Death due to sudden arrhythmic death syndrome (SADS) may have repercussions for surviving family members. Alcohol misuse accounts for 1.4% of deaths in England and Wales and is associated with a greater risk of sudden death than the general population [14]. Liver problems, such as cirrhosis, hepatitis and fatty liver. [1] Complications may include sudden death. The https:// ensures that you are connecting to the Am J Epidemiol. In this cohort, people who died from SUDAM tended to be older, have heavier livers at PM examination, and are more likely to have a history of psychiatric illness than those who died from SADS. Cases in this cross-sectional study were identified by retrospective review of the database at our specialist cardiac pathology referral center; cases date from 1971 to 2014. 2017 Sep;13(3):278-283. doi: 10.1007/s12024-017-9877-2. Unrecorded alcohol consumption: quantitative methods of estimation. Cite this article. Scientific Reports (Sci Rep) Primary myocardial fibrosis as an alternative phenotype pathway of inherited cardiac structural disorders. Alcohol-related sudden death with hepatic fatty metamorphosis: a comprehensive clinicopathological inquiry into its pathogenesis. These findings provide valuable information on the role of alcohol intake as a trigger for SCD, which may have the potential to translate into improved prediction and prevention of alcohol related SCDs. official website and that any information you provide is encrypted 1992;68:4438. Federal government websites often end in .gov or .mil. Of note, alcohol has direct cardiotoxic effects11, and alcohol-induced myocyte death may also affect the development of anatomic substrate (i.e., myocardial fibrosis) for subsequent arrhythmias. Sudden death in the chronic alcoholic. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking and https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/what-standard-drink. Epub 2009 Dec 4. People with SUDAM are also more likely to have a positive history of psychiatric illness and illicit drug use. Comparison of significant co-existing conditions for heavy alcohol users who died from SUDAM and non-alcohol users who died from SADS. Causes of death in four cases had no morphological explanation of death and were negative for acute toxicity and ketoacidosis [8]. 2001;1(1):213. PubMed Alcohol misuse accounts for 1.4% of deaths in England and Wales and is associated with a greater risk of sudden death than the general population [1,2,3,4]. Sudden death in the chronic alcoholic. Therefore, differentiating between SUDAM and SADS identifies families likely to benefit from screening for these mutations, thus preventing further sudden arrhythmic deaths. Please enable it to take advantage of the complete set of features! BMJ. Sudden arrhythmic death syndrome: a national survey of sudden unexplained cardiac death. This study describes the characteristics of a cohort with SUDAM from a tertiary cardiovascular referral center and compares the findings with those of individuals who died from sudden arrhythmic death syndrome (SADS). Behr E, Wood DA, Wright M, Syrris P, Sheppard MN, Casey A, et al. Due to the basis of Finnish legislation, medicolegal autopsies have unified investigation protocol including meticulous cardiac examinations: macroscopic dissection and investigation of myocardium, valves and coronary arteries, and histological samples taken from 3 to 5 sections of the heart. Chronic alcohol abuse Introduction In a forensic setting, deaths due to seizures, either epileptic or other, present a well-known problem. Forensic Sci Med Pathol 13, 278283 (2017). 1 depending on the amount of alcohol consumed and the patterns of consumption. -, Wannamethee G, Shaper AG. Alcohol misuse accounts for 1.4% of deaths in England and Wales and is associated with a greater risk of sudden death than the general population [1-4].Causes of death in heavy alcohol use are related to trauma, acute intoxication or alcohol-related disease such as cirrhosis [].The cause of death may be obvious at autopsy, such as ischemic heart disease or pneumonia, but when . Intern. Clipboard, Search History, and several other advanced features are temporarily unavailable. [2] Other conditions that may present similarly include other causes of high anion gap metabolic acidosis including diabetic ketoacidosis. QT prolongation and sudden cardiac death in patients with alcoholic liver disease. Disclaimer. Finnish Institute for Health and