Cardiac Arrests: So Sudden, So Shocking

The news of sudden death of a Karnataka film star Puneeth Raj Kumar alias “Appu”, just 46, after a vigorous exercise few days ago shook millions of his fans. Another similar death which comes to mind is of Ranjan Das a 42 years old CEO and MD of SAP India, a well-known multinational corporate company after a vigorous jog in 2009. Such instances are scaring. These health freaks dying so sudenly puts exercise programs for a healthy heart into a question. A few years ago in 2018, Prof Rita Jitender former Director of Culture while participating in a program “Good Morning Kashmir”, died suddenly and shocked and surprised all the viewers.

In the case of Puneeth Raj Kumar, there was a family history of heart attacks in his father and elder brother. It is therefore likely that he might have had non critical blockages in the heart arteries and vigorous exercise can lead to rupture of these plaques leading to clotting of the artery and a heart attack which can be fatal as in this case before even reaching a treatment facility.

Ranjan Das again an exercise freak and eating very carefully was a man with lot of work stress. He used to sleep less than 4 hours for several years. Lack of sleep leads to high blood pressure and changes in blood chemistry, increasing inflammation, making blood more coagulable and making them prone to such a catastrophe, People who sleep less than 5 to 6 hours a day and are involved in stressful occupations are prone to such events.

Prof (Mrs) Rita Jatinder had previously known heart disease with an impaired heart function which makes the individual prone to sudden cardiac death. In fact, the commonest cause of Sudden Cardiac Death is the heart rhythm becoming chaotic, bizarre and very rapid. This rhythm cannot sustain life and is ineffective to pump blood and leads to cardiac arrest. If effective cardiac resuscitation, in the form of cardiac massage followed by a DC shock to normalize the rhythm is not done brain death would occur within a few minutes. Most of these patients have a poorly functioning heart as determined by left ventricular ejection fraction (LVEF) determination. Echocardiography is a very good investigation for this and is widely available. LVEF less than 35% is the usual cut off.

Sudden cardiac death is also seen in the first few hours after a heart attack. For this reason, patients with acute heart attacks are best cared in coronary care unit where equipment and personnel for handling emergencies is available round the clock.

Those patients who have LVEF < 35% are candidates for evidence-based drug treatment called 4 pillars and if need be, a prophylactic implantable defibrillator implantation (ICD) so that the arrhythmia can be detected immediately and a low intensity shock delivered. Implantation of ICD, is like a permanent pacemaker implantation. This can be lifesaving.

All patients with low LVEF should contact their treating physicians to find out whether they are candidates for ICD implantation in addition to the drugs. The treating physicians should also be made aware of this fact because all of them are not cardiologists. Some of these patients get warning symptoms in the form of transient episodes of dizziness or fainting. These should be taken very seriously and reported to their physicians especially in persons with an existing heart disease. These episodes also called syncope are often the warning symptoms.

Exercise and sudden Death:

Very strenuous exercise especially when done episodically with long periods of inactivity is a strain on the heart. It results in a sharp increase in blood pressure and increased demand of oxygen by the heart. If there are risk factors like high blood levels of bad cholesterol, smoking, diabetes etc, these can result in rupture of a vulnerable spot of cholesterol deposition in the coronary arteries (Vulnerable plaque) and lead to a heart attack. Exercise programs in persons after 30 to 40 years of age, therefore need to be started gradually. The duration and intensity should then be increased over a period of few weeks. These should then be maintained.

Sudden death in athletes and professional players

This is again an uncommon but known issue. It results from a thickened heart muscle (Hypertrophied Heart) which produces sudden bizarre heart rhythm emanating from areas where muscle has been replaced by a thickened tissue (called fibrotic areas). Sports doctors accompanying them need to be aware of these infrequent happenings.

Role of preventive heart check-ups:

It is highly recommended that everybody beyond the age of 35 years of age should have an annual check up consisting of blood biochemistry consisting of haemoglobin and blood counts, blood sugar and lipid profile, kidney and liver function tests. An electrocardiogram and preferably an exercise ECG or an echocardiogram is also recommended. The abnormalities found should be noted and appropriate treatment started. These measures minimize heart attacks.

Take home message:

Sudden death, a catastrophic event can certainly be prevented in most instances. Leading a healthy life style, moderate but regular exercise, diet rich in fruits and vegetables, periodic health checks and adequate sleep. Those with existing heart disease with impaired heart function should seek specialist consultation for the need of appropriate drugs and may be an implantable defibrillator for very high-risk cases.

Prof Upendra Kaul is founder Director of Gauri Kaul foundation. A recipient of Padma Shri and Dr B C Roy Award