/ 22 July 2011

When death is unexpected

There are several reasons why sudden death occurs. Some are extremely rare. Unfortunately, other reasons are far too common.

Sudden death is understandable if you’re standing in front of a 10-tonne truck that’s hurtling towards you, out of control. But when death occurs inexplicably, with no discernable cause (at least to the layman) or without any obvious trauma, the emotional shock is more devastating to the bereaved. And it is left to a pathologist to ascertain the reason for the fatality through a post-mortem.

There are several reasons why sudden death occurs. Some are extremely rare. Unfortunately, other reasons are far too common: heart disorders because of rhythm disturbances, high blood pressure, type-two diabetes and high cholesterol brought on through bad diets, sedentary lifestyles, smoking and obesity.

Sudden death can also occur when blood vessels to the lungs and heart become completely blocked because of a blood clot arising from deep-vein thrombosis somewhere in the body. The link between deep-vein thrombosis and people being immobile and sitting in cramped conditions for long periods of time — such as economy-class airline passengers — has gained much notoriety in the past few years. No doubt, in the South African context, long-haul taxi journeys are just as precarious.

More often than not, though, sudden death is associated with heart disease. This is when the blood vessels narrow or become clogged from cholesterol and because of the lack of blood supply it causes a heart attack. The end result is ventricular fibrillation, a severe abnormal heart rhythm (arrhythmia), which is the twitching or quivering of muscle fibres in the two lower chambers of the heart. This results in no blood being pumped out of the heart and hence causes anoxia (absence of oxygen) in the brain and other vital organs.

Sudden death is also associated with heart disorders such as congenital heart disease, heart muscle disease and ischemia, a lack of oxygen in the heart muscles because of narrowed arteries or shock. Electrocution, injury to the heart and heart surgery are also associated with this condition.

Although rare, there have been cases of seemingly fit and healthy marathon runners with no history of heart problems suffering fatal cardiac arrests during or after ultra-distance races. Research into this phenomenon showed that during a marathon the hearts of runners tested experienced tissue damage caused by inflammation that restricted blood flow through the muscle, which led to as much as half of the segments of the heart losing some degree of function. But this condition is also known to be reversible, with no lasting damage to the heart.

Probably the most devastating form of sudden death is when it happens to children. Sudden infant death syndrome (Sids), which is more commonly known as cot death, is neither predictable nor preventable. About 90% of these deaths occur among babies younger than six months who were considered previously healthy.

Compounding the agony for parents are the questions that remain unanswered. Even though various previously held theories have been disproved, the specific cause or causes for Sids remain unknown, even after post-mortems have been performed.

But for adult sudden death the causes are clear, especially with heart disease becoming more prevalent in South Africa. It is a result of lifestyle factors — rapid Westernisation and urbanisation, coupled with physical inactivity and poor diet, which leads to obesity. (South Africa has one of the world’s highest per capita spending on fast foods.)

Up to 66% of South African women are obese, 61% of adults are classed as overweight, obese or morbidly obese, 49% of our citizens do not engage in any exercise and 71% of them have never gone on a diet or tried to cut down food intake. And, shockingly, 17% of children under nine are overweight.

With statistics like that, expect to hear a lot more about sudden death in the near future.

Sudden death will be the topic of Bonitas House Call on July 30 on SABC2 at 9pm

This article originally appeared in the Mail & Guardian newspaper as a sponsored feature.