Welfare, and Regional State Administrative Agency of Northern Finland approved the review of medicolegal autopsy data by the investigators. Cardiovascular complications of eating disorders. Google Scholar. This makes research in the field of sudden unexplained death challenging. Cases in this cross-sectional study were identified by retrospective review of the database at our specialist cardiac pathology referral center; cases date from 1971 to 2014. This study describes the characteristics of a cohort with SUDAM from a tertiary cardiovascular referral center and compares the findings with those of individuals who died from sudden arrhythmic death syndrome (SADS). Our study population is drawn from the Fingesture study, which includes 5869 consecutive SCD cases from Northern Finland who underwent medicolegal autopsy 19982017. [3] Symptoms often include abdominal pain, vomiting, agitation, a fast respiratory rate, and a specific "fruity" smell. Careers. Google Scholar. 2010;46(1):1524. Heart Rhythm. and transmitted securely. Manolis, T. A., Apostolopoulos, E. J., Manolis, A. Our study identified 62 cases which meet the definition of SUDAM; a larger case series than previously reported. Alcohol is truly the bottled killer. Marcus, G. M. et al. SADS, unlike SUDAM, is often associated with heritable channelopathies that may affect surviving family members. National Library of Medicine Detailed methods of toxicological analysis have been described earlier4. Accessibility Many thanks to the Cardiac Risk in the Young (CRY) team members based at St Georges, University of London, for their assistance during the completion of this study. Unauthorized use of these marks is strictly prohibited. Statistical analyses were performed with the Statistical Package for Social Studies version 24.0 (SPSS Inc, Chicago, IL). Wong JLC, Arango-Viana JC, Squires T. Heart, liver and spleen pathology in chronic alcohol and drug users. Please enable it to take advantage of the complete set of features! 25, 1535 (2006). Coroner's post mortems in a typical UK city were studied. Yuzuriha T, Nakamura T, Shoji M, Matsushita S, Takagi S, Kono H. Alcohol and sudden death: a survey on alcohol-related deaths at Tokyo metropolitan medical Examiner's office (1989) (abstract only). Alcohol poisoning can cause a heartbeat that is not regular. A., Melita, H. & Manolis, A. S. The proarrhythmic conundrum of alcohol intake. An official website of the United States government. 1990;25:2532. Thomas AC, Knapman PA, Krikler DM, Davies MJ. Jang HN, Park HJ, Cho HS, Bae E, Lee TW, Chang SH, Park DJ. Comparison of demographic parameters revealed the SUDAM group to be older (P=0.0002); mean age 35.8years, compared with 27.7years for SADS (Table 1). SADS, unlike SUDAM, is often associated with heritable channelopathies that may affect surviving family members. All the theories are untested [17]. 174(11), 15031509. Jones, A. W. Urine as a biological specimen for forensic analysis of alcohol and variability in the urine-to-blood relationship. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. All reported p values are two-sided and values less than 0.05 were considered significant. Sudden unexplained death in alcohol misuse (SUDAM) patients have different characteristics to those who died from sudden arrhythmic death syndrome (SADS). Templeton et al. Alcohol; Cardiac; SADS; SUDAM; Sudden death. Professor Sheppard has received funding from Cardiac Risk in the Young. Introduction The consumption of alcoholic beverages has been documented as early as 10,000 BC [ 1 ]. Sudden death in the alcoholic Arthur R. Copeland Add to Mendeley https://doi.org/10.1016/0379-0738 (85)90109-4 Get rights and content Abstract A study of victims of alcohol abuse was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida. Causes of death in heavy alcohol use are related to trauma, acute intoxication or alcohol-related disease such as cirrhosis [5]. Yuzuriha T, Okudaira M, Tominaga I, Hori S, Suzuki H, Matsuo Y, et al. official website and that any information you provide is encrypted Bethesda, MD 20894, Web Policies The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The datasets generated and analysed during the current study are not publicly available due to potentially identifiable nature but are available from the corresponding author on reasonable request. Alcohol-related deaths in the United Kingdom, registered 2012. http://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/alcoholrelateddeathsintheunitedkingdom/2014-02-19 (2014). 