"Crib deaths," sudden unexpected death in infancy, or the sudden infant death syndrome: a hypersensitivity reaction.
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The effect of saphenous vein bypass grafting on the incidence of sudden cardiac death and total cardiovascular death was studied by comparing the survival of subsets of surgically and medically treated patients with coronary disease who were similar in two major prognostic variables: extent of coronary disease and ejection fraction. Significant differences in some baseline variables existed between medical and surgical subgroups with similar ejection fraction and extent of coronary disease. Medically treated patients tended to be in a lower functional class, to have more extensive ventricular contraction abnormalities, to have a larger end-diastolic volume, and to have fewer distal vessels feasible for grafting. Surgically treated patients with two vessel disease and normal or moderately reduced election fraction had improved survival when compared with medically treated patients with two vessel disease and similar ejection fraction. Improved survival of borderline statistical significance was also seen in surgically treated patients with three vessel disease and moderately reduced ejection fraction. When categorized according to end-diastolic volume, surgically treated patients with two vessel disease and normal or moderately increased end-diastolic volume also had improved survival over similarly defined medically treated patients. The sudden death rates for subgroups of mecically treated patients were 1.8 to 10.9 times higher than the rates in subgroups of surgically treated patients with a comparable extent of coronary disease and ejection fraction.
We prospectively followed 257 patients with bifascicular and trifascicular conduction-system disease and intact atrioventricular conduction who had undergone His-bundle studies. Forty-seven per cent had associated coronary-artery disease, and 23 per cent primary conduction-system disease. His-ventricular interval was moderately prolonged in 43 per cent and markedly prolonged in 12 per cent. During an average follow-up period of 25 months 50 patients died. However, death was sudden in only 27, and 17 of the sudden deaths were not due to bradyarrhythias. Actuarial analysis showed an overall mortality rate (mean +/- S.E.) of 19 +/- 2.6 per cent at two years, mortality from sudden death being 10 +/- 2.6 per cent. Permanent heart block occurred in 12. No clinical symptoms (including syncope), electrocardiographic findings, electrophysiologic data or their combination identified patients at high risk of sudden death. Sudden death due to bradyarrhythmia is uncommon in patients with bundle-branch block and intact atrioventricular conduction. Therefore, routine prophylactic use of permanent pacemakers in all such patients is inappropriate. Pacemaker implantation should be reserved for those with documented symptomatic bradyarrhythmias.
Sudden death is defined as any death that occurs less than 24 hours after the onset of first symptoms. Strokes account for 10 to 20% of all sudden deaths. The records of all residents of Rochester, Minn., who had their first stroke during the period 1955 through 1969 were analyzed. Among 255 deaths caused by the first stroke, 52 were sudden. Twenty-six of the deaths were due to primary intracerebral hemorrhage, and 20 to primary subarachnoid hemorrhage. Only two of the sudden deaths were caused by infarction: one by pontine and cerebellar infarct and the second by a cortical infarct, which resulted in death from status epilepticus. Among the nine patients who died within 2 hours of the onset of symptoms, six had primary subarachnoid hemorrhage. Hypertension was noted in 23 of the 26 patients (88%) who died of primary intracerebral hemorrhage; 8 patients with primary intracerebral hemorrhage were on long-term oral anticoagulant therapy, and all 8 were hypertensive.
Five patients with critical aortic stenosis (aortic valve area 0.6 cm2 or less) died 2 days to 21 days following cardiac catheterization performed in anticipation of cardiac surgery. A sixth patient was successfully resuscitated for spontaneous ventricular fibrillation, and successful aortic valve replacement was accomplished. Two patients had prior history of syncope; one patient, of ventricular tachycardia; three patients, of pulmonary edema; and three patients, of crescendo angina. One patient had severe hypotension during maintenance hemodialysis for chronic renal failure. The mode of death was sudden but not witnessed in two patients. The terminal cardiac rhythms were slow junctional in one patient, idioventricular in one, ventricular tachycardia in one, and ventricular fibrillation in the fourth patient. We conclude that symptomatic patients with critical aortic stenosis should be monitored after cardiac catheterization, and surgery should be performed as soon as possible since sudden death is not unusual.
Sudden death is now an infrequent occurrence in severe aortic stenosis. However, an impressive increase in pulmonary arteriolar resistance has been found in some patients with end-stage aortic stenosis dying suddenly or deteriorating suddenly after catheterisation. Pulmonary hypertension does not seem to cause sudden death, but, in conjunction with decreased cardiac output, a critical reduction in aortic orifice area, and left ventricular failure, pulmonary hypertension identifies a population at significant risk. The rare finding of severe pulmonary hypertension in aortic stenosis should be considered an important marker for sudden death and in association with left ventricular failure may indicate an urgent need for valve replacement, regardless of the apparent clinical condition of the patient. In a small number of subjects catheterised postoperatively, increased pulmonary arteriolar resistance lessened rapidly.
