It was a bright, sunny summer morning when 49-year-old Manish (name changed to protect privacy) put on his sports shoes and stepped out of the house for his daily morning walk. Just 20 minutes later, the phone rang at his home, delivering the dreaded news that Manish had collapsed and was being rushed to the hospital. Though doctors tried valiantly, Manish could not be revived from the sudden cardiac arrest he had suffered. For his family, the news came as a shock, as Manish had always looked thin and fit, and had never smoked or drunk alcohol in his life.
Doctors point out that cases like Manish’s have been on the rise for some years now. In 2014, for instance, estimates suggested that 4,280 out of every one lakh people die every year due to sudden cardiac arrest. In India, 6-8 lakh deaths every year are because of sudden cardiac arrests. What is alarming is the dismal survival rates, which are less than 5%.
In most such cases, cardiac arrest seems completely unpredictable. However, doctors point out that cardiac arrest often results from longstanding cardiac problems that could be detected and prevented earlier. “While the cardiac arrest itself may be sudden, it is often caused by blockages in the heart. These build up over time and do not happen overnight,” says Dr Deep Chandh Raja S, Consultant Cardiologist & Clinical Lead- Cardiac Electrophysiology at Kauvery Hospital, Chennai.
While cardiac arrests are devastating because of the suddenness with which they strike, symptoms in heart attacks may emerge and build up hours, days or even weeks before the heart attack. These symptoms range from chest pain, acidity-like complaints, heart burns, and difficulty in breathing. These are due to blockage in the heart’s blood vessels. A massive heart attack can, of course, lead to sudden cardiac arrest without preceding warning signs. While the heart does not stop beating in a heart attack, in a cardiac arrest an electrical malfunction stops the heart from beating steadily, preventing it from pumping blood to the brain and other parts of the body. “Within seconds, the brain is deprived of blood and the patient loses consciousness. And because the respiratory centres are in the brain, the person also stops breathing,” explains Dr Deep Chandh Raja. If the heart is not restarted, death occurs within minutes.
While heart attacks and cardiac arrests have different presentations, notes Dr Deep Chandh Raja, they are also closely linked. One of the most common causes of cardiac arrest is coronary artery disease, in which the arteries get clogged with cholesterol or other deposits, also leading to heart attacks. Most of the times, the occurrence of a massive heart attack is the trigger for the sudden cardiac arrest.
Understanding the mechanism is important in preventing cardiac arrests, because these blockages build up over time and can be prevented using lifestyle changes and medications before becoming lethal. Patients above the age of 40, particularly with conditions such as diabetes, hypertension, obesity, excessive psychological stress, birth defects, family history of heart problems and a habit of smoking are at a higher risk for cardiac arrest. Hence, it is important for people to undergo regular heart health screenings. While such tests are often prescribed for people above the age of 40, the age of onset of cardiac problems is rapidly falling and even people in their late 20s and 30s should take care if they have anyone of the risk factors, says Dr Deep Chandh Raja. “Have a health check-up regularly and maintain a balanced diet with regular exercise, no smoking and learn to manage stress.” he adds.
Besides coronary artery disease and heart attacks, cardiac arrest can also result from improper development and functioning of the heart such as cardiomyopathy, heart valve disease, congenital heart disease and electrical malfunctions such as Brugada syndrome and long QT syndrome. Many of these cases can be detected and treated with early screening, says Dr Deep Chandh Raja.
While cardiac arrests can sometimes come on with no warning at all, patients may also sometimes experience some symptoms shortly before a cardiac arrest such as chest pain or discomfort, rapid or irregular heartbeats, wheezing, breathlessness, dizziness or fainting. Patients should not dismiss such symptoms and should immediately consult with a doctor.
One frequent problem, says Dr Deep Chandh Raja, is that patients often ignore anginal equivalents or cardiac symptoms such as jaw pain, acidity, and so on. If patients go into cardiac arrest, he explains, they would typically be unconscious with no breathing and no pulse. In such cases, speed is of the essence and those nearby should begin cardiopulmonary resuscitation (CPR) within seconds after a patient collapses. “It’s very important that you don’t waste time. Administer continuous and uninterrupted CPR, at a rate of about 100-120 compressions per minute till the ambulance comes or the person regains consciousness. If you are comfortable you can also administer mouth-to-mouth resuscitation, at a rate of 2 breaths for every 30 compression,” says Dr Deep Chandh Raja. If facilities are available, a portable defibrillator can be used to restart the heart.
Less than 5% of Out-of-Hospital Cardiac Arrest patients survive, largely because of the failure to provide immediate and effective treatment. In such a scenario, says Dr Deep Chandh Raja, it is vital for many more people to learn CPR, as keeping the patient’s blood flowing till they reach a hospital could be the difference between life and death. “At Kauvery Hospital, we run a bystander CPR training program called Restart-a-Heart as well as Basic Life Support workshops in association with the Kauvery Heart Rhythm Services, which have trained a variety of people in effective life-saving skills,” says Dr Deep Chandh Raja.
This article was published in association with Kauvery Hospital.