1997;32(6):74552. Addiction. Frequently drinking too much alcohol is harmful to health. Stiles MK, Wilde AAM, Abrams DJ, Ackerman MJ, Albert CM, Behr ER, Chugh SS, Cornel MC, Gardner K, Ingles J, James CA, Juang JJ, Kb S, Kaufman ES, Krahn AD, Lubitz SA, MacLeod H, Morillo CA, Nademanee K, Probst V, Saarel EV, Sacilotto L, Semsarian C, Sheppard MN, Shimizu W, Skinner JR, Tfelt-Hansen J, Wang DW. Drug Test. In other words, alcohol is the cause of 5.3% of all human deaths annually. Determination of the primary cause of death was based on a combination of autopsy findings, clinical records, and police reports. Alcohol Clin Exp Res. The objective of the present study was to investigate the association between the timing of alcohol intake and SCD. Comparison of post mortem liver examination findings for heavy alcohol users who died from SUDAM and non-alcohol users who died from SADS, *There was a statistically significant difference (P=0.0033). All the theories are untested [17]. National Library of Medicine Diabet Med. Templeton AH, Carter KLT, Sheron N, Gallagher PJ, Verrill C. Sudden unexpected death in alcohol misusean unrecognized public health issue? Physical . To obtain Being able to better discriminate between these two diagnoses of exclusion in heavy alcohol users may be useful in initiating screening of family members for potentially fatal ion channelopathies. Fatty Liver and the Forensic Pathologist. 1993;28(3):95119. Stiles MK, Wilde AAM, Abrams DJ, Ackerman MJ, Albert CM, Behr ER, Chugh SS, Cornel MC, Gardner K, Ingles J, James CA, Jimmy Juang JM, Kb S, Kaufman ES, Krahn AD, Lubitz SA, MacLeod H, Morillo CA, Nademanee K, Probst V, Saarel EV, Sacilotto L, Semsarian C, Sheppard MN, Shimizu W, Skinner JR, Tfelt-Hansen J, Wang DW. Data analysis was performed using a standard spreadsheet package (Microsoft Excel 2010). https://doi.org/10.7326/M21-0228 (2021). 1988;36:10511. Blood alcohol levels in Finnish victims of non-ischaemic sudden cardiac death. The association between alcohol intake and SCD seems to be somewhat analogous to alcohol intake and atrial fibrillation, which also occurs mostly several hours after alcohol intake or during the late stage of inebriation12, reinforcing the hypothesis that alcohol has the greatest arrhythmogenic potential during the late stage of inebriation. Careers. In comparison to the SADS group, people who died from SUDAM were significantly older and the mean liver weight was significantly greater than those who died from SADS. Our study shows that people who die from SUDAM tend to be older and have heavier livers which are more likely to demonstrate fatty change than people who died from SADS. Notably more fatty livers were encountered in the SUDAM group (15, 24.2%) compared with SADS (1, 2.4%). If left untreated, it is progressive and can be fatal. St Georges Healthcare NHS Trust, Cellular Pathology, St Georges Hospital, Blackshaw Road, London, SW17 0QT, UK, CRY Department of Cardiovascular Pathology, St Georges, University of London, Cranmer Terrace, London, SW17 0RE, UK, You can also search for this author in 146, 6983. An autopsy series of 1658 cases showed that death certificates mentioned alcohol-related diseases in less than half of these cases [20]. Lancet. The SUDAM group were older than the SADS group; mean age 35.8 years and 27.7 years respectively (P=0.0002). 2010;12(3):10510. Beldie A. Late ventricular potentials and heavy drinking. The cause of SADS is often a channelopathy, and in many instances these are heritable; in one study 22% of families were diagnosed with inherited cardiac disease following the death of the proband from SADS [9]. On the contrary, alcohol consumption may protect against IHD associated heart failure. Sudden Death in Adults: A Practical Flow Chart for Pathologist Guidance. Circulation 137(25), 27162726. Forensic Sci Med Pathol. Dr Sorkin declares no conflict of interests. Although these findings are arguably anticipated, they gain significance as it has not previously been demonstrated that they are typically present in SUDAM but not SADS. The recorded co-existing medical conditions were broadly similar for the SUDAM and SADS groups (Table (Table3).3). Several attractive theories attribute such deaths to ethanol withdrawal induced hypoglycemia or hypomagnesemia, pulmonary fat embolization from fatty liver, or other facets of the alcohol withdrawal syndrome, including ethanol