Dr. P N in his early 40’s, was a healthy active person, engaged in his profession with working hours of 8-10 per day. He never had an indication of any kind of ill health. That day morning he was in the pink of his health. He had a good workout at the gymnasium after which he experienced a mild chest discomfort. Within few minutes, he collapsed. He rolled up his eyeballs and fell on the ground. Doctor declared him to be dead. This is horrendous. It took away a young doctor from the society whilst he was at the peak of his name and fame. It took away a bread winner from the family and a father from their young children. This is not a new story. From time to time it figures in the media.

WHY DOES THIS HAPPEN?
CAN WE PREVENT IT?
CAN WE PREDICT IT?
CAN WE EFFECTIVELY TREAT IT?

This condition is called Sudden Cardiac Death (SCD). Medically, it is defined as natural death from cardiac causes accompanied with sudden loss of consciousness within 1 hour of the onset of a cardiac event. Its incidence is 0.2 to 0.4% in the USA population. In fact 65% of the patients who are admitted to the ICCU with a heart attack never had any previous premonitions. Virtually more than 7 million deaths are attributed to SCD worldwide.

Our heart is like an electric pump through which blood flows to all parts of the body, in a rhythmic fashion. Whenever this rhythm is disturbed, there can be rapid, erratic electrical impulses called arrhythmias which are of many varieties depending upon the area of the heart from where they arise. Most common cause of SCD is a type of arrhythmia called ventricular fibrillation wherein the heart beats much faster than usual and this causes the electric pumping activity to go erratic and out of control. In people with a normal healthy heart, an outside trigger such as an electric shock, the use of illegal drugs or an injury to the chest wall can also cause SCD.

There are various other conditions that can cause SCD such as Coronary Artery Disease in which there is a block or narrowing in the blood vessels (arteries) that supply blood to the heart. These blocks are usually fat or cholesterol deposits that cause narrowing of the vessel and thus there is a compromise in the blood flow. Sometimes a small portion of such deposit can get dislodged and can shut down an entire artery leading to a heart attack. This can cause arrhythmia and sudden cardiac arrest. It can also leave behind dead or scar tissue in the heart which can itself become an arrhythmia trigger.

Sudden cardiac arrest is so often linked with coronary artery disease, that risk factors of both these conditions are similar. These include family history of coronary artery disease, smoking, high blood pressure, high blood cholesterol, obesity, diabetes, sedentary lifestyle, drinking too much of alcohol. Other factors that may increase your risk of sudden cardiac arrest include a family history of cardiac arrest, a previous heart attack, age of 45 years for men and age of 55 years for women. Men are two to three times more likely to experience sudden cardiac arrest than women, using illegal drugs such as cocaine or amphetamines, nutritional imbalance such as low potassium or magnesium levels.

Patients of sudden cardiac arrest can come with sudden collapse, no pulse, no breathing, and loss of consciousness. Sometimes, other signs and symptoms can be noted in some like fatigue, fainting, black outs, dizziness, chest pain, shortness of breath, weakness, palpitations or vomiting. But, sudden cardiac arrest often occurs with no warning.

Sudden cardiac arrest requires immediate action for survival. In such cases, patient requires CPR (Cardio Pulmonary Resuscitation). This is an emergency procedure performed to restore blood circulation and breathing to an arrested patient. It involves chest compressions at least 5 cms deep at a rate of at least 100 per minute. This helps to create artificial circulation by manually pumping blood through the heart. Also, the rescuer may provide artificial breathing by exhaling into the patient’s mouth. CPR can restore partial blood flow of oxygenated blood to the brain and heart. It is a very useful emergency treatment which can help in saving the patient’s life till medical aid arrives.

Once the medical personnel arrive, they can give an electric shock to the patient’s chest wall through a device called defibrillator. This device is useful in patients of fatal arrhythmias. The shock momentarily stops the heart and the chaotic rhythm. This often allows the normal heart rhythm to restart. The shock may be administered by emergency personnel or by a citizen if a public-use defibrillator is available. Defibrillators are available in small, portable form and come with built-in automated instructions to ensure proper use. They’re programmed to recognise ventricular fibrillation and send a shock only when it’s appropriate.

There’s no sure way to know your risk of sudden cardiac arrest, so reducing the risk is the best strategy. Steps to take include regular checkups, screening for heart disease, living a hearty-healthy lifestyle with approaches like no smoking, a nutritious and balanced diet and physically active life.

If you know you have heart disease or conditions that make you more vulnerable to an unhealthy heart, your doctor may recommend that you take appropriate steps to improve your health, such as taking medicines for high cholesterol, carefully managing diabetes and high blood pressure or restriction of physical activity.

It is essential for the entire community to be trained in basic CPR. This saves lives. This training should not only be conducted in every corporate and government office, but should also be given in schools and colleges. Roadside camps and training programs can be held by various agencies. Every person in this country should know CPR and if possible operating a defibrillator. You never know when you will be faced with a situation when someone collapses next to you. At that time you should be prepared.