What are the lessons that we have learnt from the death of a 27-year-old post-graduate programme (PGP) student of the Indian Institute of Management, Bengaluru (IIMB), who died after a sudden cardiac arrest? A high achiever, a successful corporate intern and popular among his peers, he had the makings of what you would say the life that everybody aspires for. In fact, sudden cardiac arrests among the young is an increasing phenomenon and it is a myth that it is a rare occurrence. In fact, the frequency of similar news reports highlight the need to probe the triggers that we may be overlooking and build an awareness around them.
WHAT IS A SUDDEN CARDIAC ARREST?
“A sudden cardiac arrest is described as a condition where the heart stops abruptly and loses all its activity due to an irregular heart rhythm or electrical impulse. This irregularity sends the heart into a panic mode and its ventricles or lower chambers quiver and contract in an uncoordinated manner. So the heart cannot pump oxygenated blood that your body needs. In the first few minutes, the blood flow to the brain is affected and the patient loses consciousness. And within eight minutes, all major organs shut down in the absence of a blood flow unless the patient is attended to,” says Dr Pradeep Haranahalli, Consultant, Interventional Cardiologist, Manipal Hospital, Bengaluru.
HOW IS SUDDEN CARDIAC ARREST DIFFERENT FROM A HEART ATTACK?
Sudden cardiac arrest isn’t the same as a heart attack. “A heart attack is caused by blockages or plaque deposits and clotting in arteries which restrict blood flow to the blocked parts of the heart, causing muscle scarring. A sudden cardiac arrest is not caused by a blockage. However, if the heart attack can change the heart’s electrical impulses and cause irregular heartbeats, then it could become a trigger for a sudden cardiac arrest. A heart attack is quickly identifiable with ECG changes. But a sudden cardiac arrest doesn’t give you that time at all,” says Dr Manish Hinduja, Consultant, Adult Cardiac Surgery, Kokilaben Hospital, Mumbai.
WHAT TRIGGERS SUDDEN CARDIAC ARREST IN NORMAL PEOPLE?
1) “Most data available in scientific reviews till now show that sudden cardiac arrests among the young are the result of a genetic condition called Hypertrophic Cardiomyopathy (HCM), a rare genetic disorder. This condition ends up thickening the heart muscle and is usually caused by abnormal genes. The thickened heart muscle stiffens up and cannot pump the required amount of oxygenated blood with each heartbeat. This causes arrhythmia or irregular heartbeats and by extension triggers a sudden cardiac arrest,” Dr Haranahalli says. “People with HCM usually are not even aware that they have a unique condition and may only feel symptoms with exercise or exertion, which in turn lead to abnormal heart rhythms,” he adds.
2) As for regular heart attacks causing malfunctioning electric impulses in the heart and sudden cardiac arrests, he says that about “10 to 15 per cent of overall heart attacks lead to such events.” Usually, young age heart attacks mostly cause sudden cardiac arrests.
3) Sometimes, says Dr Haranahalli, other electrolyte channel-related genetic conditions, too, make the heart vulnerable to abnormal rhythms. “Most often they are unidentified until the event when they usually develop extreme fatigue and lose consciousness, collapsing then and there.”
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4) Dr Hinduja points to a heart valve disease, where leaking and narrowing valves can lead to stretching or thickening of the heart muscle, which in turn “puts the patient at an increased risk of developing a heart rhythm problem.”
5) Normally, increasing stress levels are seen as a lifestyle marker for heart attacks. “But they can trigger an episode of abnormal heart rhythms in somebody already stressed and has a traumatic experience over and above it,” says Dr Haranahalli.
6) Endothelial dysfunction is a type of non-obstructive coronary artery disease (CAD). “What happens is that though there are no arterial blockages as such, the blood vessels of the heart narrow down instead of dilating. This again increases vulnerability to abnormal heart rhythms leading to sudden cardiac arrest,” says Dr Haranahalli.
7) Global data has shown that COVID-19 infections had caused myocarditis, leading to scarred heart tissue that interferes with heart rhythm. “The sustained abnormal electrical activity within the heart leads to abnormal rhythms. Asymptomatic or silent viral infection, apparently trivial, can have myocardial or heart muscle involvement, triggering episodes of irregular rhythm and sudden cardiac arrest,” he adds.
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8) And sometimes there’s an element of surprise that the heart cannot adjust to. “Suppose you have had a totally sedentary life and suddenly you take to unaccustomed physical exertion and pitch it high, it can lead to sudden cardiac arrests. Any sudden changes, such as starting vigorous physical activities, HIIT (high intensity interval training), gymming, may exacerbate the hidden cardiac conditions that we are ignorant of. That’s why we ask patients to build their exercise routine gradually,” explains Dr Haranahalli.
WHAT ARE SYMPTOMS?
Since the onset of sudden cardiac arrest is very sudden and makes you unconscious quickly, there aren’t any warning signs as such. But watch out for sudden fatigue, cold sweat and dizziness, raise an alarm and seek medical help quickly. “Sometimes, you may experience unusual beating of the heart, fluttering or pounding.”
HOW TO PREVENT SUDDEN CARDIAC ARRESTS?
“Indians must do an ECG and echocardiogram as part of their physical review in early age to identify underlying genetic conditions. Pre-athletic or sporting event health checkups as well as baseline sugar and cholesterol checks are enough to identify risk factors,” says Dr Haranahalli. Dr Hinduja suggests keeping a close watch on the family’s cardiac history. “If there has been a history of cardiac arrests in either their maternal or paternal lines, patients must check which age they had it. If they see that anybody a generation above has had sudden cardiac arrests at age 50, we would advise to test for genetic conditions at least a decade earlier,” he says.
LINE OF TREATMENT
If the patient has been lucky enough to have had access to emergency response, then the person can subsequently have medications to help restore the heart’s rhythm and improve blood flow. Or have implantable cardioverter defibrillators (ICDs) under your skin to manage and reduce the risk of sudden cardiac arrest. “Otherwise, what holds good for general heart health holds good for prevention of sudden cardiac arrest. This means lifestyle correction in terms of diet, sleep, exercise, keeping blood sugar, cholesterol in control and losing weight. In terms of medication, there are nitrates, which open constricted blood vessels, calcium channel blockers which widen blood vessels and statins, which, apart from lowering cholesterol levels in the bloodstream, also repair heart walls,” says Dr Haranahalli.
