“Sudden death syndrome”: what it is and what are the causes of the disease that killed Navalny. It’s a mystery about the body


By John

According to Russian authorities, Alexei Navalny died from what they call ‘sudden death syndrome’. It is a thesis that does not convince the family nor many governments and many Western observers who are asking for clarification on the causes of the death of the Russian opponent. The ‘mystery’ of the disappearance of the dissident’s body contributes to growing doubts.

‘Sudden death’ is however determined by an unexpected and sudden cardiac arrest almost always linked to ventricular fibrillation. There are several possible causes of sudden death. «This deadly arrhythmia – explains Giulio Molon, director of the UOC Cardiologia Irccs S.Cuore Don Calabria of Negrar di Verona – causes the heart to stop, not to contract effectively, and there is an arrest of circulation. If you don’t intervene promptly you will die in a few minutes.”

The most frequent cause of sudden death «is ischemic heart disease, in the context of an acute heart attack or which can occur in a patient who has a previous heart attack; other causes are dilated or hypertrophic heart disease or genetic heart disease with a heart that is morphologically and functionally normal but has variations within the proteins that control the electrical activity of the heart and lead these people to have high risks of sudden death , such as Brugada or long QT syndrome. The final outcome of sudden death – says Molon – is always this arrhythmia which does not allow an effective contraction of the heart and leads to a circulation arrest. It can come suddenly even in people who have no known heart disease.”

In particular, sudden or Brugada death is a genetically transmitted heart disease that predisposes to the risk of malignant ventricular arrhythmias and can cause sudden death in young adults with a structurally healthy heart. According to the center, the Auxologico Irccs Foundation of Milan, “men manifest the disease more frequently than women and it is unlikely to occur in childhood”. Before the Russian opponent Alexei Navalny, the syndrome has been compared to the case of the former Fiorentina captain, Davide Astori, who died before a match in 2018. The disease has an estimated prevalence of 5 in 10,000. According to data from an international commission in which the Cardiomyopathies Center and the Cardiac Rehabilitation Unit of Auxologico participated for Italy, every year there are 4-5 million sudden deaths in the world, of which 300 thousand in Europe: almost a thousand per day.

It is not easy to diagnose it: patients suffering from Brugada syndrome can also be totally asymptomatic or manifest the symptoms of the disease with episodes of syncope not preceded by warnings. Characteristic of this disease is an extreme variability of clinical and, above all, electrocardiographic presentation. A timely diagnosis is crucial for this syndrome, explains Auxologico. Therapy depends on the patient’s risk level. It can range from a simple six-monthly clinical follow-up to the implantation of defibrillators in patients who are deemed to have a higher arrhythmic risk or who have already experienced arrhythmic manifestations of the disease. Brugada Syndrome “does not have a defined clinical progression, so a patient can remain in the low arrhythmic risk range throughout his life, or some characteristics may become apparent which demonstrate that the risk level has changed”.