SUDDEN CARDIAC DEATH

Sudden cardiac death (SCD) not only brings an abrupt end to one’s life, worse it can be extremely traumatic to the family, friends and eye witnesses. SCD is defined as death occurring after 1-2 hours of onset of symptoms. To many of us out there, it is thought that sudden cardiac death occurs suddenly without any symptoms. This is generally not true. In a study in Germany, 90% of patients had symptoms of chest pain, dizziness, breathlessness or nausea or vomiting. Majority are of high risk for SCD, meaning they had a previous history of coronary artery disease or other forms of dilated cardiomyopathy, diabetic or were on drugs that could provoke lethal arrhythmias.

The most common cause of SCD is a heart attack, accounting for 80% of all SCD. In a heart attack there is a sudden abrupt cessation of flow to the affected coronary artery, meaning the artery to the heart muscles. There are 3 major coronary arteries. Because there is cessation of flow to the muscles, there will be muscle death. But most importantly, the abrupt closure of the artery causes ventricular fibrillation in 10-15% of patients with heart attacks. If this was to happen at home, unfortunately chances are patients will never make it to the hospital alive.

The other common causes of sudden cardiac death

Cardiomyopathies. Cardiomyopathies encompass diseases of the heart. In these patients the underlying poor heart function makes them susceptible to abnormal rhythms that can be fatal, such as ventricular tachycardia and ventricular fibrillation.
Genetic disorders. These conditions include long and short QT syndrome and brugada syndrome. In these conditions there is a single gene mutation and this causes unstable cardiac electrical activity which inevitably will result in malignant arrhythmias. As a practising cardiologist, I have met a family with 4 daughters, 3 of whom died in their sleep during their teenage years from long QT syndrome. It is very devastating and sad.
Noncardiac causes of SCD include intracranial bleed, rupture of an aneurysm, and drug overdose.

Most patients have had symptoms prior to their untimely death. Many patients do not reveal this to their family, let alone their friends the symptoms they have been having. People tend to have these preconceived ideas that their symptoms may be nothing much, it will go away. It is not uncommon for the general public to have this mindset. Worse many already know they have underlying risk factors like diabetes, hypertension and hypercholesterolemia and are not adhering to medical advice. It is important to consult your doctors if you have symptoms as many of these SCD are preventable.

Prevention of SCD starts from the patient. Leading a healthy lifestyle is a step towards a lower risk for many illnesses. Simple measures such as eating in moderation can prevent obesity, high cholesterol, diabetes and hypertension, all of which are modifiable risk factors for coronary artery disease. Cessation of smoking without doubt is a step towards a longer and healthier life. Just one year after quitting smoking, your risk of heart attack will drop sharply and in 2-5 years your risk will be the same as a nonsmoker.

It is important to get yourself examined and investigated to know your risk factors for heart diseases and discuss with your doctor how you can reduce your risk for SCD. Many basic investigations suffice in helping you know health better. This is especially so if you have a family history of diabetes, hypertension and heart diseases. Don’t take a SCD occurence in the family lightly. Many people with a family history of sudden cardiac death may have the inheritable syndrome that predisposes them to SCD too. Most SCD are preventable by simple measures.

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