Thermogenic supplement use does not alter characteristics of sudden death in the young.

BACKGROUND: To evaluate supplement use, most notably ephedra, which has been temporally associated with sudden death. Animal models suggest increased myocardial irritability may predispose to primary arrhythmic death. METHODS: Clinical, pathological, and investigative records from the Office of the Armed Forces Medical Examiner's Cardiovascular Death Registry were reviewed. Forty-eight cases of those with known supplement use were compared to 144 age-, gender-, and socioeconomic-matched controls in a 1:3 case:control manner. RESULTS: Of the 48 sudden deaths temporally associated with supplement use, the mean age was 34.2 ± 10.0 years and predominantly male (n = 44, 91.7%). The underlying cause of death was fatal atherosclerotic coronary disease in 18 (37.5%), sudden unexplained death in 16 (33.3%), and hypertrophic cardiomyopathy in six (12.5%). Compared with controls, there were no statistically significant differences in adjudicated cause of death. On autopsy, there were no differences in cardiac mass, ventricular wall thickness, or presence of atherosclerosis in those known to be taking identified supplements compared to a control population. In the subject ≥35 years, and known to be taking supplements, there was a significant increase in causality of death as due to sudden unexplained death (relative risk = 5.1 [95% confidence interval, 1.4-18.7]). CONCLUSIONS: Active surveillance of mortality in an autopsy-derived series of young adults finds atherosclerotic coronary disease and idiopathic sudden death are common etiologies of death when taking supplements, but no cardiac structural or histologic mechanism to suggest different pathologic process than a matched control population.

Sudden death in young adults: an autopsy-based series of a population undergoing active surveillance.

OBJECTIVES: The purpose of this study was to define the incidence and characterization of cardiovascular cause of sudden death in the young. BACKGROUND: The epidemiology of sudden cardiac death (SCD) in young adults is based on small studies and uncontrolled observations. Identifying causes of sudden death in this population is important for guiding approaches to prevention. METHODS: We performed a retrospective cohort study using demographic and autopsy data from the Department of Defense Cardiovascular Death Registry over a 10-year period comprising 15.2 million person-years of active surveillance. RESULTS: We reviewed all nontraumatic sudden deaths in persons 18 years of age and over. We identified 902 subjects in whom the adjudicated cause of death was of potential cardiac etiology, with a mean age of 38 ± 11 years. The mortality rate for SCD per 100,000 person-years for the study period was 6.7 for males and 1.4 for females (p < 0.0001). Sudden death was attributed to a cardiac condition in 715 (79.3%) and was unexplained in 187 (20.7%). The incidence of sudden unexplained death (SUD) was 1.2 per 100,000 person-years for persons <35 years of age, and 2.0 per 100,000 person-years for those ≥ 35 years of age (p < 0.001). The incidence of fatal atherosclerotic coronary artery disease was 0.7 per 100,000 person-years for those <35 years of age, and 13.7 per 100,000 person-years for those ≥ 35 years of age (p < 0.001). CONCLUSIONS: Prevention of sudden death in the young adult should focus on evaluation for causes known to be associated with SUD (e.g., primary arrhythmia) among persons <35 years of age, with an emphasis on atherosclerotic coronary disease in those ≥ 35 years of age.

Platypnea-orthodeoxia: an unusual case of hypoxemia.

A 52 year old female presented for two weeks of acute onset dyspnea on exertion. She was found to be hypoxic with a room air saturation of 88%. Baseline echocardiogram was normal with the exception of aortic root dilation. Right and left heart catheterizations were performed. The coronary arteries were normal in original and without disease. The right heart catheterization demonstrated normal pulmonary pressures and "no evidence of intra-cardiac shunt". Repeat echocardiogram was performed with agitated saline contrast and revealed a small amount of right to left shunting across the intra-atrial septum with cough while supine and significant right to left shunting while upright; these findings were consistent with the presence of a patent foramen ovale (PFO) and platypnea-orthodeoxia syndrome. The patient underwent percutaneous closure of her PFO with an Amplatzer device, and exhibited rapid resolution of her symptoms and hypoxia. She is off oxygen and has returned to work as a nurse practitioner. The case highlights the importance of clinical vigilance and consideration of this syndrome in the differential diagnosis of unexplained hypoxia. Our patient had a dramatic and positive outcome: complete alleviation of dyspnea and oxygen dependence after PFO closure.

Comfort and efficacy of a longer and thinner endoscope for average risk colon cancer screening.

The aim of this prospective study was to assess patient comfort during nonsedated screening sigmoidoscopy with the use of a standard 60-cm sigmoidoscope compared with a thinner 100-cm upper endoscope. Patients undergoing routine colon cancer screening with sigmoidoscopy were randomly assigned to either a 60-cm sigmoidoscope or a 100-cm upper endoscope. The procedure time, depth of insertion, anatomic landmarks, and presence of polyps were documented. Likert 7-point scales and visual analog scales (VAS) were performed to measure comfort and symptoms immediately after the procedure and again in 1 week. These scales, procedure time, insertion depth, percent reaching transverse colon, and percent with polyps were analyzed. Eighty-one patients were enrolled with 38 in the 100-cm group and 43 in the 60-cm group. Patients in the 100-cm group reported greater comfort on the VAS compared with the 60-cm group (P = .035) as well as less cramping on the initial Likert scale (P = .017). One week later, the 100-cm group reported higher comfort (P = .015) and less bloating (P = .040). Procedure time was longer for the 100-cm group (8.8 versus 5.9 minutes; P = .001). Insertion depth was 74 versus 56 cm (P = .001), and percent reaching splenic flexure was 76% versus 35% (P = .001) in the 100 and 60 cm groups, respectively. More adenomas were found with the 100-cm scope (P = .035). The use of a thinner and longer endoscope is more comfortable than a standard sigmoidoscope. Although a 100-cm endoscope procedure takes longer to perform, it allows better evaluation of the colon and misses fewer adenomas.