"WE HUMANS do not like things left up in the air, we find living with uncertainty very difficult," says Dr Bartley Sheehan, Dun Laoghaire coroner for the last 24 years, about the new term being used in medical circles to describe a sad, fatal and mysterious phenomenon: Sudden Adult Death Syndrome.
Every year a small number of seemingly healthy, generally young people die with no apparent cause for their death. The number is so small that there are no statistics for it. These deaths have recently become known as Sudden Adult Deaths. "The term Sudden Adult Death Syndrome is putting a name to our experience, it makes it sound very important, although we know nothing about it," says Dr Sheehan.
He feels that there are probably more SADS than are recorded because incidences may be notified as something else to avoid entering the unsatisfactory "cause of death unknown" on death certificates.
Dr Dervla Royston, a pathologist at Beaumont Hospital, Dublin, was involved in the case of the sudden death of a healthy 34 year old man last December which an inquest earlier this year suggested might fall into the Sudden Adult Death category
She agrees with Dr Sheehan that SADS his really a deficiency in our knowledge" and goes further by saying that she doesn't believe it is a syndrome at all. "It's just a label," she believes.
Sudden Adult Deaths are most likely caused by serious heart rhythm disturbances. The vast majority of heart arrhythmia are harmless: many normal people have them according to Dr Brian Maurer, consultant cardiologist at St Vincent's Hospital, Dublin.
"The heart beat is regulated by our natural pacemaker which is situated on the top of the heart. It sends out impulses which cause the heart to beat. If something interferes with the electrical impulses, the heart rhythm is changed," he says.
Normally the heart rights itself quickly but two forms of arrhythmia can be fatal. One is asystole arilithmia which stops the heart for a moment: if the heart is unable to restart itself the person dies. The other arrhythmia is ventricular fibrillation. When this occurs the co ordination between the pumping chambers is disrupted and the heart is no longer able to pump blood to the body, consequently the person dies.
The reason why heart arrhythmia are blamed for SADS is that they leave no structural damage to the heart so at the autopsy there is no evidence pointing to the cause of death. Dr Sheehan recalls a house visit that he made on a patient a number of years ago when, during his examination of her heart, the patient experienced ventricular fibrillation and died immediately.
Dr Maurer stresses that Sudden Adult Death Syndrome or unexplained death syndrome as it is sometimes called is very rare and the public has nothing to be alarmed about.
Sudden Infant Death Syndrome is the more common and more widely known syndrome and Dr Tom Matthews, Professor of Paediatrics at UCD, believes that the mechanism of death is similar if not identical. Professor Matthews says "it is legitimate to link the mechanism of death but the risk factors associated with SIDS are not relevant to SADS, say for example lying a baby down on its front".
All four doctors concur on the view that Sudden Adult Death Syndrome is a new concept used to explain the inexplicable. Dr Matthews adds however that "if you don't identify it as a syndrome it will not be studied".