dependent maladaptive derangements of neurotransmitters. The prevalence of fatty liver (84.6% vs. 70.3%; p<0.001) and liver cirrhosis (28.2% vs. 21.3%; p<0.001) at autopsy was more common in alcohol related SCD. Cardiological assessment of first-degree relatives in sudden arrhythmic death syndrome. Article The site is secure. CAS https://doi.org/10.1038/s41598-022-20250-3, DOI: https://doi.org/10.1038/s41598-022-20250-3. People with SUDAM are also more likely to have a positive history of psychiatric illness and illicit drug use. Normal organ weights in men Part II: The brain, lungs, liver, spleen, and kidneys. Alcohol, diseases of alcoholics and alcoholic liver disease. Clipboard, Search History, and several other advanced features are temporarily unavailable. Differentiating between SUDAM and SADS identifies families likely to benefit from screening for these mutations, thus preventing further sudden arrhythmic deaths. Templeton et al. Alcohol concentrations in blood and urine were measured from 3,470 SCD victims. Perkiomaki J, Hookana E, Kaikkonen K, Junttila J, Kortelainen ML, Huikuri H. Blood alcohol in victims of sudden cardiac death in northern Finland. The circumstances were unknown for more cases in the SUDAM (8, 12.9%) group than SADS (1, 2.4%). Subjects in whom autopsy revealed non-cardiac causes of sudden death (e.g., cerebral hemorrhage, pulmonary embolism, non-natural causes) were not included in the Fingesture study. Copeland AR. SUDAM is an increasingly recognized cause of death in heavy alcohol users. There was also a higher incidence of significant psychiatric illness in SUDAM (19.7%) than SADS (2.4%) cases. 3 Chronic heavy drinking is known to increase the incidence of sudden death, 4 and ingestion of substantial amounts of alcohol may lead to the occurrence of atrial fibrillation, increased ventricular ectopic activity, 5 and ventricular tachyarrhythmias. Sutanto, H. et al. Alcoholism is known to be greatly underdiagnosed in death certificates, a fact that biases estimates of alcohol-related mortality. There was no established history regarding illicit drug use in 43 (69.4%) cases of SUDAM and 12 (29.3%) cases of SADS. 2012;(33):368Y372. Olds K, Langlois NE, Blumbergs P, Byard RW. Cases in this retrospective cross-sectional study were identified from a database of referrals to our center spanning approximately 40 years. Federal government websites often end in .gov or .mil. Careers, Unable to load your collection due to an error. Although SUDAM and SADS are diagnoses of exclusion it is important to differentiate between these two groups, on the balance of probabilities, as it can have significant implications for surviving family members. Cardiol Review. Article You are using a browser version with limited support for CSS. In these cases, toxicological causes of death were excluded but alcoholic ketoacidosis was not. Accessibility HHS Vulnerability Disclosure, Help The actor died in February at the age of 34. These cases of death often include cases of sudden, unexpected death of chronic alcoholics, the causes of which are numerous: injury, gastrointestinal bleeding, drowning, acute alcohol poisoning, other poisoning and aspiration of the contents of the stomach or blood [2], [3], [4]. Sudden death in alcoholism is usually seen in an older (greater than 50years) white male who dies from chronic alcoholism with a terminal negative blood alcohol. Disclaimer. Secrest AM, Becker DJ, Kelsey SF, LaPorte RE, Orchard TJ. Article http://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/alcoholrelateddeathsintheunitedkingdom/2014-02-19, https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking, https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/what-standard-drink. Casiero D, Frishman WH. Characterizing sudden death and dead-in-bed syndrome in type 1 diabetes: analysis from two childhood-onset type 1 diabetes registries. Severe derangements of . [2] The ketone which is present is mostly beta-hydroxybutyrate rather than acetoacetate resulting in only a weakly positive nitroprusside test. CAS 62 cases of SUDAM and 41 cases of SADS were identified. PMC This article does not contain any studies with human participants or animals performed by any of the authors. 