Supportive needs of parents confronted with sudden cardiac death--a qualitative study.

The death of a close family member is one of life's greatest tragedies. When death is sudden and unexpected, there is an increased risk of posttraumatic reactions and complicated mourning. Care of the bereaved is still often overlooked in medical training and clinical practise. The aim of this study was to elucidate the perceived support and the needs of bereaved parents confronted with sudden cardiac death (SCD) in a young son or daughter. Data were derived from a qualitative contents analysis of tape-recorded, in-depth interviews with bereaved parents confronted with SCD 5-12 years post-loss. The 20 deceased individuals were part of the Swedish forensic SCD cohort of 15-35 year olds from 1992 to 1999. One third of the parents had had no contact with the emergency department (ED), one third had been disappointed after meeting care-givers at the ED who did not act with sensitivity and consistency, while one third were more or less satisfied with the handling at the ED. A majority of the parents experienced a lack of follow-up care; they had been left mainly to themselves to find information and support. Four factors were identified as being particularly important for the parents: evidence, reconstruction, explanation and sensitivity. There is a need of better routines to help the suddenly bereaved. A model of the major needs and a plan for the support needed are proposed.

Characteristics and outcome amongst young adults suffering from out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation is attempted.

OBJECTIVES: Amongst patients suffering from out-of-hospital cardiac arrest, young adults represent a minority. However, these victims suffer from the catastrophe when they are in a very active phase of life and have a long life expectancy. This survey aims to describe young adults in Sweden who suffer from out-of-hospital cardiac arrest and in whom cardiopulmonary resuscitation (CPR) is attempted in terms of characteristics and outcome. DESIGN: Prospective and descriptive design. SUBJECTS AND METHODS: Young adults (18-35 years) who suffered from out-of-hospital cardiac arrest in whom CPR was attempted and who were included in the Swedish Cardiac Arrest Registry between 1990 and 2004. MAIN OUTCOME MEASURES: Survival to 1 month. RESULTS: In all, 1105 young adults (3.1% of all the patients in the registry) were included, of which 29% were females, 51% were nonwitnessed and 15% had a cardiac aetiology. Only 17% were found in ventricular fibrillation, 53% received bystander CPR. The overall survival to 1 month was 6.3%. High survival was found amongst patients found in ventricular fibrillation (20.8%) and those with a cardiac aetiology (14.8%). Ventricular fibrillation at the arrival of the rescue team remained an independent predictor of an increased chance of survival (odds ratio: 7.43; 95% confidence interval: 3.44-16.65). CONCLUSION: Amongst young adults suffering from out-of-hospital cardiac arrest and in whom CPR was attempted, a minority survived to 1 month. Subgroups with a higher survival could be defined (patients found in ventricular fibrillation and patients in whom there was a cardiac aetiology). However, only one independent predictor of an increased chance of survival could be demonstrated, i.e. ventricular fibrillation at the arrival of the rescue team.

Sudden cardiac death in the young in Sweden: electrocardiogram in relation to forensic diagnosis.

OBJECTIVES: To study electrocardiogram (ECG) in relation to forensic diagnosis in young persons who suffered a sudden cardiac death (SCD) in Sweden during 1992-99. DESIGN: A register study of a national database of forensic medicine in Sweden, selecting all cases of SCD 15-35 years of age. In this group, 12-lead ECGs and clinical data were searched for in military conscription and medical records. The ECGs were re-analysed and classified according to the Minnesota code criteria. SETTING: The whole nation of Sweden. SUBJECTS: Sudden cardiac death victims (66 individuals), 15-35 years of age, where it was possible to obtain an ECG recording. RESULTS: We observed major or minor ECG abnormalities in 82% of the subjects. The most common changes were T wave abnormalities (35%), ST segment changes (32%) and conduction defects (20%). The ECGs were evaluated as pathological in 50% of the cases, more often in arrhythmogenic right ventricular cardiomyopathy (88%) and hypertrophic cardiomyopathy (82%). Cardiac-related symptoms were seen in 76% of the total group and there was a family history of a similar cardiac condition in 18%. CONCLUSIONS: Pathological ECGs were common in young SCD victims, in spite of being taken many years before death. An ECG could help identify prospective victims of SCD, and should always be taken in cases with possible cardiac-related symptoms or a family history of SCD. The pathological ECGs were often found in connection with routine screening at military enlistment for men, which raises the question of a routine screening in the young, including women.

