Can accidental drowning occur medically?

Health Care Comments Off

Dr KK Aggarwal

Recipient of Padma Shri

Actor Sridevi died of accidental drowning in her hotel bath tub after losing consciousness, according to the forensic report by the Dubai govt. on Monday. However, the report, which carries the stamp of the “Ministry of Health UAE” and the director of preventive medicine, Dubai, Dr Sami Wadie, does not state the cause of unconsciousness.

Can accidental drowning occur medically? Yes. Medical conditions can cause accidental drowning. Seizure disorders, which can be first-onset episode, can cause accidental drowning. Alcohol and/or use of illicit drugs increases risk of accidental drowning as it may affect balance, coordination and judgment. Stroke, syncopal attack (heart attack) or undetected primary cardiac arrhythmia are other factors that can cause accidental drowning. A gasping patient with ventricular arrhythmia will end up with drowning.

If there are no signs of struggle, then ‘accidental drowning’ can be a medical opinion. It is up to the police to accept this opinion or find it as a case of ‘homicidal drowning’ and investigate any foul play.

Some salient facts on accidental drowning

Drowning is the third most common cause of accidental death. A victim of drowning can be revived by cardiopulmonary resuscitation (CPR) with rescue breathing. Prolonged resuscitation, up to many hours, has been known to revive patients with hypothermia and cardiac arrest.

Antemortem drowning can be identified by the presence of fine, white, leathery, copious froth or foam tinged with blood at the mouth and nostrils (Froth is of lasting nature and large in quantity), cadaveric spasms in hands, diatoms in tissues from brain, liver and bone marrow of long bones, presence of water in stomach and intestines, voluminous water logged lungs along with fine froth in lungs and air passages.

A bathtub drowning is a major cause of death in a bathtub. The bathtub is the most common site of seizure-induced drowning; hence, patients with epilepsy should be advised to take showers instead of baths. Heart attack leading to syncope and subsequent falling in the tub can cause drowning. Besides the causes discussed above, mutations in the cardiac ryanodine receptor (RyR)-2 gene, which is associated with familial polymorphic VT in the absence of structural heart disease or QT prolongation, have been identified in some individuals with unexplained drowning. Concomitant trauma, paralysis, heart attack or hypothermia, which can lead to rapid exhaustion or cardiac arrhythmias are other factors for accidental drowning. Duration of submersion >5 minutes is the most critical factor.

Several studies have reported incidents of bath tub drowning with varying medical histories as follows:

  • A total of 268 victims were found unconscious or dead during tub bathing. After postmortem examination, the manner of death was judged as natural cause in 191 (71.2%) and accidental drowning in 63 (23.5%) cases. Drowning water inhalation, which was confirmed in 72% of victims, was absent in the others. Whereas, inhalational findings were more frequent in victims with other backgrounds such as alcohol intake, mobility disturbance, and history of epilepsy (Am J Forensic Med Pathol. 2013 Jun;34(2):164-8).
  • In a series of 14 cases of suicide by drowning in the bath in the Bristol area, England between 1974 and 1996, six cases had evidence of concomitant alcohol or substance use. Seven cases had a past psychiatric history and a history of previous deliberate self-harm. Most drowned at home, face down, fully clothed (Med Sci Law. 1999 Oct;39(4):349-53).
  • A retrospective review of 92 deaths in the bathtub in Maryland found 71.7% incidence of bathtub drowning; 28.3% were the absence of bathtub drowning. Three leading contributory causes of death were cardiovascular disease, drug/alcohol-related death, and seizure disorder in both groups More than triple overlapped drowning-related signs (history of recovery from the water, foam in the air way, watery fluid in the sphenoid sinuses, hyperinflated lungs and watery fluid in the stomach contents) could be beneficial for the diagnosis of a bathtub drowning. (Forensic Sci Int. 2015 Aug;253:64-70).
  • In a retrospective analysis of 245 bathtub death cases between 1971 and 1988 carried out in the Institute of Legal Medicine in Hamburg, 66 cases proved to be natural deaths, 76 were classified as suicides, 39 as accidents and 13 as homicides, while 51 fatalities remained unclear with respect to one of these groups. About 50% of the victims were alcoholized.  (Arch Kriminol. 1991 Jul-Aug;188(1-2):35-46).

Dr KK Aggarwal

Padma Shri AwardeeVice President CMAAOGroup Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Chronic exposure to environmental noise increases risk of heart disease

Health Care Comments Off

Chronic exposure to environmental noise from road traffic and aircrafts can increase the risk of coronary heart disease, heart failure, stroke and arterial hypertension. And the potential mechanisms underlying this increased risk have been explored in a study published online February 5, 2018 in the Journal of the American College of Cardiology.

The study proposes that noise induces a stress response, characterized by activation of the sympathetic nervous system and increased levels of hormones, which will initiate sequelae and ultimately lead to vascular damage. Traffic noise may disrupt the body on the cellular level in a way that increases the risk of common heart disease risk factors such as hypertension and diabetes because noise is associated with oxidative stress, vascular dysfunction, autonomic imbalance and metabolic abnormalities.

Autonomic imbalance due to environmental noise is also suggested as a potential factor contributing to the cardiovascular risk factors including progression of atherosclerotic process.

(Source: ACC Press release, February 5, 2018)

Timely treatment can improve chances of recovery after a stroke

Health Care, Heart Care Foundation of India, Medicine Comments Off

Eating green leafy vegetables can reduce the risk of a stroke

New Delhi, 04 January 2018: Consuming green leafy vegetables may be a novel way to reduce stress and lower the risk of experiencing a stroke, as per a recent study. People who ate more green leafy vegetables had 64% lower risk of experiencing a stroke. Researchers studied 682 patients (average age 53.7 years) who experienced brain bleeds.

A stroke occurs when the blood supply to part of the brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. It is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “A stroke may be caused by a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may experience only a temporary disruption of blood flow to their brain (transient ischemic attack, or TIA). A TIA — also known as a mini-stroke — is a brief period of symptoms similar to those in a stroke. A temporary decrease in blood supply to part of your brain causes TIAs, which often last less than five minutes. Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood flow to part of the brain. A TIA doesn’t leave lasting symptoms because the blockage is temporary.”

The acronym FAST can be used to recognize the warning signs of stroke: face drooping, arm weakness, speech difficulty, and time to emergency. The disabilities caused due to a stroke can be temporary or permanent, depending on how long the brain lacks blood flow and which part is affected. And now the stroke window has been extended to 24 hours. All cases of strokes must reach a stroke center within 24 hours to curtail the damage.

Adding further, Dr Aggarwal, who is also Vice President of CMAAO, said, “Stroke is an emergency and getting timely help and treatment is extremely important. Hence, it is very important to act fast to identify these patients. Early treatment improves the chances of recovery. While one cannot control factors such as race, gender, and genetic predisposition, it is possible to make certain lifestyle changes which will go a long way in reducing a person’s chances of getting a stroke at a young age.”

Stroke is preventable. About 90 of strokes are associated with 10 risks factors that are modifiable. Some tips to prevent stroke include the following.

  • Control high blood pressure
  • Do moderate exercise 5 times a week
  • Eat a healthy balanced diet high in fruit vegetables low in sodium
  • Reduce your cholesterol
  • Maintain a healthy BMI or waist to hip ratio
  • Stop smoking and avoid second hand exposure
  • Reduce alcohol intake
  • Identify and treat atrial fibrillation
  • Reduce your risk from diabetes talk to your doctor
  • Get educated about stroke

« Previous Entries