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Old 11-01-2006, 05:59 PM
loco4viento loco4viento is offline
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Join Date: Nov 2006
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Default Re: Kiteboarder Suffers Fatal Heart Attack

Quote:
Originally Posted by RickI
My question is, is it reasonable to assume that a normal adult male, somewhat overweight would be at a significant risk of suffering a fatal heart attack under the general circumstances of this accident? I suspect his anxiety mounted substantially as the accident played out, perhaps augmented after activating the quick release. I am not necessarily looking for an opinion on a pharmacological basis for the heart attack given all the unknowns in the available information.

Thank you for your time and consideration in this matter.

* USN Phedra Cut, more information at: http://www.bodyactive-online.co.uk/S...-PhedraCut.asp
Hi Rick,

I'll start by saying it is certainly possible to have suffered a fatal heart attack given his health condition, medication use and the stressful situation he unfortunately encountered. However, I suspect there may be more involved in this case.

I really don't know if a complete autopsy revealed a myocardial infarction or was there simply a conclusion that he succumbed to a fatal heart attack after ruling out a few obvious other possibilities. So often we read a "cause of death" that is merely a diagnosis of exclusion; the true diagnosis wasn't actually made but makes sense after ruling out other likely possibilities. It isn't really known if a tissue diagnosis was made, and even if so, the infarction would likely be a secondary event in this case.

If a myocardial infarction and actual coronary artery disease were found in a complete autopsy I would guess that this might even have occurred during resuscitative efforts. It is certainly very possible that he experienced some form of hypoventilation or even apnea prior to being reached by rescuers. His body habitus put him at greatly elevated risk of airway obstruction which at his weight leads to hypoxia very quickly...and hypoxia as well as catecholamine surges (adrenaline rush from fear/panic) could lead to a fatal arrhythmia very quickly. Although his lungs had no sea water by report, he may well have had laryngospasm, a protective reflex complete closure of the vocal cords which can occur with even a slight amount of water or other substance touching the cords. There are very many possibilities here, and being overweight and on an ephedra type drug greatly increase the chance of hypoxia and arrhythmia. My guess is that he encountered tremendous difficulties, anxiety, got banged around on the water plenty, may have "gotten the wind knocked out" of him, possibly developed some degree of laryngospasm, got dragged up the beach where he likely furthered his hypoxia, hypoventilation, hypercapnea with more airway obstruction and results of his body habitus and even possibly position/harness (waist harness more risky), and in a short time developed an arrhythmia from which he was not resuscitated. However, there are numerous other possibilities including spine-related or brain-related events.

Of course none of this speculation can change what happened or even do much to prevent a future recurrence in another unfortunate person. Aside from the usual kitesurfing advice such as choosing when and where to kite, the only medical advice that might come from this or another incident would be to do everything possible to maintain an open airway and ensure adequate ventilation when encountering an unconscious victim. Big people, especially obese people, become hypoxic VERY quickly and are quite prone to fatal arrhythmias when this happens. Ventilation is critical.

Anyway, I'd say that a "heart attack" is possible and most likely a secondary event in this case.

My deepest sympathy for this man and all who will miss him in their lives.

John
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