that if the victim were standing, they´d incline their body forwards, and slightly bend their knees prior to flaccidly collapsing on the floor. That´s useful to know so that the assistants can hush up to help the victim, since the initial minutes are the ones that still provide the possibility of saving an individual´s life. That´s a detail to observe, being important to those who watch sports, in which athletes often fall down, the falls ranging from fake to fatal ones.

Sudden deaths, in a vast majority of cases, are caused by arrhythmias of the cardiac cycle. At first place is ventricular fibrillation, which is usually preceded by ventricular tachycardia. Other arrhythmias that may lead to sudden death are the atrioventricular blocks and sinus arrests. All these arrhythmias lead to a decline in the cardiac output, with absence of blood in the brain, the organ most sensitive to lack of oxygen, which makes an individual lose their senses in a few seconds.

When a heart arrest or a severe arrhythmia takes place, and the person loses their senses, already with apparent death, the victim can be brought back to life within the first minutes, IF IMMEDIATELY HELPED. Help must follow some key rules. It must be quick and effective, for which training is required, and count on available medications and equipment, as well as qualified people to handle these.

Cardiac arrhythmias, and subsequent sudden death, may result from a sum of factors that cause them. Thus, a previously sick heart may present fatal arrhythmia if exposed to excessive effort or certain drugs. Sudden deaths of otherwise healthy people under the effect of cocaine or Ecstasy have become increasingly common. In these cases, sudden death can be accounted for by the toxic effect of these drugs on the heart, through the vasoconstrictor effect on the coronaries, plus the strain from dancing or other physical activity.

Other sudden deaths can be elicited by vagal reflexes. The examples are deaths caused by traumas in the testicles, or punching to the so-called solar plexus, which can lead a boxer to die. A trauma to the chest, at the level of the precordium, can cause death. The example is the soccer player whose chest is hit by a ball exactly when his heart has finished the systole – the blood refluxing and distending the aortic valve. If exactly at that moment a ball hits violently the chest, this valve can be lacerated. That is the reason why it is recommended that goalkeepers wear a padded shirt.

Medications, even the ones regarded as harmless – nasal decongestants or drugs for losing weight – or the ones that act on the nervous system – stimulants or antidepressants; or yet some medications for heart diseases, can cause severe arrhythmia that may end up being fatal.

The practice of extreme efforts may be related with sudden death. The word “extreme” doesn´t have the same meaning for all people. It depends on the conditioning of the individual making the effort, or whether or not there is a known illness. An individual with a heart condition, on subjecting himself to an excessive effort, may pass away. An example is a person knowingly or unknowingly suffering from an ischemic heart disease that dies during sexual intercourse.

We should remember a Greek hero, the soldier Phillipides, the patron of marathon, who in 490 B.C., after running 42 km to inform his commander Miltiades of the Greeks´ victory over the Persians in the battle of Marathon, dropped dead right after conveying the news.

That was a sudden death that at the time bereaved the Greek warriors and has been remembered by humankind up to this day.

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