John McCall, from Collone, near Armagh City, was an A-Level pupil at Armagh Royal School. He hoped to go on to study architecture at Queen’s University, Belfast.
Stephen Lyness, from Portadown, was an apprentice plasterer. He was a very outgoing and very active person, who fitted a lot into his short life. He was interested in all kinds of sports, particularly soccer, in which he played for St Mary’s club. He also did voluntary work for St Mary’s Youth Club summer scheme. Since his death his family have organised fundraising activities for research into sudden cardiac death.
Ciara Agnew, from Derriaghy, was a pupil at St Dominic’s High School, Belfast, and was one of five children. She was a normal fun-loving girl, who was full of life and always seemed healthy. She loved playing music and enjoyed swimming and netball at school.
Nicholas Collins, from Ballinderry, near Lisburn, had just finished his GCSE examinations and started a Media Studies course at Belfast Institute of Further & Higher Education. He was very fit and played basketball for a club in Lisburn.
Aaron Lundy, from Portstewart, was a very talented all-round sportsman. He won the Irish Under-15 Championship trophy in golf and was selected to play for Ulster at 16. At 17 he won the Irish Daily Mail Championship and in the same year the British Daily Mail Boys’ Championship in the USA. He was then selected for the Irish national boys’ squad, playing off a scratch handicap. A very fit young man, he also enjoyed participating in basketball, cross-country running and football. Aaron’s father, John, is now the Northern Ireland representative of the CRY group.
Marcella Doherty, from Bellaghy, worked as a hairdresser in her home village, and hoped to expand her business to include a beauty salon in the near future. She loved driving and had an ambition to buy a red Audi A4. She took a lot of exercise in the nine months before her death, and on one night a week before she experienced palpitations she completed 40 lengths of the swimming-pool.
Mary Mooney, from Newry, had just completed Beauty Therapy examinations at Newry Institute of Further & Higher Education, and was about to embark on a course of Aromatherapy. She was naturally fit and liked to take exercise. Her family has set up Mary’s Trust in her memory, to provide life-saving equipment in the local area.
Richard Martin, from Cabra, near Irvinestown, was a pupil at Portora Royal School, Enniskillen. The youngest of four brothers, he was a model pupil, having got four As in his AS Level examinations, and he hoped to study Medicine at university. He was also an able sportsman, which he showed by earning his place on the school rugby first team within weeks of taking up the game. He was very active in various other activities, including those of the Boys’ Brigade, of which he was a member.
Cormac McAnallen from An Bréantar, near Dungannon, was a secondary school-teacher at St. Catherine’s College, Armagh, and was best known as the captain of the county Tyrone Gaelic football team. With Tyrone he won many honours, including the All-Ireland Senior Championship in 2003, a national All-Star in 2003, and the national Young Player of the Year award in 2001, having played with his club, An Eaglais, from a young age. From 2001 to 2003 he played for Ireland in the Compromise Rules series against Australia. Cormac also played basketball for Ulster at underage level, and was a keen participant in quizzes, winning the TV series Blackboard Jungle and an All-Ireland Scór na nÓg medal. He was engaged to be married. The Cormac Trust was set up in his memory.
Gary Duffin, from Coalisland, was a joiner with a local construction firm. He was one of five children in the family, and he was engaged to be married in the summer. He played hurling for the Naomh Colmcille club, and also had a keen interest in football.
Gerard Gallagher, from Kiltyclogher, had just finished his final examinations at the Institute of Technology, Sligo. On the day that he died he had got the news that he had been appointed to a job in Dublin. He played Gaelic football for Glenfarne club, and soccer for Manorhamilton Rangers. He took part in athletics when he was younger, and was always quite fit.
Robert Finnerty, from Ballintubber, Claremorris, had recently qualified as a carpenter and had just gone to London to work for the summer. He planned to go to Australia with friends in the autumn, and intended to undergo a course in the use of Automated External Defibrillator on his return. He qualified as a water safety instructor and went on to instruct kids to be lifeguards, He also taught as a swimming instructor with a local swimming club. He was very passionate about water-safety, and had a way with teaching it. It was something he did in his free time. He also played indoor soccer.
