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Genetic autopsies to unravel the mystery of sudden deaths (elpais.com)
52 points by PaulHoule 8 months ago | hide | past | favorite | 57 comments



My sister had one of those "blank autopsies." Otherwise healthy 29-year-old women just don't normally experience sudden cardiac death, even when they are 8 months pregnant.

The medical examiner's report even said that since the cause of the sudden cardiac death could not be determined, any of her siblings or offspring (me and our brother; her son didn't recover brain activity after being without oxygen for an hour before they could do the C-section) receive a full cardiac workup and look into testing for any lethal heritable cardiac channelopathies.

Neither of us found anybody who would do a broad-scale genetic test on the basis of the report, but we both saw cardiologists who confirmed our hearts are apparently fine.

It's much too late now to take her blood (she passed away six years ago), but I thought the lab had retained some of it for later testing. It's probably one of those things that'll just stay a mystery, but I'm glad fewer people will have to wonder.


I’m so sorry for your loss.

Some heart problems aren’t really detectable after death. I have Long QT syndrome, which is basically an electrical problem that affects heart rhythm and makes people who have it susceptible to sudden cardiac arrest. Because it’s an electrical problem, you wouldn’t see it if the heart isn’t beating. It’s taken out at least two people in my genetic family. I’m not sure if you were tested for that (genetic testing would be best), but it might be worth looking into.

LongQT is notoriously difficult to pick up on an EKG unless they are using a 12-lead EKG and looking for it and even then it might be a no show. When I was tested, I was originally told by the cardiologist that I did not have it. Then my daughter was tested and she _did_ have it, and she would have only gotten it from me. So they did genetic testing on me and confirmed.

The cardiologist was wrong, but it wasn’t his fault. I’d suggest getting additional testing other than an EKG.


> I have Long QT syndrome

Man, didn’t expect to see this here today. My siblings (from another mother) all have Long QT or are carriers. Two have pacemakers. Their mother died of sudden cardiac event while sleeping which in retrospect was obviously Long QT. I live on the other side of the country and two of my sisters are visiting now and I just read them your comment. One (with a pacemaker, the second to have seizures as a teen) had very much the same experiences as you, with confused cardiologists changing their diagnoses. Back then, it was a miracle they got a diagnosis at all because we happened to live close to a very important cardiology centre.

Anyways, not entirely sure why I am posting this other than to say we experienced a very similar thing and it is quite scary and I am sorry you are going through it. It’s awful, but thankfully manageable with beta blockers or pacemakers. It could be worse, but it’s pretty traumatic. Hope you and your daughter stay ok :-)


That’s crazy. Other than my daughter I’ve never met anyone else who has it.

You totally nailed it lol- I have a defibrillator implant (no pacing) but have never had an event. And my daughter and I both take beta blockers.

It really does keep it under control; Its weird to think about how something so dangerous can be so easily managed when you know what’s going on.

I hope the path to diagnosis for your family was quick. It took awhile in mine and even then I’m not 100% sure how they figured it out.


My understanding also is that you can get long QT from certain drugs, like the early (but still highly effective) antidepressant imipramine.

https://www.ncbi.nlm.nih.gov/books/NBK534864/

I don’t know if it’s a hazard to everyone or if someone who has a propensity to long QT is particularly susceptible to those drugs


The path to diagnosis was around 30 years ago when they started having seizures. It took approx 3 years or so to identify it and again, only by luck given our proximity to a major cardiac centre. I wonder whether something like the Apple Watch EKG could identify it today such that it could alert people that they should go for confirmation by a cardiologist?


I don't know about the Apple Watch but there's a handheld personal EKG called Kardia (https://kardia.com) that works well. You hold the ends of the device and place the bottom on your knee (on bare skin) and take an EKG. You can easily fit this thing in your pocket.

I think our cardiologist worked with them on developing the device and we use it to take EKGs and remotely send them to the clinic. I think it's sensitive enough they can use it to look for stuff like this, but I also think LongQT is tricky enough to detect it just may not always show up. Maybe you could do a series of EKGs over a period of time and send them all in or something.


Are there other hallmarks of the condition that might help rule it in or out?

They told us part of the heart muscle itself was dead, meaning there would have been no hope of resuscitation, but also that it showed signs of multiple infarcts. They just didn't know if they were all at once or had happened over years and had never been diagnosed.

Medical neglect is a not-insignificant part of our childhood stories, and it's hard to figure out what we don't even know to pay attention to as adults.


I wish I had more to offer, here.

I don't think there are, but I'm not a doctor.

It's usually tested for genetically or with an ekg. It doesn't have any outward physical signs or traits that I'm aware of. There are several different subtypes and each has different triggers; so diagnosis usually happens in response to an event. For example, passing out when the phone rings because you're surprised. I don't think a lot of doctors know much about it. In my case, I didn't find out I had it until I was in my 40s and that was because I made contact with my biological family (I'm adopted) and they told me I needed to get checked for it.


I'm so sorry for your loss.

In my first year of college, I lost a close friend in a similar way. Perfectly healthy 18-year-old girl. Went to sleep in her dorm one night and never woke up. It was my first real experience with death, at least at an age that I could truly understand what was happening, and I think not having a real cause made it so much more difficult to process.

