The recent untimely death of Sridevi in Dubai threw up many controversies and ethical issues especially concerning the media’s role in the story. What started off with a feeding frenzy with everyone pitching in, soon degenerated into a complete farce, especially after an over-enthusiastic TV reporter jumped inside a bathtub in a macabre act to recreate the circumstances that led to Sridevi’s accidental death in an upscale Dubai hotel. To make matters worse, the reportage was sexist, lurid and offensive surpassing all norms of decency. Sridevi was a fashionista whose every outing was feverishly covered and commented on but it isn’t without reason that reputed writer Shobha De, upset with the rant and rave, chose to dub us all as “closet voyeurs”.
Sudden Death Syndrome (SDS) is an umbrella term used for the many different causes of cardiac arrest in relatively young people. The most common causes of unexpected sudden cardiac death in the young (aged 35 and under) include conditions that lead to the thickening, enlargement or abnormal structure of the heart muscle. There are irregularities of the electrical impulses that upset the natural rhythm of the heart and lead to cardiac arrest. Dr Steven Cox avers that in 80% of young sudden cardiac deaths, there will be no family history and no symptoms, which is why it is so important that all young people have their hearts checked.
Sudden Death Syndrome is defined as a non-traumatic, non-violent, unexpected occurrence resulting from cardiac arrest within as little as six hours of previously witnessed normal health. It is often difficult to consider that someone who is apparently young and fit may be at risk.
Sporty youngsters stress their hearts the most. If they have an underlying cardiac abnormality they are more likely to be at risk. Sports itself does not lead to cardiac arrest but it can act as a trigger for a young person to die suddenly, by exacerbating an undetected condition.
There is a simple way to diagnose most of the abnormalities that can lead to sudden death. This is by having an ECG test. For extra clarity, an echocardiogram can be taken if necessary. An ECG screening is recommended if there have been any young sudden deaths in the family, or if a young person is suffering from symptoms of chest pain, breathlessness, palpitations, dizziness and fainting.
Sudden death occurs because of the dreaded phenomenon known as “ventricular fibrillation”, which causes your heart to beat quickly and chaotically. This is an emergency condition that may be brought on by a heart dysfunction, in the setting of myocardial or coronary abnormalities or primary rhythm disorders. The main structural causes are hypertrophic cardiomyopathy (particularly with extreme thickening of left ventricle), anomalies of coronary arteries, Marfan syndrome, and arrhythmogenic right ventricular (RV) dysplasia. Prolonged QT syndrome and Wolff-Parkinson-White (WPW) syndrome have also been implicated. Children with birth defects (e.g. Aortic Stenosis, Ebstein’s anomaly) are at higher risk for sudden death.
Sudden death is associated with stressful situations, including the so-called “voodoo death”, typically involving central nervous system mechanisms. Establishing a cause–effect relationship between sudden death and stroke is complicated, because these patients usually have risk factors for coronary disease as well. However, it has been observed that patients with lateral medullary and pontine strokes die unexpectedly and also have a high incidence of autonomic dysregulation (e.g. labile blood pressure and tachycardia). Post-mortem analysis of stroke patients who died suddenly without any evidence of coronary disease often evince myofibrillar disarray.
The incidence of sudden cardiac death (SCD) is based on studies from North America and Western Europe with very few countries in Asia having conducted robust studies evaluating the occurrence of SCD. In India, in recent years, varying methods of assessment such as verbal autopsies, questionnaires, and quantification of surrogate endpoints such as cardiovascular disease profiles have been used to estimate the incidence of SCD. These studies have shown that the incidence of SCD is on the rise, especially in urban regions, which may be largely attributed to the increase in prevalence of coronary artery disease, diabetes and hypertension in India.
Even as we come to grips with Sridevi’s sudden death, let me tell you about the shocking death of Fiorentina captain, David Aston, an Italy international, at the age of 31 due to sudden death. Researchers now suggest that chances of young men dying of sudden death during the weekend are higher than women. Aston was found dead without any clue just before a decisive match. Although cardiac arrest is different from a heart attack, the two distinct conditions are interlinked. Sudden death can occur after a heart attack or during recovery. The study also found that young men were more susceptible to the “weekend effect” compared to women.
Sudden deaths are an unmitigated tragedy. First of all, we eschew the painful goodbyes that cannot be said and will never be explained. Then, it is the thing that hits you the hardest because you least expect it. Left poignantly to cry, paradoxically, tears are the only words the heart can’t express. This is the very reason why Jesus Himself realising the contingency of death, forewarned us… “You know quite well that the day of the Lord’s return will come unexpectedly… like a thief in the night…”
(Dr Francisco Colaço is a seniormost consulting physician, pioneer of Echocardiography in Goa)