The majority of adolescent deaths are sudden and unexpected; of these, the great majority result from violence. These violent deaths largely accounted for the 25% increase in total adolescent mortality during the 1960s. Yet, sudden death in adolescence is not a distinct entity and receives little study from either pediatricians or pathologists. Some cases of sudden death in adolescence are puzzling and difficult to classify. The pathologist must in each case obtain a detailed history, usually perform a complete autopsy, and obtain consultation when necessary. Only then will each case be adequately studied, and related medical questions and other problems be properly resolved.
Three reported charateristics of sudden death in the wild rat, (1) bradycardia, (2) decreased survival without whiskers, and (3) increased suvival with preexposure to the stressor, are demonstrated in the domestic rat. Differences in sudden death between wild and domestic rats are discussed as well as possible interpretations of the phenomenon.
Of 21 sudden deaths in sportsmen, 18 were thought to be caused by heart attacks either during or after sport. There was firm evidence of ischaemic heart-disease in 9, strongly suggestive evidence in 7, but in 2 there was only suggestive clinical evidence. As a group, these subjects were characterised by (1) a mean age above thirty (above twenty-five for rugby players); (2) a family history of early heart-attacks; and (3) antecedent symptoms of chest pain or pressure in 9, fatigue or blackout in 4, and minor complaints in 2. Most were known to their medical practitioners. Psychological factors were thought to be important in 8. Doctors, players and referees should be aware that severe sporting exertion as in rugby football involves a risk which for most players is relatively minor, but in the minority predisposed to heart-attacks by family history, smoking, or age (as in referees) the risk is more serious. To reduce hazard of sudden death in exercise, players and referees should be warned against smoking and informed of the serious implications of the development of chest pain, pressure, or undue tiredness before, during, or after sport.
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Sudden death is a recognized complication in symptomatic patients with hypertrophic cardiomyopathy. However, its occurrence in patients with no or transient previous cardiac symptoms presents a particularly challenging diagnostic and therapeutic dilemma. Therefore, 26 patients with hypertrophic cardiomyopathy whose death was the first definitive manifestation of cardiac disease were evaluated. Their ages ranged from 8 to 49 years (mean 18) and 23 were less than 25 years of age; 19 were male and 7 female. Of the 26 patients, 13 died during or immediately after moderate or severe physical exertion. Of 12 patients with previous cardiac catheterization, 6 had no or a small left ventricular outflow tract gradient under basal conditions and 6 had an outflow gradient of 50 mm Hg or greater. Left ventricular end-diastolic pressure was elevated in nine patients, and the ventricular septum was moderately to severely thickened (17 mm or more) in all patients. The electrocardiogram was abnormal in all 19 patients studied before death. Thus, sudden death may be the first definitive manifestation of cardiac disease in some patients with hypertrophic cardiomyopathy. Although the effects of patient selection in this study group cannot be excluded, sudden death was common in children and young adults and was often related to physical exertion; each patient showed a distinctly abnormal electrocardiogram and moderate to severe ventricular septal thickening.
Sudden death syndrome usually occurs in heavy, fast-growing and healthy-looking broilers. Most of the affected birds are males. The characteristic necropsy changes are seen in well-fleshed broilers with edema and generalized pulmonary congestion, recently ingested feed in the crop and gizzard, distended intestine with creamy content and empty gall bladder. The liver and kidneys are slightly enlarged and the latter have patchy areas of subcapsular hemorrhage. The heart contains clotted blood in the atria but the ventricles are often empty and the left ventricle in particular assumes a hypertrophied appearance. Microscopic examination of heart muscle reveals degeneration of fibers, separation of cardiac muscle fibers by edema and infiltration of heterophils. The lungs have severe vascular congestion, inflammatory cell infiltration in the mucosa of the secondary bronchi and edema fluid in the tertiary bronchi and interlobular connective tissue. The liver has moderate bile duct hyperplasia, periportal hepatitis and mononuclear cell infiltration adjacent to bile ducts which possibly leads to bile duct constriction. The kidneys have subcapsular and parenchymatous hemorrhage.