They did find a cousin afterwards who had an undiagnosed heart defect, but they said that it was likely unrelated. Still, a small bit of light I suppose from an otherwise tragic event, that otherwise it might not have been found and he might not have known.


My mom's grandfather passed away from an aneurysm in his 40s. Her brother died of an aneurysm in his 20s. Her younger sister had some sort of brain-blood-vessel anomaly related to a benign tumor, but she had it removed. My mom had an aneurysm burst in her 70s but she survived. Her neurologist said that all my great-grandpa's descendents should get brain MRIs to determine if we have the same problem.

Several of my siblings and our kids got brains scans, but nobody found anything to report on them.

Meanwhile, two of my mom's younger sisters (both in their 70s) just passed away since 2021 from pancreatic cancer. Scary stuff.


God I'm sorry for you and your family.


If she ever did some sort of surgery, they often have some samples they keep frozen for various purposes.


I'd be very wary of this. Very few medical conditions have any kind of strong and simple link to known genes or gene networks.

"This gene combo has a 10% chance of mortality due to cardiac causes" doesn't tell you much about one person who died suddenly. There are a lot of people with those genes who didn't die suddenly of that thing, or did but of something else.

So at best you're working with a sort of a shrug in a certain direction.


While I agree that you want to be wary of any particular claims, and more study is warranted to establish the effectiveness of any particular intervention based on data, there’s a Bayesian justification to looking at otherwise unexplained deaths. “When you have eliminated the impossible, all that remains, no matter how improbable, must be the truth.”


And what about when "all that remains" is 47 different possibilities? That's not a very satisfying truth.


You have to start the process of elimination somewhere. Sometimes that process involves multiple steps.


My maternal great-grandfather, maternal uncle, and mother all had burst brain aneurysms; my mother fortunately survived hers. Her sister had a blood-vessel abnormality in her brain related to a benign tumor.

Whether the genes / gene networks are known or not, it seems very obvious that there's something hereditary going on there.

In one of the cases in the article, the 15-year-old who died had scarring in his heart and a blood relative who already had a heart implant related to arrythmias. They confirmed he had genes related to this issue as well. Seems pretty open-and-shut.


My favorite theory on genes is the omnigenic model. In that model, EVERY gene expressed in a cell affects the other ones. It seems to explain for me why we have such trouble converting genetic testing results to actionable outcomes. Since humans have 20,000-25,000 genes, the different permutations of that possible and interacting are staggering.

https://en.wikipedia.org/wiki/Omnigenic_model


I think channelopathies are an exception to that general rule, so it would depend how specific the issue is that they're identifying.


Yes, some channelopathies are simple Mendelian traits, i.e. just one variant is explaining most of the phenotype variability.


Even if this particular research doesn't lead to any life expectancy improvements directly, it can still further our understanding of the mechanisms involved, and possibly lead to effective interventions when coupled with future studies.


Yeah, memento mori. Not entirely related, but I was diagnosed with a complete AV block over a year ago, but refused pacemaker implantation. Just reminds me that if even semingly healthy people can die like this, then I have no hope for the future, not at all.


May I ask why you chose to refuse the pacemaker?


Because I think that it's not a life worth living, because living like this would feel fake, artificial. I don't want it to depend entirely on some device with battery. Moreover, it brings problems and potential risks on its own and is unlikely to extend lifespan significantly.


The only piece that makes sense about what you said is that it is unlikely to extend lifespan. Do you consider all life-saving medical interventions to be "living a fake life"?

I experienced a very bad compound fracture of my wrist, and I have metal plates and a bunch screws permanently implanted into my left radius and ulna. I don't consider the use of my left hand to be fake or artificial, but by your rationale I'm fooling myself.


What I meant is "being kept alive by artificial means". You can live without having a functioning hand - you can't without a functioning heart. But, to some extent yes, if it's something your body cannot recover (well enough) from, and you have to resort to external interventions by planting some kind of artificial material into you body, it's faking your body's capabilities. May be life saving or improve quality of live significantly for sure, but it's an illusion, it's not you in your biological entirety. I am not smart or eloquent enough to describe it in detail, but that's the gist of it.


Is the use of eyeglasses or hearing aids "fake" too? Or do you have some kind of fear of contamination, being "less-than-human"? Your views seem quite abnormal.


>Is the use of eyeglasses or hearing aids "fake" too?

Yes.

>Or do you have some kind of fear of contamination, being "less-than-human"?

No. In fact, I have nothing against external life enhancing tools of any kind, be it glasses, hearing aids or anything else. I do not look down on anyone for having any kind of artificial devices, either invasive or non invasive. Just for me personally, the idea of having artificial devices as a permanent part of biological flesh feels awful. I like technology, but at hand's reach.

>Your views seem quite abnormal.

Good.


I have a defibrillator implant and run half marathons and 5ks. I view it as a challenge to get past that limitation.

I respect your view, but maybe it’s not as limiting as you think it is. The pacemaker doesn’t define you, it just gives you the backup you need so you can do whatever you want to do.


