Sudden Cardiac Death in a Young Man with Migraine-associated Arrhythmia

A 31-year-old man with migraine-induced syncope and bradycardia with subsequent pacemaker implantation died unexpectedly. Clinically unsuspected cardiac anomalies were found at autopsy including myocardial bridging of the left anterior descending artery and shelf-like coronary artery ostia. Nortriptyline was identified by toxicologic analysis. A review of the autopsy findings, the historical information, and the effects of the possible arrhythmogenic circumstances is undertaken and the potential contributions to the death are discussed. Cardiac arrhythmias have been documented during migraines. Coronary artery bridging has been known to lead to ischemia and infarction, ventricular tachycardia, and sudden death; however, these are very rare sequelae. Congenital coronary artery anomalies have been linked to sudden cardiac death, but only rarely cause death in people younger than 31 years. Migraines and the autopsy findings described have been associated with cardiac arrhythmia and sudden death. Altogether, they led to the unexpected death of this young man.     

Social integration: Approaches and issues

The World Summit for Social Development, to be held in Copenhagen in March 1995, will consider three closely inter-related themes: decreasing poverty, reducing unemployment, and enhancing social integration. With the support of the United Nations Development Programme, the United Nations Research Institute for Social Development (UNRISD) has been mobilising its worldwide network of scholars, activists, and development practitioners to promote reflection on major social issues, channel new information and ideas into the Summit preparatory process, and build public support for a successful Summit. To illustrate some of this work, we reproduce below the Summary of a Briefing Paper written by Cynthia Hewitt de Alcántara.     

Track II Diplomacy: From a Track I Perspective

Huge changes are taking place in international diplomacy which have created an opening and a certain appreciation for the contributions that can be made by private citizens to international peacemaking. This article provides a snapshot of diplomatic thinking about Track II/nonofficial diplomacy, from interviews with distinguished American diplomats. As thoughts of two-way collaboration develop, it becomes increasingly important to be clear about the limits and potentially unique contributions of Track II. Open respectful dialogue between Tracks I and II is also necessary to overcome past resentments and to develop mechanisms by which the skills and insights of Track II can be fed into Track I, with greater effectiveness and integrity.