Thursday, January 15, 2009

Seasons of the heart - sudden death

One of the more interesting reports in the newspapers recently, other than the usual stuff about human organ trade and the conflicts within regulatory agencies :), was the tragic report about the student who died suddenly. Raffles Institution student Tee Yan Chyuan, merely 12 years of age, had collapsed suddenly after a game of badminton and died. He had apparently been very fit before, and was said to have died from cardio-respiratory failure failure....which generally means no one knows why. I don't think the forensics report is out yet, at least not out in the public domain.

I have posted a bit about this before. In an adult, usually the more senior ones, the commonest cause of such sudden deaths are usually related to an fatal arrhythmia (cardiac seizure) due to coronary insufficiency. Although these patients are getting younger and younger, coronary insufficiency is unable to account for the cases who are very young, who die suddenly. Most certainly, this young boy would not have died of coronary insufficiency. Coincidentally, there is a current report in CNN about the same kind of problem but in patients treated with antipsychotic drugs.

Just Googling the problem turns up various reviews about this problem. A fairly representative review can be found here. It always amazes me that the heart can maintain such intricate rhythms without failing. Something of a miracle no matter how you look at it. Yet I believe sometimes it does seize up....but very very rarely. Sometimes it occurs in the context of coronary insufficiency, when the heart does not get enough oxygen. But in the very young it may inexplicably just seize up for no other reason than the delicate mechanisms driving the heart rhythms just screw up. Sometimes this may be the consequence of a rare (very rare) genetic abnormality of the various mechanisms (ion channels etc) regulating the flow of ions and electrical currents of the heart. This may often require some sort of environmental trigger, such as exercise or some medicine/chemical. There is a particular genetic abnormality of calcium handling that confers a high risk of a heart seizing up particularly during exercise. I don't think we will ever know what really happened to this boy. Such deaths leave no footprints, and I can imagine it will be very difficult for the forensic team to figure this out (CSI or no).

Understanding this, of course presents little comfort to the family of Tan Yan Chyuan. My heart goes out to them. It is a very tragic and painful loss. I can't imagine the pain of ever losing any of my own bao beis (precious ones).

No comments: