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Sudden death. Most of us think of a game tied at the end of regulation time; sometimes though, it’s really something shocking!

This weekend we were saddened to hear of the unexpected death of Associate Justice of the Supreme Court of the United States, Antonin Scalia. Justice Scalia was found dead after he failed to show up for breakfast at a West Texas hunting lodge while on a quail hunting trip. Details of his passing are still emerging, and I certainly have no information except what I’ve gathered from news media, but it does seem that he suffered what most doctors would initially label “sudden death.”

Most who pass unexpectedly die because of some catastrophic failure of the heart, lungs and/or the blood vessels that carry nutrients and oxygen throughout our bodies.

The Uniform Determination of Death Act, promulgated by the National Conference of Commissioners on Uniform State Laws in 1981, and adopted by most U.S. states, identifies two ways of determining death. First is an irreversible loss of brain function including those involuntary activities, like breathing, needed to support life; the other is the irreversible cessation of circulatory and respiratory functions.

So, what are the possible causes sudden death? A powerful tool that doctors use in sorting out a particular person’s problem from the many diseases or processes that look alike, is the concept of “differential diagnosis.” This is the intellectual exercise in which you assemble a comprehensive list of all the diseases, injuries, abnormalities, indeed all causes that could possibly explain the particular combination of symptoms (strictly speaking, what a patient complains of), signs (what a doctor observes about a patient using senses and simple tools like a stethoscope), and findings (the results of tests and special examinations, like X-rays, blood tests and EKGs etc.). Once this list is established you winnow it down by deciding what characteristics match best, doing different tests, studies or exams to rule out, discount or firm up your “working” diagnosis. At some level of certainty, often based on the severity of the situation, you need to move on to treatment, never quite stopping the diagnostic process as the situation evolves.

Finding a person dead, hours after they seemed perfectly well, especially if they have no known chronic medical problem, leads to an initial differential diagnostic list heavy with cardiac, respiratory and vascular possibilities.

Abrupt clotting of narrowed coronary arteries that feed the heart muscle causes a heart attack. In a heart attack the heart muscle, starved for fuel, either fails to squeeze strongly enough to pump blood or becomes so irritable that its rhythmic, coordinated series of movements degenerate into a fatal, uncoordinated rhythm. Sometimes these deadly arrhythmias occur spontaneously because of a variety of causes such as too much or too little of certain nutrients like potassium or calcium, the effects of drugs or even inborn structural abnormalities.

Clots that develop from sluggish blood flow in veins in the abdomen, pelvis or legs can break loose and plug up the vessels that lead to the lung. This pulmonary embolus can lead to deadly irritation of the heart rhythm, low oxygen levels, sudden heart pumping failure and rapid death.

Sudden obstruction or rupture of blood vessels that feed the brain can lead to catastrophic and rapidly fatal stroke. Sometimes large blood vessels including the body’s biggest, the aorta, can tear internally and its layers peel apart like an old tire, causing branches to close off or even the vessel to burst, leading to rapid internal bleeding and death.

Respiratory problems can lead to sudden death as well. Anything that suddenly blocks the passage of air into and out of the lungs can irritate the body so severely that heart function or rhythm collapses. Seizures from an abnormal area in the brain can lead to unheralded death.

Many other things can trigger a cardiorespiratory arrest but they all end the same; breathing stops, the heart stops, the brain’s electrical activity ceases and then, what’s next? That’s the BIG question.

Alfred Casale To Your Health
https://www.timesleader.com/wp-content/uploads/2016/02/web1_casale-2.jpg.optimal.jpgAlfred Casale To Your Health

By Alfred Casale

To Your Health

Dr. Alfred Casale is chairman of surgery for the Geisinger Heart Institute, co-director of the Cardiovascular Service Line for the Geisinger Health System and Associate Chief Medical Officer for the Geisinger Wyoming Valley Medical Center. Readers may write to him via [email protected].