Sudden, unexpected cardiac or unexplained death in England: a national survey

Bowker, Timothy J.; Wood, D; Davies, M. J.; Sheppard, Mary N.; Cary, N.; Burton, J; Chambers, Dominic; Dawling, Sheila; Hobson, H.L.; Pyke, Stephen; Riemersma, Rudolph A.; Thompson, Simon G.

doi:10.1093/qjmed/hcg038

Cited by 141 publications

(102 citation statements)

References 21 publications

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“…On the other hand, it can of course take some time for rare, but serious chronic toxic effects that can cause sudden death, such as clozapine-induced cardiomyopathy or myocarditis (Wooltorton, 2002), to be associated with a given compound. This latter comment notwithstanding, it has been suggested that the aetiology of sudden, unexpected, cardiac-related or otherwise unexplained deaths will not be studied systematically until such deaths are identified by a name such as Sudden Adult Death Syndrome (SADS; Bowker et al, 2003). Figure 1).…”

Section: Post-mortem Toxicologymentioning

confidence: 99%

Fatal toxicity of drugs used in psychiatry

Flanagan

2007

Hum. Psychopharmacol. Clin. Exp.

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Certified deaths from fatal poisoning (accidents, suicides and open verdicts) in England and Wales have declined steadily (from 3952 in 1979 to 2565 in 2004). There was also a small annual reduction in suicides in males and in females over this period. In 2004, self-poisoning accounted for 25% of suicides and open verdicts in males (n ¼ 862) and 45% in females (n ¼ 540).Poisoning death rates per million prescriptions were about 10 times higher for tricyclic antidepressants (TCAs) than for selective serotonin reuptake inhibitors (SSRIs), England and Wales, 1993-2004. However, despite the increased prescription of SSRIs and related compounds in recent years, there has been only a slight decrease (some 10%) in the annual number of antidepressant-related poisoning deaths, in line with the reduction in suicides (all methods) over this period. Citalopram appears to have higher overdose toxicity than other SSRIs. Of newer non-SSRI antidepressants, the overdose toxicity of venlafaxine, although lower than that of TCAs, appears to be higher than that of SSRIs, with seizures, serotonin syndrome, rhabdomyolysis, renal failure and hepatic failure having been reported.Poisoning deaths involving antipsychotics either alone, or with other drugs and/or alcohol are many fewer than those involving antidepressants (713 and 5602 deaths, respectively, England and Wales, 1993-2004). Following the restriction on thioridazine usage (2000), thioridazine-associated fatal poisoning fell to zero by 2002, but this was balanced by an increase in deaths associated with atypical antipsychotics, most notably clozapine, olanzapine and quetiapine. Antipsychotic-related poisoning deaths were higher in 2004 than at any time since 1993.

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Section: Post-mortem Toxicologymentioning

confidence: 99%

Fatal toxicity of drugs used in psychiatry

Flanagan

2007

Hum. Psychopharmacol. Clin. Exp.

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“…[6][7][8][9][10] A differential diagnosis includes the entity known as idiopathic myocardial fibrosis (IMF), which accounts for 1-3% of cases of SCD. [11][12][13] IMF is characterised by heterogeneous interstitial fibrosis with a predilection for the inferior LV wall. 13 Replacement fibrosis is also observed and fatty infiltration is usually absent.…”

Section: Case Reportmentioning

confidence: 99%

Left Dominant Arrhythmogenic Cardiomyopathy Causing Sustained Ventricular Tachycardia – A Case Report

Guglielmi¹,

Cannas²,

Arancio³

et al. 2016

European Journal of Arrhythmia &Amp; Electrophysiology

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A 56-year-old white man was admitted to hospital because of palpitations and dyspnoea. He had no family history of cardiomyopathy or sudden death, and the electrocardiograms (ECG) of his son and parents were normal. He had an history of palpitations, and in the emergency department ECG showed sustained ventricular tachycardia-flutter with inferior axis right bundle branch block (RBBB) in V1 and heart rate 250 beats per minute. His standard ECG showed a complete RBBB pattern with minor ST-T segment changes. 2D echo and coronary angiography were normal, while magnetic resonance imaging (MRI) revealed a reduction in left mid-lateral wall thickening with hypokinetic movement and mild reduction of ejection fraction. An Extensive sub-epicardial area of conspicuous left ventricular intra-myocardial fat and sub-epicardial left ventricular late enhancement in lateral wall, was also seen at MRI. Case reportA 56-year-old white man was admitted to hospital because of palpitations and dyspnoea. He had no family history of cardiomyopathy or sudden death. He complained of palpitations starting in 2002, but had not been to see a doctor. In the emergency department, the ECG showed sustained ventricular tachycardia-flutter with apparently inferior axis right bundle branch block (RBBB) in V1 and heart rate 250 beats per minute (Figure 1). The ventricular tachycardia was associated with initial signs and symptoms of left heart failure and the patient was referred to the Coronary Care Unit where sinus rhythm was restored by direct current electric shock. Symptoms promptly restored after the procedure. The results of the investigation performed are listed in Table 1. LimitationsGenetic studies have not yet been performed because of high cost/ effectiveness ratio. DiscussionAfter the description of Markus and Fontaine, 1 the arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) has crossed the borders of the right ventricle. LDAC has been recognised as an associated or isolated entity also characterised pathologically by fibro-adipose replacement of the LV, often occurring as a circumferential band in the outer third of the myocardium and the right side of the inter-ventricular septum.2-5 First described at post-mortem examination in sudden cardiac death (SCD) victims,

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“…43 A national survey of the US law enforcement agency reported that 81% of police officers respond to emergency and 50% provide some level of medical care. 5 Security Officers in Casinos The placement of AEDs in casinos has produced favorable outcomes; 44 over approximately 3 years, security officers in 10 casinos used AEDs in 148 cases of cardiac arrest. The mean time from witnessed collapse to delivery of the first shock by the security officer was considerably faster (4.4 min) than the paramedics (10 min).…”

Section: Types Of Responders and Work Places For The Pad Programmentioning

confidence: 99%