1994;18:25560. Drug concentrations in post-mortem femoral blood compared with therapeutic concentrations in plasma. Differences in specific cardiac parameters and toxicology/biochemistry results were not explored, as these were all essentially normal in order to meet the diagnostic criteria of SUDAM and SADS. PubMedGoogle Scholar. Eighty-six percent of alcohol-related SCD victims had higher urine alcohol concentration than blood alcohol concentration, referring to the late-stage inebriation. In these cases, toxicological causes of death were excluded but alcoholic ketoacidosis was not. Post mortem liver examination was more likely to reveal heavy livers in SUDAM than SADS (2196.1g and 1572.4g respectively; P=0.0033) and more fatty liver change (24.2% and 2.4%). Epub 2020 Oct 19. Sudden, unexpected cardiac or unexplained death in England: a national survey. 2009 Dec;6(12):3070-81. doi: 10.3390/ijerph6123070. However, 3.5% had primary myocardial fibrosis, which is an especially common autopsy finding among young SCD victims6,7. [3] However, a mixed acid-base disorder may be present especially if vomiting is contributing to a hypochloremic alkalosis. Case series have described heavy alcohol users dying suddenly with the only abnormality at autopsy examination being fatty liver change. Brain damage, including dementia. A detailed comparison between early and late-stage SCD is presented in Table 1. PM liver examination descriptions were available for 39 (62.9%) SUDAM cases and 16 (38.1%) SADS cases (Table 5). Mostofsky E, Chahal HS, Mukamal KJ, Rimm EB, Mittleman MA. The study population is drawn from the Fingesture study, which has prospectively collected data from all SCDs in Northern Finland (population600,000) since 19981,2,5. However, given that a relatively high proportion of SCD cases had alcohol in blood/urine and that alcohol intake has well-established proarrhythmic effects, it is unlikely that alcohol would have been an innocent bystander in SCD. This is an under-recognized entity. PubMed Unable to load your collection due to an error, Unable to load your delegates due to an error. Screening of family members has revealed such channelopathies in one fifth of cases, allowing appropriate steps to be taken to reduce their risk of sudden arrhythmic death, such as through careful monitoring and the use of implantable cardiac defibrillators [9]. Thus, family members may benefit from screening for channelopathies in cases of SUDAM, as already advocated in SADS. Longo's autopsy report cited chronic ethanol abuse and classified the actor's . 2019 Sep;114(9):1670-1678. doi: 10.1111/add.14703. Accidents (like falls or burns) and injuries (like fractures or drowning). This is particularly true of the availability of liver histology and family history of sudden cardiac death. When considering the heart and cardiovascular system, high doses of alcohol can have both acute (depression of cardiac contractility, cardiac rhythm disturbances, arterial hypertension, sudden death) and chronic effects (ventricular dysfunction, atrial dysfunction, arrhythmia, alcoholic cardiomyopathy and heart failure) 11. Sudden, unexpected cardiac or unexplained death in England: a national survey. Reported liver weights of SUDAM cases were significantly greater than for SADS cases; mean weights 2196g and 1572g respectively (P=0.0033). National Institute on Alcohol Abuse and Alcoholism. Family-based cardiac screening in relatives of victims of sudden arrhythmic death syndrome. The .gov means its official. Wong JLC, Arango-Viana JC, Squires T. Heart, liver and spleen pathology in chronic alcohol and drug users. Those who died during the late stage had higher blood (1.20.9 vs. 1.00.8; p<0.001) and urine alcohol levels (1.81.2 vs. 0.70.8; p<0.001), were younger (6110 vs. 6411; p<0.001), more often male (89% vs. 83%; p=0.01), had a lower prevalence of myocardial fibrosis (91.2% vs. 95.9%; p=0.02), had a higher prevalence of fatty liver (85.8% vs. 77.6%; p=0.003) and higher liver weight (1812707g vs. 1613690g; p<0.001) compared to those who died during the early stage. Sudden unexpected death in alcohol misuse--an unrecognized public health issue? Individuals with an alcohol use disorder (alcoholism) will likely experience the symptoms of physical dependence as well as psychological effects. It was not possible to reliably compare the occurrence of family history of sudden death in people who died from SUDAM and SADS as the data was missing in 51 SUDAM cases (82.2%) and 29 SADS cases (68.3%). The most common causes of death in alcohol-related SCDs were coronary artery disease (CAD) (63.7%), hypertensive myocardial disease (11.0%), alcoholic cardiomyopathy (9.5%), and obesity-related cardiomyopathy (8.4%), and the proportions of cardiac hypertrophy (70.1%) and myocardial fibrosis (91.9%) were high. PubMed Central Coroner's post mortemspost mortems were deemed to have died of alcohol associated arrhythmic death It is proposed that the reason for limited information regarding the circumstances surrounding death and family history in the SUDAM group is a result of social isolation which is often associated with heavy alcohol use. Post mortem liver examination was more likely to reveal heavy livers in SUDAM than SADS (2196.1g and 1572.4g respectively; P=0.0033) and more fatty liver change (24.2% and 2.4%). There are no published studies comparing deaths attributed to SUDAM with those attributed to SADS. People who died from SUDAM were also more likely to be known illicit drug users than those who died from SADS (25.8% and 0% respectively; Table 3). 2003;362:14579. [2] Consciousness is generally normal. Forensic Sci Med Pathol. The study complies with the Declaration of Helsinki, and the Ethics Committee of Northern Ostrobothnia Hospital District and the National Authority for Medicolegal Affairs (Valvira) approved the study. Templeton AH, Carter KL, Sheron N, Gallagher PJ, Verrill C. Int J Environ Res Public Health. The diagnosis of SUDAM was made in line with the parameters described by Templeton and colleagues; a history of chronic excess alcohol consumption, no significant cardiac pathology, no anatomical cause of death, no toxicological cause of death, and no evidence of ketoacidosis on biochemical investigation [8]. The https:// ensures that you are connecting to the Cell Cardiol. Sudden death in the alcoholic. This study describes the characteristics of a cohort with SUDAM from a tertiary cardiovascular referral center and compares the findings with those of individuals who died from sudden arrhythmic death syndrome (SADS). and alcohol consumption was reported in 16 cases (11.7%). SCD was defined as witnessed death within 6h of the onset of the symptoms and as unwitnessed death, within 24h of the time the victim was last seen in a stable state of health, and the death was determined to be due to cardiac disease in the subsequent medicolegal autopsy. This can reduce glucose availability and lead to hypoglycemia and increased reliance on fatty acid and ketone metabolism. SUDAM tends to occur in individuals who are older and have heavier livers than those with SADS. Schematic illustration of the study protocol and results. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. A more quantifiable definition of heavy alcohol use would also have allowed investigation of the magnitude and duration of excess alcohol use and the post mortem changes observed in this cohort. Overview Alcohol use disorder is a pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol or continuing to use alcohol even when it causes problems. Sperling MR. The https:// ensures that you are connecting to the National Institute on Alcohol Abuse and Alcoholism. https://doi.org/10.1080/07853890.2021.1890204, https://doi.org/10.1016/j.tcm.2021.03.003, https://doi.org/10.1161/CIRCULATIONAHA.117.032175, https://doi.org/10.1016/j.jacc.2016.02.062, https://doi.org/10.1016/j.yjmcc.2020.07.007, http://creativecommons.org/licenses/by/4.0/. Although a common paradigm indicates that great majority of the SCDs after middle age is due to CAD, less than two-thirds of alcohol related SCDs had evidence of CAD in the autopsy, and less than 10% had alcoholic cardiomyopathy, but, intriguingly, still more than 90% had myocardial fibrosis and 70% had cardiac hypertrophy. Randall B. It has been shown that QT interval prolongation is associated with increased risk of sudden cardiac death in the context of alcoholic liver disease and psychiatric illness [23, 24]. 1St Georges Healthcare NHS Trust, Cellular Pathology, St Georges Hospital, Blackshaw Road, London, SW17 0QT UK, 2CRY Department of Cardiovascular Pathology, St Georges, University of London, Cranmer Terrace, London, SW17 0RE UK. Correspondence to In the meantime, to ensure continued support, we are displaying the site without styles Professor Sheppard has received funding from Cardiac Risk in the Young. Alcoholism. Eighty-six percent of the SCDs associated with prior alcohol intake had BACUAC, referring to the late-stage, whereas 14% had BAC>UAC, referring to the early-stage of inebriation.
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sudden death from chronic alcoholism