Shane Kennedy, from Ballaghadereen, was a student of Information Technology at the National University of Ireland, Galway (formerly U.C.G.). He had just completed his first year on that course. He was a fit, healthy young man, who played golf and soccer occasionally, and won many medals for running in local Community Games when he was younger. He was also a big fan of Liverpool soccer team and loved listening to music.
Darius Vasseghi, Dublin, was a student of Electronic Engineering at University College Dublin. Having lived previously in Iran and France, he was a person of diverse cultural influences and was fluent in six languages. He was a champion fencer and was national champion in both countries several times, representing them in many international competitions, including two world championships. On his death he was captain of UCD team and member of the Irish squad. He was also an accomplished clarinet player, a woodwork marquetry master, computer expert and tennis player. Since Darius’ death, his mother, Mary, has been one of the main founders of the Irish Sudden Cardiac Death (in the young) Support Group.
Conor Martin, from Rialto, was a pupil completing his transition year at De La Salle School, Churchtown. He was an only child. A tall, well-built boy, he played rugby for his school and for the DLSP club, and was rarely ill. He was always smiling and cheerful. He was very interested in all kinds of music, from Luke Kelly to 2Pac. On the night prior to his death he had attended a school graduation ceremony.
Cliona Murphy, from Raheny, worked as a personal assistant with a leading bank in the Irish Financial Services Centre. From an early age she was very sporty, taking part in school hockey, tennis and swimming. At 18 ‘wanderlust’ took her to the USA. She worked in Washington D.C. and California, and lived in New York City for several years. During a year’s stay in New Zealand and Australia her ambition led her to take up competitive sailing, and she excelled, qualifying for the Sydney to Hobart yacht-race in 1992. On her return to Ireland she joined Howth Yacht Club and raced in the Squib class. Cliona’s dream came true when she was invited onto the all-women’s crew in the ‘Around Ireland’ race 1993. She was very popular and a loyal friend to many. The Cardiomyopathy Support Group was founded in her memory.
Brian Bergin, from Ballybrophy, Borris-in-Ossory, worked in construction, doing building and chimney repair work. He was one of a family of seven children, and was married in June 2001, one year prior to his death.
Gerard Leddy, from Collon, was a manager of a dairy farm, and was about to travel to England for a change of employment. It is possible that his family has had a possible history of conditions which cause sudden cardiac death.
Noel Quill came from Johnstown, Castlebridge, near Wexford. He was the eldest of a family of four children, and he played Gaelic football for the local Shelmalier club. He had just got his Degree in Business Studies from Waterford Institute of Technology, and he was on the verge of many exciting things when he died. He commenced his first full time job the previous Monday with American company PFPC International in Drinagh, Wexford. He booked a holiday to Florida with a group of friends on Thursday, and bought a car on Friday evening. He was to be groomsman at his uncles wedding on Saturday - the day that he died.
Darragh Kelly, from Greystones, was a student embarking on a Construction Engineering course at Dundalk Institute of Technology, having returned some months previously from travelling abroad. He was the eldest and only boy of four children in his family. He participated in a wide range of sports – he played soccer for Greystones and later Kilcoole; he excelled in Gaelic football and rugby at St. David’s Secondary School in Greystones, travelling to a schools international rugby tournament in Italy in 1999. He was also proficient at both swimming and sprinting.
Richie Doyle, from Bray, was a sales rep. and a graduate of Dublin Institute of Technology. He was 6 feet 6 inches tall, and kept very fit – he was a very keen soccer player, he jogged and walked the dog regularly, and he was very careful about what he ate. Since his death his family has raised funds for the purchase and distribution of 14 defibrillators for local sports clubs and secondary schools.