You're already an enormously complex device and your heart beat is triggered by many tiny batteries inside of you.


Yes, but they are biological with which I was born with and not a manufactured chunk of metal with circuits.


The fact that you're on this website typing with a computer means that your life has been materially altered by the development of computers, thanks to all of the hours of the humans that came before us, working learning and building, to bring technology, and you are using that technology to explain that you don't want to use that technology to prolong your life.

I've spent a quarter of my life building tools and environments to help advance spaceflight - I hope to hell that everyone in the future who has the potential to be helped by my work takes advantage of it, otherwise what was it for?


That's not what I had in mind. Whatever.


My dog required a pacemaker due to a total block at a young age. It cost us basically nothing because she was insured. Would you have considered her any less of a dog? If your pet required a pacemaker would you love them any less? Would you refuse them the procedure?


I don't consider anyone "less" for having any kind of medical intervention. If it required a pacemaker, I would agree without a second though, absolutely.


That's your decision but a defeatist view.

Not everyone is the same, nor are the lives they lead, the lifestyles they lead (exercise/diet). In a population of our size there is likely going to be seemingly health people who unfortunately pass away, but that shouldn't stop people from being able to attempt to repair their health problems and ultimately live longer.

These people didn't have a choice, but you did.


Not to suggest that the phenomena are necessarily related (though it wouldn't surprise me), there's also this:

>Sudden unexpected death in epilepsy (SUDEP) is a fatal complication of epilepsy. It is defined as the sudden and unexpected, non-traumatic and non-drowning death of a person with epilepsy, without a toxicological or anatomical cause of death detected during the post-mortem examination.

https://en.wikipedia.org/wiki/SUDEP .


A cardiologist told me that the hearth rhythm is a chaotic system.

My inference is, chaotic systems are, well, chaotic. Sudden cardiac deaths could be simply the result of a healthy chaotic system going off the reservation.


If there's nothing they can do, I don't want to know.

I don't want to know if I'm predisposed to cancer, ALS, Alzheimers, heart disease, stroke, or anything else if there's nothing that can be done to change that. I also don't want to be hacked up by a surgeon, irradiated, and pumped full of toxic chemicals to give me another year or two.


Two sudden unexplained fatal heart attacks in my family recently. Healthy men. Yes, they received all the "vax" shots. They were quite diligent about that.

If I was of a conspiratorial mind, I might suspect that the vax was the cause.


Wow, crazy that they didn't have anything else in common besides that, like lifestyle or genetics.


Yeah, that crazy heart attack gene ya'know.


Why does it seem like most autopsies are done purely for curiosity, without any actual benefit to anyone living or dead?


I really can't follow what you mean and fail to understand where they're being performed where there would be no benefit at all.

Many of them are performed because they're required by law, to establish a cause of death both for the families but also potentially to understand if someone else was responsible for the death.

Many of them are performed because outside of the above, we have historically learnt an enormous amount about the human body through studying them, particularly for unique injuries or illnesses.

Otherwise, there are many that aren't performed at all


They're often performed pursuant to law.


That just moves the question to why does the law require it? Just for curiosity?


The law mostly doesn't require it. Only if a crime is suspected, or perhaps in case of accidental death to determine if the accident caused the death or something else happened first (e.g. stroke, heart attack) that lead to the fatal accident (could be very important to determine liability, if any).

But your average old or sick person passing away at home, generally does not get autopsied.


to ensure or assure no foul play and to keep stats of what's killing us and sometimes try to mitigate those things.


For the same reason we investigate plane crashes, to fucking know what really happened. What is a death certificate without an autopsy is just a scratch on the surface. Sometimes we need to go deeper.


This looks like a good cover for vaccines that may or may not help, but governments push down the throat of people anyway. Oh, you're okay? That was us. Oh you're not/dead? Here is a genetic marker for BullshitX that caused it. Not us.


Yeah and a thinly veiled one at that, reused the same phrase as the Died Suddenly documentary that covered the blood clot autopsies.

Lots of studies and news articles now coming out how common sudden death from cardio problems are, strange timing.


It's known that Covid infection can cause heart issues, and winter infections have been peaking recently.


the spike protein itself causes heart issues, present in both covid and the vaccines.


Yes, the fact that they talk about EVERYTHING else apart from vaccines as a probable cause is telling. That is not to say that it is indeed the vaccines causing this but there should at least be a thorough investigation.

The amount of all cause mortality data coming out from different nations is quite telling.


Nobody would ever entertain the mRNA vaccines as a cause hypothesis. That would amount to immediate career suicide. We live in late-ussr times now, embrace the suck and try not to think too much about such things.


How about this:

Billions of years of evolution where a heart has been present for millions of those. This is plenty of time to iron out kinks.

(last 100 years) Hundreds of thousands of chemical compounds in our air, food, environment, and even injected or otherwise ingested by us for which we did not evolve to tolerate.

People are dying more often of strange illnesses we've never seen or studied up until recent decades.

Media, Politicians, Industry heads: "Durrrrr it's genetic factors"

It's nearly certain that the uptick in sudden deaths is our own doing.




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