Statistical analysis of 525 cases of sudden death was done on the data of forensic medical examinations of cadavers of subjects suffering from ischemic heart disease (IHD). In the structure of cases of sudden death in IHD the percentage of men was shown to be approximately twice as high as that of women. An increase in the percentage of women in older age groups and a stronger effect of the age factor in women on the frequency of sudden death in IHD were noted. There was a strong correlation between the frequency of sudden death in IHD and the heart mass. Most cases of sudden death in IHD were registered in the autumn-winter period.
Two deaths after sudden severe asthma attacks in young people are reported from a clinic set up to identify and manage "at risk" patients. These deaths occurred despite frequent visits at which recommendations made by previous studies were implemented. The risk factors and management of such episodes have been reviewed. Precautions taken proved inadequate due to the severe, abrupt nature of the attacks, failure of the patients' immediate treatment, and delay in reaching hospital. Consideration should be given to the self-administration of subcutaneous adrenaline or specific beta-agonists, the provision of a detailed medical card, and free access to the nearest hospital in such cases.
Forty-seven patients died suddenly during the late hospital phase of acute myocardial infarction. Risk factors associated with late in-hospital sudden death included prior cardiovascular disease, circulatory failure while in the coronary care unit, and certain arrhythmias and conduction disturbances while in the coronary care unit. These were associated with a twofold to sixfold increase in late in-hospital phase sudden death. The most prevalent risk factor occured in 62% of the sudden-death patients; the highest incidence of sudden death with a single risk factor was 2.6%, and the greatest relative risk was 6.0. Relative risks were uniformly greater for males than females. Multiple factors were associated with a greater risk than single factors. These risk factors characterize the group of sudden-death patients as a whole but do not allow precise identification of individual patients at high risk.
Broiler chicken flocks were studied to determine the mortality from sudden death syndrome occurring in the flocks. The difference in the incidence of the syndrome in pullets and cockerels, and the age at which the most birds are affected were also studied. The weight of sudden death syndrome birds was compared with the flock average and the effect of continuous lighting as opposed to intermittent lighting was examined. The results suggest that; continuous lighting produces more sudden death syndrome deaths than intermittent lighting; that the incidence of sudden death syndrome is higher in cockerels than pullets; that the highest death rate occurred during the third and fourth weeks of life, and that sudden death syndrome birds on the average were heavier than the flock average.
The sudden death rate from coronary heart disease over a mean period of 4 years was related to the electrocardiographic findings in 3 groups of subjects, survivors of myocardial infarction, employed men, and employed men with no symptoms or history of coronary disease. Within each group the sudden death rate correlated with the number of electrocardiographic findings, particularly Q, ST, and T wave items. However, between groups there were large differences in sudden death rates in subjects with the same findings. These were greatest in the case of ventricular conduction disturbances and disturbances of rhythm and rate which appeared to be benign in those free of symptoms but ominous after infarction. Findings predictive of sudden death were also predictive of non-sudden coronary deaths. It is concluded that the electrocardiogram is only one of several aids to the diagnosis and assessment of severity of disease and not a substitute. Prognoses derived from clinical case series are inappropriate to symptomless individuals in whom isolated electrocardiographic findings denote little increase in risk.
Sudden death syndrome (SDS), caused by Fusarium virguliforme, is one of the most economically important diseases limiting soybean production worldwide. Although numerous quantitative trait loci (QTL) associated with SDS resistance have been reported, inconsistencies among mapping populations, marker systems, and experimental conditions have hindered the identification of robust resistance loci for soybean improvement. In this study, a comprehensive meta-analysis was conducted to integrate published QTL and identify stable consensus genomic regions associated with SDS resistance. After a systematic literature survey and data curation, 153 QTL derived from 14 linkage-mapping studies were analyzed using a custom R-based workflow, resulting in the identification of 23 consensus meta-QTL (MQTL) distributed across 17 chromosomes. Several MQTL, particularly those located on chromosomes 6, 8, 18, and 20, were supported by multiple independent studies and represented major genomic hotspots for SDS resistance. Physical localization and functional annotation of these MQTL identified 217 candidate genes, including genes predicted to be involved in plant defense, signal transduction, transcriptional regulation, and secondary metabolism. Gene Ontology enrichment analysis identified response to salicylic acid as the only biological process that remained significant after FDR correction, whereas Kyoto Encyclopedia of Genes and Genomes pathway analysis did not identify significantly enriched pathways. Independent support using five published genome-wide association studies further supported several MQTL, especially those on chromosomes 6, 18, and 20, thereby increasing confidence in these genomic regions. The identified MQTL and prioritized candidate genes provide potential genomic resources for future marker development, improvement applications, and functional validation aimed at improving soybean resistance to SDS.