Robert Manning, from Cratloe, was a secondary school pupil. The eldest of three boys, he was full of enthusiasm for life in a quiet, unassuming way. He was 6’3” in height and was supposedly very healthy. He was an avid oarsman and also loved karate and rugby. His friends looked up to him as he could defuse any tricky situation or pass a funny “tongue-in-cheek” comment which people found endearing. In his memory, a friend released a tribute single ‘Re-Unite’ for the Robert Manning Fund, which was donated to CROI (the West of Ireland Cardiology Foundation).
Miriam O’Sullivan, from Firies, worked as a marketing manager in the Gleneagle Hotel in Killarney. The youngest of three children, she was engaged to be married in June 2004. She was very active generally and apparently very fit; at the time she died she was taking swimming lessons and building a house. She was also very helpful and wise beyond her years.
Jamie Curtin, from Limerick City, worked with horses. He was a very laid-back person, who although not athletic, was apparently healthy and had never spent time in hospital since birth. He loved horses and motorbikes, and was just ten days short of his 16th birthday when he died.
Ross Cooney, from Limerick, was a first-year Business Studies student at the University of Limerick. Ross was an only son, with one younger sister. He was a young man of many talents: he was a skilful debater, a qualified lifeguard, and a holder of a Chief Scout Award, and standing 6’4” tall he was a promising athlete. He is equally remembered as a lovable character, with a bright and bubbly personality and a high regard for others. Ross’s life was cut short while representing his university at the National Basketball Arena in Tallaght, in an intervarsities tournament. He died suddenly on court when the team had just started a match.
Consider someone who has just died of a heart attack. His organs are intact, he hasn't lost blood. All that's happened is his heart has stopped beating—the definition of "clinical death"—and his brain has shut down to conserve oxygen. But what has actually died?
As recently as 1993, when Dr. Sherwin Nuland wrote the best seller "How We Die," the conventional answer was that it was his cells that had died. The patient couldn't be revived because the tissues of his brain and heart had suffered irreversible damage from lack of oxygen. This process was understood to begin after just four or five minutes. If the patient doesn't receive cardiopulmonary resuscitation within that time, and if his heart can't be restarted soon thereafter, he is unlikely to recover. That dogma went unquestioned until researchers actually looked at oxygen-starved heart cells under a microscope. What they saw amazed them, according to Dr. Lance Becker, an authority on emergency medicine at the University of Pennsylvania. "After one hour," he says, "we couldn't see evidence the cells had died. We thought we'd done something wrong." In fact, cells cut off from their blood supply died only hours later.
But if the cells are still alive, why can't doctors revive someone who has been dead for an hour? Because once the cells have been without oxygen for more than five minutes, they die when their oxygen supply is resumed. It was that "astounding" discovery, Becker says, that led him to his post as the director of Penn's Center for Resuscitation Science, a newly created research institute operating on one of medicine's newest frontiers: treating the dead.
Biologists are still grappling with the implications of this new view of cell death—not passive extinguishment, like a candle flickering out when you cover it with a glass, but an active biochemical event triggered by "reperfusion," the resumption of oxygen supply. The research takes them deep into the machinery of the cell, to the tiny membrane-enclosed structures known as mitochondria where cellular fuel is oxidized to provide energy. Mitochondria control the process known as apoptosis, the programmed death of abnormal cells that is the body's primary defense against cancer. "It looks to us," says Becker, "as if the cellular surveillance mechanism cannot tell the difference between a cancer cell and a cell being reperfused with oxygen. Something throws the switch that makes the cell die."
With this realization came another: that standard emergency-room procedure has it exactly backward. When someone collapses on the street of cardiac arrest, if he's lucky he will receive immediate CPR, maintaining circulation until he can be revived in the hospital. But the rest will have gone 10 or 15 minutes or more without a heartbeat by the time they reach the emergency department. And then what happens? "We give them oxygen," Becker says. "We jolt the heart with the paddles, we pump in epinephrine to force it to beat, so it's taking up more oxygen." Blood-starved heart muscle is suddenly flooded with oxygen, precisely the situation that leads to cell death. Instead, Becker says, we should aim to reduce oxygen uptake, slow metabolism and adjust the blood chemistry for gradual and safe reperfusion.
