By Dr. K. Javeed Nayeem, MD

The sudden passing away of the apparently ‘Fit as a Fiddle’ film actor, Puneeth Rajkumar , the ‘Apple of the Eye’ of every one of his fans, has not only shocked them but most other people too. This is so not only because of the suddenness of the event but because everyone naturally felt that it was not even the time for a young, active and healthy person to die. A third reason for the shock perhaps stems from the fact that most lay people believe that deaths like these are extremely rare. But contrary to this belief, Sudden Cardiac Death or SCD is a very well-known medical entity and a whopping three hundred and fifty thousand SCDs occur worldwide each year! Sadly, it is a problem which, despite all the advancements in medical science, has a very dismal survival rate with or without medical help, unlike most other medical problems.

And, again, contrary to most people’s perceptions, SCDs are really not so sudden at all and therefore despite their lethality, they are fairly effectively prevented, rather than treated. It is just that most persons miss the early warning signs that certainly could have taken the ‘suddenness’ out of such an attack. Most people who die due to this problem die within ten minutes if medical help does not become available to them immediately.

And, sadly, more often than not, ten minutes is less than the time it takes for the people around to realise that something has gone wrong seriously with the person who has collapsed and it is not just another case of fainting due to exhaustion or an epileptic fit, let alone giving them the time to react and summon medical help.

Another sad fact is that any resuscitation after about five minutes may not be a very fruitful achievement because it takes less time than that for the cells of an oxygen-starved brain to die permanently, leaving the affected person completely brain dead and in a permanent vegetative state. In most cases, this suddenness therefore completely precludes the possibility of an ambulance or medical rescue team reaching the spot. Perhaps the only other medical event that kills people just as suddenly is a Pulmonary embolism, which thankfully is much rarer.

Studies show that many persons who succumb to SCD are the ones who missed the early warning signs and thus did not seek the help that could have saved their lives by preventing the fatal event. A medical study conducted at a leading heart hospital in New York has shown that at least fifty percent of the people who had a sudden cardiac arrest had some warning signs or symptoms up to a week before, which were missed by them and sometimes by their doctors too. And, while nearly eighty percent of them had such symptoms a day before, ninety percent of them had them an hour before the event.

And, in most cities across the world today, an hour is more than enough for the patient to reach a good medical facility or for a competent and adequately equipped medical team to reach the spot of the event. But unfortunately, it was found that only twelve percent of the people sought the medical help which could have saved their lives.

The events that usually herald a SCD are chest pain or chest discomfort in 46 percent of the cases with shortness of breath in 18 percent and nausea, abdominal pain or heart burn in 20 percent. While most people think that heart attacks are the reason why SCDs occur, they are only partly correct. Medical experts know that while heart attacks too can kill suddenly, it is the electrical disturbances in the heart which can cause it to stop working suddenly and helplessly, which are the real cause of SCDs. I feel that it will be worthwhile to enlighten you in a nutshell, about the difference between these two killer events.

A heart attack is actually a circulatory problem. The heart, which as we all know, is a pumping organ, actually has two circulatory systems in it. The larger one is the one that keeps the blood flowing through all parts of the body and the lungs while the smaller one is the one that keeps the blood flowing through its own muscle to keep it nourished and beating.

Interestingly, it is the much, much smaller system that is the potential killer!  It is the three very narrow blood vessels, called the coronary arteries which are highly prone to getting blocked gradually due to fatty and calcific deposits or suddenly due to a wandering blood clot which when choked, can prevent blood flow to the heart muscle, leading to its death. And, a death of a sufficiently large portion of the heart muscle naturally translates into the death of its owner! But while heart attacks too can kill suddenly, most heart attacks thankfully give enough time for most patients to reach good hospitals where they can be treated.

On the other hand, an SCD is very often due to an electrical malfunction within the heart where the heart just stops beating which kills the patient much faster.  Now, in addition to having a tiny circulatory system of its own, the heart also has an electrical conducting system which stimulates its muscle to keep beating steadily at its own normal pace, non-stop and life-long. Any malfunction of this electrical system can cause the heart to lose its rhythm and start beating too slowly or too rapidly or to become erratic and irregular. This loss of rhythm can be a much deadlier killer than any heart attack and our journey into this realm begins next weekend ! So, please stay tuned!

[Note: This column is

sixteen-years-old today]

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