In such cases, supportive care and timely transport can be not only lifesaving, but also prevent long-term consequences from right heart failure and pulmonary hypertension. Lastly, acute aortic catastrophe, namely dissection or aneurysmal rupture, can cause sudden death. In patients with vascular disease often the result of long-term comorbidities such as hypertension, high cholesterol or smoking , turbulent blood flow in the aorta can lead to outpouchings aneurysms of the arterial wall at points of stress due to weakening of the vessel from atherosclerosis.
While initially benign, as these aneurysms grow in diameter over the years, they become increasingly at risk for rupture. An aortic aneurysm, although generally painless, can cause pain that radiates to the back or flank when acutely expanding or upon rupturing.
Aortic rupture results in extensive internal bleeding. After exsanguination from the rupture, but prior to death, PEA is likely to be encountered due to extensive volume loss. These patients will require management in an intensive care unit and, very likely, surgery if the aneurysm is rapidly expanding or has already ruptured. There are three layers of the healthy aorta that keep blood within the artery. See Figure 5 below.
Chest CT scan demonstrating the dissecting layers of the aorta with an intimal flap noted within the lumen of the vessel where the innermost layer is being separated from the outer two layers by shearing stress. Pain from aortic dissection is sudden and maximal in intensity at onset for the majority of patients. This is unlike angina, which builds in intensity and is rarely felt as ripping or tearing. In approximately one third of patients with aortic dissection, there will be a greater than 15 mmHg difference in systolic blood pressure between the upper extremities and approximately one quarter will have a diastolic murmur.
Thus, any interventions beyond aspirin for chest pain should be pursued only after the diagnosis of dissection has been considered and thoughtfully ruled out. Key concepts: Aortic rupture from aneurysm or dissection requires the thoughtful practitioner to first consider the diagnosis in any patient with chest pain, flank pain, abdominal pain or sudden collapse.
This is particularly true in elderly patients with hypertension who present with either ripping or tearing chest pain in the case of dissection, or in the case of ruptured aortic aneurysm patients presenting with severe back, flank or abdominal pain. Reducing hypertension and tachycardia while expediting transfer to a specialized medical center is critical. Through improved awareness, the skilled provider will be able to more efficiently initiate appropriate therapy and avoid the pitfalls of misdiagnosis and resultant unintended harm to the patient.
References 1. Sudden cardiac death in hypertrophic cardiomyopathy. Circ Arrhythm Electrophysiol. Bastiaenen R, Behr ER. Sudden death and ion channel disease: Pathophysiology and implications for management.
Sudden cardiac death caused by coronary heart disease. Hypokalemia leading to torsades de pointes. Gen Hosp Psychiatry. Alpert MA. Sudden cardiac arrest and sudden cardiac death on dialysis: Epidemiology, evaluation, treatment, and prevention.
Hemodial Int. J Am Coll Cardiol. Every year about one in , people aged between one and 35 dies suddenly of a natural cause. The vast majority of sudden death cases in the young are caused by diseases of the heart. In young adults and in individuals above the age of 35 the most important cause of sudden cardiac death is a heart attack myocardial infarction caused by a blood clot that obstructs the blood and oxygen flowing to a part of the heart. The damage this causes can induce potentially fatal cardiac arrhythmias.
In young adults, heart attacks may be due to inherited abnormalities that lead to high cholesterol levels. And in this group, and also in children, diseases of the heart muscle in which, for example, parts of the heart enlarge hypertrophic cardiomyopathy , dilate dilated cardiomyopathy , or in which the muscle tissue is replaced by scar tissue and fat instead of muscle tissue arrhythmogenic cardiomyopathy , are important causes of sudden cardiac death.
However, more recent research points to a genetic component which could be identified in families, leading to monitoring of the heart rate in susceptible individuals. Drug therapy is also a possibility once particular weaknesses have been confirmed.
According to CRY, sudden death can also occur as a complication after some viral illnesses viral myocarditis, for example combined with physical exertion. Another exercise-related cause of sudden death is deemed to be due to an undetected anomaly in the coronary arteries. According to CRY, this is the second commonest cause of death after cardiomyopathy, mentioned earlier in young athletes.
Warning signs here include chest pains and blackouts during physical exercise. Cox, who is both the founder and chief executive of CRY, started the support group because she was angry that there wasn't a public awareness of the number of fit and apparently healthy young people dying suddenly. She believes part of the problem lies with GPs who don't take seriously enough parents' - usually mother's - worries about one of their children. If a child has these and there was a sudden death in the family which was unaccounted for, this should set off the alarm bells.
A family like this should be screened for heart problems. At this stage, they have done most of their growing and it is an appropriate time to evaluate a cardiac problem.
An ECG won't cover everything but it will raise awareness that young people can have cardiac problems too. While he is not against the idea of screening in principle, Dr Hugh McCann, cardiologist at the Mater Hospital, Dublin, does foresee certain complicating factors if such a screening programme were to be introduced. While you can never compare one person's tragedy with another's, the lack of context and the absence of clues regarding why the person died adds an extra dimension to the grieving process for many bereaved parents.
She died after a school fight. The answers are more complicated than the simple, common phrase would lead many to believe, and they even have legal ramifications. Here is a look inside the process doctors go through to determine whether a death was "natural," and what exactly that means or doesn't.
What are 'natural causes'? It might not seem to mean much at all. But when a death certificate says a person's death was "natural," it is really ruling out the involvement of external causes. The person did not take their own life and they were not killed by somebody else or in an accident such as a car crash or drug overdose.
Read More. South Carolina fifth-grader Raniya Wright died of natural causes, prosecutor says. Death certificates almost always include more details about specifically how the body failed, such as heart disease or kidney failure, even if it is only the best guess of the coroner a trained official or medical examiner a doctor charged with investigating the death. David R. Fowler, president of the National Association of Medical Examiners. You weigh the evidence, and based on the predominance of evidence you come to a decision that I think this is what caused the problem, but I'm going to be an honest person and list all these other causes," Fowler said.
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