Sudden Death from Arrest by the Police

Kara asked whether this article about the sudden death of young men when arrested by police is for real.

The article details data presented before the European Society of Cardiology concerning 60 unexplained deaths over 10 years in Spain. The individuals were all relatively young men that were taken into police custody. The reports from these cases show no previous history of cardiovascular disease. They believe they can rule out mistreatment or drug use from the autopsies as well.

The author of the study, Manuel Martinez Selles, argues that this sudden death may represent a new syndrome not unlike when caged animals die of catecholamine storms. Catecholamines are stress hormones -- adrenaline is one -- and in particularly high doses they can cause cardiac arrthymias and sudden death.

I have a several comments:

1) I can't say without reading the autopsies, but I am skeptical that drugs were not involved. I want to see the toxicology screens. Cocaine use can present in the ER with coronary vasospasm -- a condition where the coronary arteries that serve the heart spasm and close -- and it resembles a heart attack. The only case that I saw while I was in the hospital of a healthy young person presenting with a heart attack was a young woman who had done too much coke. And she didn't want to admit that either...

Just saying. I am suspicious until I see a tox screen.

2) I wrote a post before about sudden death in a young marathon runner. If you read that post, most of the causes of sudden death in young people do not have previous histories of cardiovascular disease. In most cases, they had some developmental or electrical abnormality in their heart that went undiagnosed until stress -- in this case vigorous exercise -- caused them to have a cardiac arrest.

This is particularly relevant in this case as in previous study of 43 sudden deaths attributed to stress, the vast majority were found to have undiagnosed heart abnormalities or presymptomatic occlusion of the coronary arteries (occlusion that could eventually lead to a heart attack):

In 38 cases, a cardiac cause of death was found as follows: coronary heart disease, 27 cases; cardiomyopathy, 6 cases; aortic valvular stenosis, 2 cases and right ventricular dysplasia, 3 cases. A coronary artery thrombosis was found in 8 cases of sudden coronary death...In conclusion, it appears from our autopsy study that SSD [stress-related sudden death] occurs primarily in those individuals with severe heart disease, especially coronary heart disease.

So again: I would need to see the autopsy reports, but I am skeptical until they confirm that these individuals did not have an undiagnosed heart condition.

3) There are cases of sudden death related to stress in individuals without identifiable heart problems or drug use, but they are nearly exclusively in older women.

A community health survey shows that this syndrome presents very similarly to a heart attack, that it is triggered by extreme psychological stress, and that it is reversible. This syndrome resembles one identified in older women in Japan called Takotsubo cardiomyopathy. A takotsubo is a type of octopus trap. The syndrome is named this because the x-ray (a ventriculogram that shows the insides of the chambers of the heart using contrast) has a very characteristic look to it with a bulging bottom of the heart and a cinched top of the heart. Apparently this looks like an octopus trap. Go figure...

Anyway, in Takotsubo cardiomyopathy the patient presents with symptoms resembling a heart attack after severe emotional stress. We think that the cause is probably coronary vasospasm (very similar to that causes by cocaine), but that the spasming vessels are probably on the level of blood vessels to small to be seen on the angiogram.

Thus, it is indeed possible for someone to have something resembling a heart attack from severe stress. However, there are two reasons to be skeptical that this was the case with the men in Spain. First, this syndrome is mostly seen in older women -- the average age in the community health survey was 65. Second, the women don't usually die from this. Though they sometimes require medical interventions to restore blood flow, they usually recover.

I have to say that I don't know what is going on in Spain, but I am skeptical that it constitutes a new syndrome. I am skeptical that healthy young men would die from to much adrenaline without some underlying heart abnormality or drug use. Those are the two issue that have to be confirmed.


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It strikes me that the "stress" involved here could be related to rough treatment by cops... which case wouldn't that rather invalidate the study?

I'd like to see their stats repeated with a control group which, say, fell down the stairs ;>

Of course! Being zapped with 200,000 volts from a Taser and beaten savagely with batons have absolutely nothing to do with people in custody dying. What's the name of this syndrome? "The Stupid Public Will Believe Anything We Tell Them Syndrome." What a relief to know that the medical establishment has identified this for us.

In the US the police kill captives by putting enough of their weight on the thorax to overwhelm the diaphragm so that the victim asphyxiates with an open airway and no sign of choking. When he's dead, they will leave him face down in the open, so there will be uncertainty of the time of death. With no broken bones, obviously there was no police brutality. The ME will reports something about the decedent being overly excited.

You've probably seen videos where three or four cops have somebody cuffed and pinned down while another cop takes his truncheon and uses it to violently ram the end into the soft tissue of the neck. This can kill through internal ruptures, leaving no broken bones, and thus the ME will report only damage caused by struggling, unlawfully, against the authorities.

In this country, no victim of the police as any right of self defense.

There is historical precedent for this, under King George of England.

By Rose Colored Glasses (not verified) on 04 Sep 2008 #permalink

I live in Ireland, in a town of 20,000 people 25 miles for so from Dublin. A few years ago, I was selected to serve on a coroner's jury.

The coroner basically walked us through the deaths of some individuals, such as a road accident and a couple of deaths of elderly people in hospital. He suggested the verdicts and we complied. A senior policeman was present and some families, but no lawyers. There were some questioning of witnesses, usually the doctors who pronounced death, or the policeman read from witnesses' statements. None of the deaths were conentious in any way.

I actually forget most of the verdicts, but all were of the "death by cardiac arrest" etc. It was really a formality. All the deaths were very prosaic, except one, and the whole thing would convince you how much death is part of everyday life.

The one which sticks in my mind, and which is similar to the death of the marathon runner mentioned above, was of a young carpenter woh suddenly keeled over and died on the building site where he worked. He was a fit young man, a Gaelic footballer at Under-21 level. His mates and himself had been indulging in some horseplay (I forget what, maybe wrestling) when he suddenly collapsed without a sound. Efforts to revive him failed, and he was pronounced dead on arrival at hospital. No reason for death was found except his heart had stopped.

The coroner told us of a syndrome called "sudden death syndrome (SDS)" and said he knew of other cases.Basically, he requested the verdict "death by SDS" and we complied. he said the finding would help fund research into the condition. Before this, such deaths may have been classified differently and so get lost in the system.

In a general discussion with the family, he advised them all to have their hearts checked as there may have been some congenital weakness running in the family.

Some (but surely not all) of the deaths in police custody may be due to this condition, if it is real. We will probably have to await the outcome of the research the coroner spoke about, which hopefully is being conducted.

"In this country, no victim of the police as any right of self defense."

While in almost no case is it a wise idea, some states (for instance, in Texas Penal Code 9.31) do actually explicitly allow for self-defense against excessive force by police. I'm not sure there's been any cases where such a defense has worked, however.