Fund manager, 47, dies of sudden cardiac arrest while on holiday: How young Indians can get a simple test and prevent this silent heart risk

“Now sudden cardiac arrest can be caused by a heart attack too, when a blockage leads to disturbance in electric impulses of the heart. But it can also be caused by so many other reasons. It can happen when the heart’s lower chambers contract in a very rapid and uncoordinated manner as a result of which the heart cannot pump oxygenated blood that your body needs. This is called ventricular fibrillation. Other reasons are changes in the thickness of the heart muscle and its enlargement, heart rhythm problems or arrhythmia because of genetics and a weak heart, when the heart can’t pump enough blood to meet the body’s needs,” explains Dr Darshan Krishnappa, cardiac electrophysiologist at Manipal Hospitals, Bengaluru, formerly at AIIMS and PGIMER.

“The best part is that many heart arrhythmias can be effectively managed or controlled with medication and lower the risk of sudden cardiac arrest. But people are focussed on heart attacks and the cardiologist and do not know that cardiac electrophysiologists can help them regularise their heartbeats and prevent sudden cardiac arrest,” he adds. He demystifies sudden cardiac arrest. Excerpts from an interview.

Why do we overlook arrhythmia?

Some arrhythmias are episodic. So, by the time a patient complains of discomfort and reports to the emergency, the heart has settled again. An electrocardiogram (ECG) also finds the heart’s electrical impulses to be normal. A lot of young patients experience paroxysmal supraventricular tachycardia (PSVT), a type of arrhythmia where the heart beats get caught in a loop. Then they beat too fast (over 100 to 250 beats per minute) due to rapid electrical signals starting in the upper chambers (atria) of the heart, causing sudden palpitations, shortness of breath, dizziness, fainting spells or chest pain. Since it blows over easily, an ECG cannot capture irregular heartbeats during an episode.

Now, this is common in young patients as it can be brought on by excessive use of caffeine, alcohol, tobacco, stimulants, stress, fatigue, dehydration, intense exercise and conditions like anaemia and hyperthyroidism. Unidentified and untreated, it is mistaken as anxiety and panic attack. Over time it weakens the heart, which in turn can trigger sudden cardiac arrest.

What causes a heart to weaken?

A weak heart can be caused by genetics, hormonal changes brought on by both hyper and hypo thyroidism, copper and selenium deficiencies and inflammation of the heart muscle.

Why sudden cardiac arrest can happen when you are relaxed, at ease and during vacations

That’s because the underlying triggers, primarily electrical problems within the heart, are often related to pre-existing conditions that do not always produce symptoms or require physical exertion to be triggered.

During deep relaxation or sleep, your parasympathetic system (rest and digest mode) is activated. This can slow heart rate and destabilize electrical activity in people prone to arrhythmias.
Some lethal arrhythmias actually occur more often at rest or during sleep, not during stress.

Many argue why sudden cardiac arrest happens when a person is on vacation. That’s because stress hormones and inflammation don’t disappear instantly. The heart may still be vulnerable even after the stress subsides. Besides, there is an abrupt change of routine. You could have too many glasses of alcohol, eat heavy meals, get dehydrated, sleep less and suddenly decide to take up an adventure activity or run a half marathon. These can alter the balance of electrolytes (potassium, magnesium) which can trigger abnormal heart rhythms. In fact, some cardiac arrhythmias are more likely during rest than physical exertion.

Can sudden cardiac arrests be prevented?

Yes, through easy screening methods. Since ECG is limited in efficacy, I would advise all asymptomatic adults to get an echocardiogram (echo) done as part of a routine checkup to prevent sudden cardiac arrests. Its sound waves find inflammation and hidden structural heart problems like thickening of heart muscles or valve issues, all of which cause dangerous arrhythmias.

Most importantly, it measures the percentage of blood pumped out with each heartbeat, what we call an ejection fraction, which shows how well your heart is functioning. An ejection fraction between 55 to 75 per cent is considered normal but below 35 per cent indicates a high risk of sudden cardiac arrest. This percentage is the best marker of a weak heart and studies have shown that sudden cardiac arrests happen the most in people with a weak heart.

If the ECG and Echo show some abnormalities, then we advise a cardiac Holter, which records the heart rhythms over 48 hours to a week to understand its pattern, exercise stress testing that evaluates heart rhythm under exertion and an electrophysiology (EP) study that tests how easily dangerous rhythms can be triggered.

For better monitoring, we advise maintaining a BP chart at home at certain times of the day, recorded on a home device.

What about treatment?

We usually advise medication. When that doesn’t work as well as we expect it to, then we go for a procedure to set up an Implantable Cardioverter-Defibrillator (ICD). This is a small, battery-powered device placed under the skin, typically near the collarbone, that monitors heart rhythms and delivers electrical shocks to correct life-threatening arrhythmias. I call it the watchman of the heart that prevents sudden cardiac arrest. It uses wires (leads) connected to the heart to detect problems. But this is only for high-risk patients.

Otherwise, preventing sudden cardiac arrest begins early with eight lifestyle preventive strategies. Manage blood sugar, BP, stress, sleep, exercise, obesity, diet and give up smoking.