Sudden death

Perfectly healthy and very fit, going about their studies or work…..suddenly they collapse and die.
Dropping dead due to the heart stopping suddenly seems to be the explanation, leaving dear and near ones in shocked disbelief.

"Yes, these deaths are very sudden and unexpected," Consultant Cardiologist Dr. Gamini Galappatthy, currently attached to the Kalutara General Hospital says, explaining that it is usually due to sudden cardiac arrest following an electrical rhythm abnormality in the heart called ventricular fibrillation (VF).
In some of these victims, especially the elderly or the middle-aged, cardiac arrest can follow soon after a massive heart attack, MediScene understands.

This can happen in so-called “normal” people who have not been diagnosed with any cardiac problems before this “massive” event -- Sudden Cardiac Death Syndrome, which in many instances kills them immediately, according to Dr. Galappatthy.

Referring to the different categories of people who may succumb in a matter of minutes to Sudden Cardiac Death Syndrome, Dr. Galappatthy picks Cardiomyopathy, a genetic condition, as the leading cause in young adults in the 14-30 year age-group. Cardiomyopathy leads to VF and sudden death.
The three such leading types of Cardiomyopathy, according to this Cardiologist, are:

Hypertrophic obstructive – this is a genetic condition where the heart muscle becomes thick which blocks the blood-pumping action of the heart. This makes the heart, a powerful organ, to work harder, resulting in the heart rhythm going awry (arrhythmia or fibrillation), points out Dr. Galappatthy, and is as widespread as 1 in 500. Going through life without any symptoms, this condition could fell a person suddenly during exertion such as exercising on the treadmill, jogging or a strenuous game of tennis.

Long QT Syndrome – this is a rarer disorder involving the heart’s electrical activity. In those who have this condition, exercise or stress can make the heartbeat go wild, he says, explaining that ‘long QT’ is an abnormal pattern seen on an electrocardiogram (ECG). Plunging into detail, he says that each heartbeat is mapped in an ECG as five distinct electrical waves namely P, Q, R. S and T. The activity between Q and T is the QT interval which focuses on the heart’s lower chambers or ventricles. “The QT interval represents about a third of each heartbeat cycle and a longer one can disrupt the workings of the heart,” says Dr. Galappatthy.

Brugada Syndrome – once again connected to irregular heartbeats and abnormal patterns seen on an ECG, this condition comes about due to the electrical activity at cellular level in the heart not being coordinated.

Reiterating that these three types of Cardiomyopathy are linked to abnormalities in the electrical activity of the heart at cellular level, particularly the ventricles, Dr. Galappatthy says VF means that the efficiency of the contraction of the heart is impaired. This prevents blood not only going to the brain but also to the heart itself and sudden death comes in its wake because of cardiac arrest.

Strongly advising all members of families which have had a sudden death like that to get screened, he stresses that it would be essential before undertaking any strenuous physical activity. Some of the warning signs of Cardiomyopathy will be palpitations (feeling the heart beat), fainting during exertion, feeling light-headed after exercise or shortness of breath, MediScene learns, while the screening is by a simple ECG which records the electrical activity of the heart.

The normal heart rate should be 70 beats per minute with a consistent and even heart rhythm, says Dr. Galappatthy. “The only way to revive someone who has collapsed due to Cardiomyopathy which is caused by VF which is a twitching or quivering of heart muscle fibres (fibrils) when the blood is not removed from the heart is to give ‘shock treatment’ in layman’s parlance,” he says, for VF is an emergency, with a very slim line between life and death.

Advising anyone who is around a person who has collapsed to keep the head and neck of the victim at the same level of the body to make his breathing easier, this Cardiologist urges that immediate mouth-to-mouth breathing should be administered along with chest compressions (cardiopulmonary resuscitation) while seeking medical help.

“We are discussing the need to set up external defibrillators at public places which can be used by lay people in such emergencies to give a quick electric shock through the chest to the heart to restore the heartbeat,” says Dr. Galappatthy, pointing out that the airport has these in keeping with international guidelines. These external defibrillators are handy because when you keep its pedals on the chest of the victim, it will guide the person administering the shocks what to do.

Those who have survived VF or are at a high risk of suffering one could be given medication or depending on the risk a defibrillator (like a pace-maker) implanted, which would step in if VF occurs to give the heart a shock and prevent cardiac arrest and death, he explains.

Not only is VF a matter of life and death, but even the shock administered is a “big event” felt by the patient like a sharp kick on the chest for a fraction of a second, according to Dr. Galappatthy. If administered externally, the victim gets 150-200 joules and internally only about 20 joules. Even when 20 joules are given internally, the victim could momentarily become dizzy or faint for the unexpected shock.

Other rare reasons for dropping dead after sports or exertion when young would be if born with abnormal coronary arteries or abnormal heart valves. While the first condition is difficult to diagnose, those with abnormally tight valves would have harsh sounds or "murmurs" detectable by doctors when listening to the chest with a stethoscope. Such doubts can then be cleared with an echocardiogram or a heart scan done by a Cardiologist.

Meanwhile, the sudden death of persons in the 50s could be due to exercised-induced heart attacks if they have risk factors such as diabetes, hypertension (high blood pressure) and cholesterol, he points out. Although there has been no angina (chest pain or discomfort due to the heart muscle not getting adequate blood) in the past, strenuous activity could damage built-up cholesterol plaque on the wall of coronary arteries, forming a clot which blocks blood flow to the heart muscle causing a heart attack or myocardial infarction (MI) and sudden death.

However, many lives have been saved when the patient is brought to hospital as soon as possible, with the gold standard for those brought in before 12 hours of suffering a heart attack being primary coronary intervention in the form of angioplasty and stenting.