Researchers are still working out how best to do this. A study at four hospitals, published last year by the University of California, showed a remarkable rate of success in treating sudden cardiac arrest with an approach that involved, among other things, a "cardioplegic" blood infusion to keep the heart in a state of suspended animation. Patients were put on a heart-lung bypass machine to maintain circulation to the brain until the heart could be safely restarted. The study involved just 34 patients, but 80 percent of them were discharged from the hospital alive. In one study of traditional methods, the figure was about 15 percent.
Becker also endorses hypothermia—lowering body temperature from 37 to 33 degrees Celsius—which appears to slow the chemical reactions touched off by reperfusion. He has developed an injectable slurry of salt and ice to cool the blood quickly that he hopes to make part of the standard emergency-response kit. "In an emergency department, you work like mad for half an hour on someone whose heart stopped, and finally someone says, 'I don't think we're going to get this guy back,' and then you just stop," Becker says. The body on the cart is dead, but its trillions of cells are all still alive. Becker wants to resolve that paradox in favor of life.Syncope is a prevalent disorder, accounting for 1-3% of emergency department (ED) visits and as many as 6% of hospital admissions each year in the United States. As much as 50% of the population may experience a syncopal event during their lifetime. Although many etiologies for syncope are recognized, studies suggest categorization into cardiac, noncardiac, and unknown groups for the purposes of future risk stratification may be helpful in the initial evaluation. Cardiac syncope is associated with increased mortality, whereas noncardiac syncope is not. In addition, significant morbidity may result from falls or accidents that result from syncope.
Syncope is usually benign; however, in a subset of patients, this symptom presages a life-threatening event. As a result of this risk, hospital admission is frequent because of the difficulties encountered in promptly addressing causes of syncope, the lack of a diagnostic criterion standard, and concern about potentially dangerous arrhythmias.
Once a diagnostic category is identified, limited therapies are available. Little is known regarding the effects of therapies on longevity. Those with initially unknown causes may require further costly testing. Most individual tests have low diagnostic yield and provide limited insight into guiding future clinical management.
Pathophysiology
Syncope occurs due to global cerebral hypoperfusion. Brain parenchyma depends on adequate blood flow to provide a constant supply of glucose, the primary metabolic substrate. Brain tissue cannot store energy in the form of high-energy phosphates found elsewhere in the body; therefore, a cessation of cerebral perfusion lasting only 3-5 seconds results in syncope. Cerebral perfusion is maintained relatively constant by an intricate and complex feedback system involving cardiac output, systemic vascular resistance, arterial pressure, intravascular volume status, cerebrovascular resistance with intrinsic autoregulation, and metabolic regulation. A clinically significant defect in any one of these or subclinical defects in several of these systems may cause syncope.
Cardiac output can be diminished secondary to mechanical outflow obstruction, pump failure, hemodynamically significant arrhythmias, or conduction defects. Systemic vascular resistance can drop secondary to vasomotor instability, autonomic failure, or vasodepressor/vasovagal response. Arterial pressure decreases with all causes of hypovolemia.
A CNS event, such as a hemorrhage or an unwitnessed seizure, can also present as syncope.
Syncope can occur without reduction in cerebral blood flow in patients who have severe metabolic derangements (eg, HYPOglycemia, hyponatremia, hypoxemia).
Frequency
United States
Framingham data demonstrate a first occurrence rate of 6.2 cases per 1000 patient-years.1, 2 Syncope reoccurs in 3% of affected individuals, and approximately 10% of affected individuals have a cardiac etiology.
A glucose level, checked by rapid fingerstick (eg, Accu-Chek), should be evaluated in any patient with syncope. HYPOglycemia can produce a clinical picture identical to syncope, including the prodromal symptoms, absence of memory for the event, and spontaneous resolution.
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