Sudden cardiac death in 15-35-year olds in Sweden during 1992-99.

OBJECTIVES: To study the incidence, pathogenesis and symptoms preceding sudden cardiovascular death amongst 15-35-year olds without substance abuse in Sweden during 1992-99. DESIGN: This was a register study of a national database of forensic medicine, Rattsbase. Clinical details were obtained from forensic, police and medical records and from interviews with family members. SETTING: The whole nation of Sweden. SUBJECTS: Individuals having suffered a sudden cardiac death. RESULTS: We found 181 cases of sudden cardiovascular death in a nationwide database, Rattsbase, in 15-35-year olds, of which 132 (73%) were male and 49 (27%) were female, and a rather stable incidence of 0.93 per 100,000 per year. Preceding symptoms were seen in half of the cases. The most common forensic diagnoses were: no structural abnormality (21.0%), coronary atherosclerosis (17.7%), dilated cardiomyopathy (12.2%), hypertrophic cardiomyopathy (10.5%) and myocarditis (10.5%). CONCLUSION: Sudden cardiovascular death was uncommon in the young, but the incidence was not decreasing. Postmortem diagnoses were often difficult to establish. There was a high frequency of structurally normal hearts. Because premortal cardiac-related symptoms are relatively common and treatment methods are developing, we should learn to recognize early symptoms of heart disease. To identify individuals at risk, further studies of preceding symptoms, life-style factors and electrocardiogram (ECG) changes are needed.

Miniplate osteosynthesis and cellular phone create disturbance of infraorbital nerve.

A 37-year-old man with a zygomatic fracture underwent surgical treatment with reduction of the fracture and osteosynthesis with a miniplate on the infraorbital rim. Postoperatively, he had numbness in the distribution area of the infraorbital nerve, but he also suffered from dysesthesia in the same area during periods when he was using his hand-held mobile phone. After surgical removal of the osteosynthesis plate, the dysesthesia associated with his mobile phone was no longer present. The plate was examined in a setup where we measured the electric current that developed on the surface of the plate under the influence of the magnetic field between the phone antenna and the metal plate. The highest currents measured on the actual plate were 141 mV in air, and 21 mV in saline. These findings indicate that there might have been a correlation between the presence of the miniplate close to the infraorbital nerve, and the dysesthesia experienced by the patient, under the influence of the energy emitted from the cellular phone.

[Sudden death among young people. ECG and selective investigation of non-specific postinfectious problems may prevent fatal outcome]. / Plötslig död bland unga. EKG och riktad utredning vid ospecifika besvär efter infektion kan förebygga dödsfall.

Three cases cardiac death in young male athletes are described, and the medical management outlined. On the basis of extensive data available in published reports, it is argued that the risk group can be more clearly distinguished clinically than is usual today. It is stressed that athletic young adults consulting for dyspnoea, cardiac arrhythmia, syncope, tiredness, or nonspecific postinfectious symptoms, may have serious cardiac disease. It is concluded that, to prevent sudden cardiac death, ECG examination should be performed without delay, followed in the case of abnormal findings by extended cardiological investigation.

Extent and flux density of static magnetic fields generated by orthodontic samarium-cobalt magnets.

The aim of this study was to measure and to analyze the extent and flux density of static magnetic fields generated by commercially available samarium-cobalt magnets used in orthodontics. The flux density was measured with a gaussmeter and a Hall probe with the magnets mounted in clinically relevant positions, i.e., in attractive and in repelling positions and also in the single position. Furthermore, the flux density between new and clinically used and recycled magnets was compared. It was found that the maximum flux density was generated at the pole faces and that magnets in attractive positions produced the highest flux density (2.2 kG), followed by the single magnet (2.0 kG) and the repelling magnets (1.7 kG). The flux density decreased rapidly (exponentially) with increased distance from the magnets. The flux density was approximately the same or less than the flux density of the earth magnetism (0.3 to 0.7 G) 60 mm from the attractive magnets, 50 mm from the single magnets, and 35 mm from the repelling magnets. The difference in flux density between new and clinically used and recycled samarium-cobalt magnets was negligible. Thus, the static magnetic field exposure of surrounding tissues can be assumed to be low, and the conceivable risk of harmful biologic effects must be regarded as small and limited when the tested orthodontic magnets are used clinically.