Who should be screened for sudden death?


MEN'S HEALTH QUESTION: Sudden death is usually caused by heart disease

Q A 15-year-old boy from our sons' school dropped dead playing football last weekend. Should we get our teenage children who also play football medically assessed?

ASudden death affects 4,000-5,000 people of all ages every year and it is principally due to heart disease. In some cases heart disease may be identified before this happens.

Unfortunately, not all events can be prevented or postponed despite current medical technologies and treatments. In young people, sudden death may occur due to heart disease, cardiomyopathy (heart muscle disease), abnormal heart rhythm, valve disease, chest trauma, drug misuse, coronary artery disease and congenital heart disease.

In 5 per cent of sudden deaths, no structural abnormality is found at postmortem and this is the case in 20-30 per cent of sudden deaths in people under 35 years.

To prevent sudden cardiac death, screening of first degree relatives is advised. At the moment, clinical guidelines in the form of a questionnaire (for those who play sports or exercise) are being drawn up to help general practitioners identify individuals at risk who might require further assessment or review by a cardiologist.

In your particular case, unless there is a family history of premature heart disease/ sudden death or your teenagers are having symptoms such as chest pain, shortness of breath, palpitations, dizzy spells/blackouts, fatigue out of proportion to the level of physical activity, then further evaluation is not usually needed.

However, if there are any concerns then parents should speak to their GP in the first instance. A clinical assessment by your GP can determine if referral to cardiology for further testing to include stress test, echo, ECG, Holter, MRI or cardiac CT and genetic testing is necessary.

Q I am 26 years old and recently developed very severe pain in my right testicle. I went to the hospital and I had to have an operation for testicular torsion. I had never heard of this condition before and I think that it might be helpful to your readers if you explained what this means.

AAcute testicular torsion as you describe is a medical emergency that needs immediate treatment. In testicular torsion the spermatic cord that provides the blood supply to a testicle is twisted, cutting off the blood supply. This causes sudden pain and swelling of the scrotum. The testicles become sore. The condition may be so painful that it causes nausea and vomiting. It will mimic infection (acute epididymitis) but it is very important to seek urgent treatment.

Testicular torsion usually only appears in young boys and is most common in their teenage years, but is also sometimes seen in men up to the age of 30 or on rare occasions in older men.

Immediate surgery - ideally within six hours of the pain starting - is the recommended treatment.

The torsion that has tightened the blood vessels is removed and the failed blood circulation to the testicles is brought back to normal.

To prevent torsion happening again, the testicles are sewn to the inner side of the scrotum (testicular fixation). It is usual to fix the opposite testicle at the same time.

If treated within six hours, there is nearly a 100 per cent chance of saving the testicle. Within 12 hours this rate decreases to 70 per cent, within 24 hours is 20 per cent, and after 24 hours the rate approaches zero.

In cases where the circulation of blood has been blocked for a long time, it may be necessary to remove the testicles. The operation is called orchidectomy.

If only one testicle is removed, the ability to reproduce should not be affected.

• This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with a contribution from Dr Robert Kelly, consultant cardiologist, Beacon Hospital and Santry Sports Clinic, Dublin