The story is all too common :
Jack, a 56 year-old civilian worker, sits in the living room watching a sitcom with his wife. Jack has not led a medically exemplary life but the heart attack he had a couple of months ago has given him an important wake-up call. “You were lucky this time, Jack,” his doctor told him. “You’ve had substantial heart damage, but the old pump is still working well enough. If you straighten up your act, you’ve got a good chance of seeing your grandbaby get married someday.” So Jack has begun a strict diet, has begun exercising under the watchful eye of local cardiac rehabilitation program, is taking all the medication his doctor has prescribed to help his heart heal and to help prevent another heart attack, and most imprtantly, has quit smoking. After only a month, he has already lost 7 kg and is jogging more than 2 km every other day. He feels better – more fit and more energetic – than he has in years. He leans back in his easy chair and smiles. “You know,” he says to his wife,” that heart attack may turn out to be one of the best things that ever happened to me.” She smiles back. “You are, no doubt, referring to the fact that you haven’t had to do a lick of housework in over a month.”
She expects a return chuckle from Jack – but all she gets is a soft gasp. She glances at her husband and is horrified by what she sees. Jack’s eyes are wide with fright, and he is gasping for air. He feebly tries to stand, but collapses to the floor. Within seconds he is unconscious, and despite his wife’s best efforts – and the efforts of the paramedics who arrive later – Jack dies.
While the sort of explanation may give some comfort to the widow – and while it may give some false comfort to the doctor as well – it is usually wrong. Most of these thousands of deaths are not due to another heart attack (that is, to another blockage of coronary artery). Instead, most are due to sudden appearance of a lethal heart arrythmia known as ventricular fibrillation. When ventricular fibrillation occurs, it usually occurs suddenly, without a shred of warning – often in mid-sentence. And unless the heart is defibrillated within a few minutes, death ensues.
Thankfully, ventricular fibrillation is an extremely rare occurrence in people with normal hearts. But in peopple who have suffered almost any form of heart muscle damage – heart attacks being by far the most common cause of heart muscle damage – ventricular fibrillation is disturbingly likely. Indeed, the more muscle damage one has sustained, the higher the risk of having sudden death from this arrythmia. And there generally are no warning signs that can tip off either the patient or their doctors that sudden death is approaching.
So, is there anything in any chance that we can do to prevent this circumstances from happening to us? Let’s start with the term of sudden death it self. Sudden death is generally considered any “natural”, unexpected death that occurs within one hour after symptoms begin. Many sudden deaths occur quite rapidly, oftentimes wihin seconds or minutes. The vast majority of sudden death is caused by heart disease, although other illnesses such as massive bleeding, strokes, and pulmonary emboli (a blood clot traveling to the lung) may also cause this problem. Sudden cardiac death frequently occurs in people with known or suspected heart disease, but it may rarely occur in people with no known cardiac abnormalities.
We will especially talk about sudden death caused by cardiac abnormalities. Sudden cardiac arrest is not a heart attack. Heart attacks occur when there is a blockage in one or more of the coronary arteries, preventing the heart from receiving enough oxygen-rich blood. If the oxygen in the blood cannot reach the heart muscle, the heart becomes damaged. In contrast, sudden cardiac arrest occurs when electrical system to the heart malfunctions and suddenly becomes very irregular. The heart beats dangerously fast. The ventricles may flutter or quiver, and blood is not delivered to the body. In the first few minutes, the greatest concern is that blood flow to the brain will be reduced so drastically that a person will lose consciousness. Death follows unless emergency treatment is begun immediately.
There are many risk factors of sudden cardiac arrest :
- Previous heart attack
- Coronary artery disease
- Ejection fraction of less than 40%, combined with ventricular tachycardia
- Prior episode of sudden cardiac arrest
- Family history of sudden cardiac arrest
- Personal or family history of certain abnormal heart rythms
- Ventricular tachycardia or ventricular fibrillation after a heart attack
- History of congenital heart defects or blood vessel abnormalities
- Hystory of syncope
- Heart failure
- Dilated cardiomyopathy
- Hypertrophic cardiomyopathy
- Significant changes in blood levels of potassium and magnesium
- Obesity
- Diabetes
- Recreational drug abuse
- Taking drugs that are “pro-arrhythmic”
If you have any of the risk factors listed above, you have to speak to your cardiologist about how to reduce your risk. Keeping regular follow-up, making certain lifestyle changes, taking medication as prescribed, and having interventional procedures or surgery, are ways you can reduce your risk. And if you still free from those risk factors, starting in your mid-to-late 30’s, take measures to prevent heart disease by doing the following :
1. Be aware of major risk factors : hypertension, high cholesterol, cigarette smoking, having family history of heart disease, and diabetes are all major risk factors that could increase your probability of having a heart attack.
2. Make a lifestyle change : think of the things that are in your power to change, like improving your diet, getting exercise, and quitting smoking. Eat 7 – 9 fruits and vegetables each day, get at least two hours of moderately intensive exercise each week.
3. Make an appointment to be evaluated : if you have a family history of heart attacks, or you think you’re at risk, spend some time with a preventive cardiologist nearby. The evaluation and blood test will reveal your HDL and LDL cholesterol, triglycerides, fasting lipid profile, blood pressure, and family history. From this checkup, the doctor will be able to determine if you need to have a non-invasive scan of your heart to look for problems, or if you need to be prescribed medication.
4. Don’t deny cardiac symptoms : if you’re experiencing shortness of breath or chest pain from exertion, get to the hospital right away.
5. Use mediacation recommended by your physician.
6. Extra : if you’re under high stress, take up meditation, yoga, tai chi, or practice any other relaxation technique for five minutes everyday. People who exercise on a regular basis, are less likely to have heart disease or die from a heart attack later in life.
Those are things you can do to modify any of risk factors you probably have. But what if you see someone experiences sudden cardiac arrest? Of course you should call for medical help. Meanwhile, you should perform CPR until emergency medical help arrives. So, it is important for you to know how to perform CPR, because it can help save a life.
We shouldn’t be afraid of death, nor life in fear of sudden death. It is merely God’s right. But if we can do something to prevent it (sudden cardiac arrest), why wouldn’t we? Don’t we all would love to live a happy, healthy, long life?
