I should note that many anecdotal causes of sudden death are best guesses, often simplified–or even created–for laypersons and family.
Determining an accurate cause requires an extensive, expert autopsy as well as toxicology testing. More frequently even an autopsy is undertaken simply to rule out foul play and an exact cause is not definitely determined. In those cases a best-guess often becomes the anecdotal cause, even if it was not a very good best guess. As examples, “previously undiagnosed fatal bronchospasm” or “fatal aspiration of medicine x” and so on are often just picked from a general list of what’s left when more likely causes have been ruled out rather than definite causes supported by clear ante- and post- mortem evidence.
H1N1 would be a highly unlikely possibility. It does not debilitate to the point of an individual being beyond seeking help before it kills.
I have personally known or known second-hand young people that died from undiagnosed congenital heart problems, strokes, aneurysms, pulmonary embolisms, carbon monoxide poisoning, and autoerotic asphyxiation . The last one is a problem with finding out because people don’t want to admit it for obvious reasons. Other possibilities are a severe allergic reaction or encephalitic shock brought on by some sort of blockage. I almost died earlier this year from a sudden and very severe medical problem. Luckily, a coworker realized that something was going horribly wrong even though I was still conscious but my judgement was gone and I refused to believe there was any problem at all. Two weeks in the ICU saved me but it was a close call and things wouldn’t have worked out if I was home alone at the time.
The first thing I’d suspect is drugs. I hate to be so negative, but you’d be surprised at how many people you think would never do drugs actually do them. There’s a misconception that people who routinely use drugs have to be out of control.
A lot of people can do drugs every week and it never shows up in their daily lives.
If the police are satisfied that there was no foul play involved, an autopsy may show little because they are not going to waste money doing a very complicated autopsy. They’ll look for basic stuff and write it off to unknown or natural causes. To a point, I can see this, since he’s dead, it makes no matter what he died from.
Finally you can’t rule out foul play, many a sudden death is the rat poison or whatever by someone with a grudge. Now-a-days it doesn’t take much and many people have friends or relationships you’re not aware of.
If a boss fires somone or an online girlfriend gets dumped. Find out where the guy lives, wait, walk in with some rat poison, into the coffee the guy goes to bed thinking he has cramps or whatever and that’s that. Well rat poison is a bad example as that really hurts but you get the idea.
And as others have said, it is possible for people to have heart attacks at any age. I know a trainer at my gym had a stroke and he was only 30. He had some sort of issue but it was never brought to light till the stroke happend. Fortunately for him, he recoved almost totally.
Thank you all very much for the input and research and personal stories.
There is currently a rumor going around that he may have been on anti psychotic meds. He was extremely stable, productive and normal day-to-day and suicide is really not a significant possibility here though.
This happened to a friend of mine over the summer. Guy was in excellent shape and had actually run 18 marathons in his lifetime. he was a sweetheart, too, so it’s no surprise that his heart was too big.
Most of the 20’s to 30’s people that I’ve known who have died without the help of a car have died of anuerisms or heart failure, not always with an underlying heart condition.
I just had a BOAF die, and another nearly so from carbon monoxide poisoning.
Turns out, when out hunting, you shouldn’t put a charcoal grill in the trailer with you for warmth…I guess stuff like that gets stressed a lot more up north than down here in Mississippi.
So, while not the same situation, carbon monoxide?
May I ask why pathologists feel compelled to make a best guess instead of marking the death down as due to “unknown causes”? I lost a sister at age 27 almost two years ago, suddenly and without apparent cause. The medical examiner took four months to issue the death certificate. When he did, he stated a cause, but admitted to us that he didn’t think that was the actual cause of death, but it was the only one that had any shred of evidence at all to support it. (The causes he thought were more likely were things he couldn’t test for or see on examination, I guess.)
This has led to some pretty significant negative consequences for our family. In many ways, it would have been better for the medical examiner to put “unknown causes.” Why the reluctance to do so? Another sister is a pathologist, but she cannot answer this question to my satisfaction.
Sorry for the hijack, but I assume Chief Pedant is a pathologist of some type and I’m curious.
To address the OP, I would prepare yourself for the possibility of the unknown. It’s quite likely you won’t get an answer, and I can tell you from experience, that is often harder to deal with than getting a concrete answer.
Sorry; just an ordinary doc boarded in Internal Medicine and ED…I have had many an occasion to make a best guess for a family why a loved one is newly dead.
I think the last line of your post summarizes the psychology: people want answers. It’s harder to deal with “we just don’t know” than a concrete answer, and at a practical level it can be quite difficult to know for certain.
“Dad died of a massive heart attack” is a universally inaccurate cause. Most cardiac sudden deaths are arrhythmias, often precipitated by minor blockages and with no new cardiac muscle death and a pretty normal post-mortem (there isn’t time for the muscle to die). But it’s satisfying and concrete. And it’s much easier to convey than “Well; anatomically everything was normal at autopsy except for some diffuse coronary arterial plaquing with a suggestion of a small acute thrombus in a tiny branch of a diagonal off the LAD.”
I am not pretending that we in medicine actively mislead or falsify, but we are sometimes guilty of simplifications and shortcuts in the name of both compassion and convenience.
Thanks for this answer. This is more or less what my sister said (more defensively). I have to say that I find it unsatisfying. I expect doctors to behave more like scientists and admit when they don’t have enough evidence to answer, instead of asserting one in a manner that makes it look like fact when it is really theory. I also expect them to choose the real, hard to explain answer over one that is less accurate but is more easily understandable by the layperson. What is so hard to understand about “arrhythmia”? (That is what is supposed to have happened to my sister. The only finding was a normal-ish amount of coronary arterial plaque. No thrombosis, no cardiac damage.)
There are unfortunate consequences for the family when doctors put down an answer that sounds good but may not be accurate. We have all been recommended by our doctors to take a long series of expensive cardiac tests because OMG, Sis’s death certificate says massive heart attack (in technical language). So we took the tests, but all any of us has is basically normal-looking slightly plaque-y arteries that are typical of Americans our age. (And that’s all Sis had.) There’s no treatment recommended for this, so all we ended up with was a huge medical bill.
Then there are the psychological and social issues that go along with having an answer on the death certificate that the ME tells you is almost certainly inaccurate. Those are a more subtle and pernicious problem. I’m sure the OP is already encountering the firestorm of gossip and rumor-mongering that surrounds this kind of death. When the ME puts one answer on the death certificate, but admits to the family he thinks it is something else, that just helps create confusion, thus feeding the rumor mill. Which in turn causes untold pain to the loved ones.
Take gentle care of yourself.