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Travel, time zones, and sudden cardiac death. Emporiatric pathology
1G. N. Wilcox Memorial Hospital, Lihue, Hawaii.
Insights
Travelers experienced sudden cardiac deaths due to coronary arteriosclerosis at younger ages. This syndrome, linked to travel stress, showed increased risks for visitors with two-vessel disease compared to locals.
Area of Science:
- Cardiology
- Travel Medicine
- Forensic Pathology
Background:
- Sudden cardiac death (SCD) typically affects older individuals.
- Previous studies on SCD have noted circadian patterns, with a morning peak.
- Coronary arteriosclerosis is a common cause of cardiac events.
Purpose of the Study:
- To investigate an unusual subset of sudden deaths among travelers.
- To identify risk factors and characteristics of these deaths.
- To explore potential causes, including travel-related stress.
Main Methods:
- Retrospective analysis of coroner's autopsies over 11 years on Kauai.
- Comparison of death incidence and characteristics between travelers and local residents.
- Examination of coronary artery disease (CAD) severity and acute coronary changes.
Main Results:
- Travelers with two-vessel disease had a significantly higher incidence of sudden death (4x), coronary thrombosis (9x), old myocardial infarcts (6x), and cardiomegaly (3x) compared to Kauaians.
- The circadian pattern of these deaths differed, showing a steady rise through the day, unlike the typical morning peak.
- Underlying chronic conditions like cardiomegaly and prior myocardial infarction were more prevalent in travelers.
Conclusions:
- A unique syndrome of sudden cardiac death, linked to coronary arteriosclerosis, affects younger travelers.
- Travel stress and time zone changes are postulated as causative factors.
- The findings highlight the impact of travel on cardiovascular health, particularly in individuals with pre-existing coronary issues.
Abstract:
In an 11-year retrospective study of coroner's autopsies on the Hawaiian island of Kauai, it was found that an unusual and apparently unique subset of travelers died suddenly. Death was caused by coronary arteriosclerosis, was characterized by acute coronary changes, and occurred in a group younger than the usual age for sudden cardiac death. Visitors with two-vessel disease had an incidence of sudden death nearly four times that of Kauaians (p less than 0.02), with a ninefold increase of coronary thrombosis (p less than 0.001), a sixfold prevalence of old myocardial infarcts (p less than 0.001), and three times the prevalence of cardiomegaly (p less than 0.001). The circadian pattern of these deaths was different from that previously described in acute myocardial infarction or sudden death, with the number of incidents rising steadily through the day in contrast to the morning peak described in previously published series. The syndrome was expressed in decedents with two-vessel coronary disease either with acute coronary artery lesions--thrombosis, hemorrhage in a plaque, or ruptured coronary artery--or no lesions, presumably spasm. Underlying chronic processes included enlarged heart or old myocardial infarct, which both occurred with a significantly greater incidence in travelers than in local residents, and in a totally different pattern from that occurring in subjects with three-vessel disease. It is postulated that the syndrome is caused by stress related to travel and time zone changes.