Cardiac fibroma presenting as sudden death in a six-month-old infant

Cardiac fibroma is a rare benign tumour which occurs predominantly in infancy and childhood. We present the case of a six-month-old female infant who died suddenly at home and was found at autopsy to have a large cardiac fibroma in the ventricular septum. The tumor was apparently asymptomatic although there was evidence of mild cardiac failure. Death was thought to be due to a fatal arrhythmia. (Au)

Portal vein thrombosis in a child with homozygous sickle-cell disease

A 13-year old boy with homozygous sickle-cell (SS) disease died suddenly at home folllowing a short history of abdominal pain. Autopsy revealed venous thrombosis of the hepatic, portal, superior mesenteric and splenic veins. Venous thrombosis is rare in SS disease and thrombosis of mesenteric vessels is most frequently seen in chronic myeloproliferative disorders. Its occurrence in SS disease raises the possibility of a common pathogenesis and adds another pathology to the causes of abdominal painful crisis. (AU)

Sudden death in athletes in Trinidad and Tobago

Sudden death related to exercise activity is a well-recognised clinical syndrome. Although the incidence is low, it is always an agonizing experience to all concerned when a young, relatively healthy individual dies suddenly. Over the last four years, we have had six proven cases of sudden death in athletics. The cause varied from congenital to acquired pathology of the heart, and there was one case of heat stroke. From this study, we were able to analyse some of the risk factors and, from a review of the literature, we are able to determine (1) the feasibility of a screening programme, and (2) the design of such a programme as would be suitable for our environment. (AU)

Sudden death in athletes in Trinidad and Tobago - abstract

Sudden death related to excercise activity is a well recognized clinical syndrome. Although the incidence is low, it is always an agonizing experience to all concerned when a young, relatively healthy individual dies suddenly. Over the last 4 years, we have encountered 6 such cases, all males 5 of whom were under 30 years of age. In 4 patients, the cause of death was a congenital heart anomaly, one, the oldest at age 33 years, had an acquired cardiac condition, and the sixth patient died of heat stroke. An adequate pre-excercise screening tool for recreational and middle-aged athletes appears to be the `Preparation for Activity Readiness Questionnaire' (PAR-Q), and in the younger athlete who may be at increased risk for medical problems, it has been suggested that specific cardiac investigations should be considered. To minimize the occurrence of heat stroke in long distance runners in Trinidad and Tobago, a programme of education among athletes and race organizers has been implemented, supplemented by a set of guidelines provided to all athletes and their clubs (AU)

Sudden cardiac death caused by coronary ostial compression by an aneurysm of the sinus of valsalva

A 22-year-old man was asymptomatic until he died suddenly after being startled. Post-mortem examination was normal except for aneurysmal dilation of the left Sinus of Valsalva, the upper margin of which formed a flap-like ridge, partially occluding the ostium of the left main coronary artery which arose immediately above it. Further compression of this "slit-like" orifice by aneurysmal distention was the proposed cause of myocardial ischaemia and arrhythmic death (AU)

Suicide in Jamaica

The paper describes the methodology and findings of a personal enquiry on suicide in Jamaica. Seventy-six possible cases of sudden death were indentified among 29,000 deaths during 1975/76. It has been confirmed that suicide is rare in Jamaica. The rate in the total population of 2,000,000 was 1.4 per 100,000 per annum in 1975/76. The results of a field survey reveal that the suicide verdict was given in 16 out of 58 probable cases. This finding gives partial support to the hypothesis that this low suicide rate was the result of social factors but which consistently lead to the under-recording of suicide. Thus the verdict of suicide will not be given among farmers but is more likely to be given among the married and those who die in prison. The epidemiology of suicide is described. The data support the view that in the stable environment of a traditional society, the clearly defined female role will act as a defence against suicide. The suicide rate of females is higher than expected among the elderly and the previously married but is lower than expected for city dwellers. It is noteworthy that suicide among males in small towns is 3 to 4 times greater that expected (AU)

Death during recovery from severe malnutrition and its possible relationship to sodium pump activity in the leucocyte

The leucocyte data on four malnourished children who died suddenly when high-energy feeding was started were retrospectively analysed. The pretreatment rate constant for sodium efflux in leucocytes was higher and the intracellular sodium concentration lower in this group than in 13 malnourished children who recovered uneventfully with feeding. Two other children with unusual leucocyte electrolyte values and sodium pump activity were identified and closely monitored when high-energy treatment was begun. They rapidly developed the syndrome of extracellular fluid overload but were successfully treated with diuretics and digoxin. Though the precise relation between the findings in the leucocytes and the development of this overload syndrome is not clear, the pretreatment leucocyte values are nevertheless valuable in predicting which malnourished children are at risk of sudden death when refeeding is started.(AU)

Gross cardiac involvement in glycogen storage disease type 3

This report describes a patient with type 3 glycogenosis diagnosed during life but who died suddenly at home and was found at necropsy to have gross cardiac involvement. The immediate cause of death was not apparent but could possibly have been related to the very unusual degree of cardiac involvement (AU)

Prognosis of idiopathic cardiomegaly in Jamaica with reference to the coronary arteries and other factors

Clinical and epidemiological features of idiopathic cardiomegaly in Jamaica are reviewed, and the high community prevalence of the disorder is shown. The frequency occurrence of sudden or unexpected death in patients whose earlier electrocardiograms had shown repeated ventricular ectopic beats has been noted. Common electrocardiographic findings included a high rate of abnormalities usually regarded as indicative of coronary artery disease: cardiac arrhythmias, particularly multiple ventricular extrasystoles; and high voltage complexes characteristic of left ventricular hypertrophy. The differences and similarities between idiopathic cardiomegaly and coronary heart disease are shown. A possible role for intramuscular lignocaine in the control of the chronic ventricular ectopic rhythms is demonstrated. There is a statistically significant association between idiopathic cardiomegaly and positive serological tests for treponemal infection. The hearts are invariably hypertrophied at necropsy. In some hearts the smaller intramuscular coronary arteries show occlusive changes. Their possible nature and significance are discussed.(AU)

Neonatal death and massive pulmonary haemorrhage in Jamaica

Examinations were carried out on 27 newborn infants dying with massive pulmonary haemorrhage. Pulmonary haemorrhage occurred in 8 percent of neonatal deaths in this hospital: 52 percent of cases died early in the neonatal period and 48 percent later. Anoxia was considered to be the main causal agent in the majority of early cases. In the later cases several factors were considered responsible.(AU)