Heart and Sudden Deaths

It is such a recurring news these days that a young person passed away suddenly. Just few days back a young cricketer died while playing and not very long ago a famous foot-ball player died while on field. With so many sudden deaths narrated as heart attack, I think it is very important for people to know and make distinction between deaths due to heart attacks and due to heart rhythm disorders. This is not merely an academic debate but has definite health implications.

Firstly, heart needs to be understood as a pump distributing blood to whole body. The pump activity is dependent on both heart muscle function and electrical system of the heart. The electrical system can be thought of as a self-propagating electricity source which needs to be ON every time to keep heart going. The electrical system works in rhythms and if you ever had a look at ECG, you would have noticed periodic bumps which doctors and cardiac physiologists interpret to see if electrical system of the heart is working well. If there is a compromise in blood supply to a part of heart muscle, the electrical activity around the affected portion is distorted causing certain patterns on ECG. Health care professionals are trained to recognise these patterns and will know what to do when they see such patterns.

Every sudden cardiac death is pronounced as heart attack. Heart attack, or myocardial infarction in medical terms, means there is a compromise in blood supply to the heart muscle and if not timely treated can lead to death due to different complications including pump failure, precipitation of serious heart rhythm disturbances (in layman terms short circuits) etc. While a large proportion of sudden cardiac deaths are caused by heart attacks, issues primary to electrical system of the heart can also cause sudden cardiac death. In-fact, sudden deaths in young people are much more attributable to dysfunctional electrical system of the heart than heart attacks. This distinction is very important because if someone dies due to heart electricity issues, there is usually some sort of predisposition which can be abnormal salt/electrolyte levels in blood, genetics (means running in families), drug abuse, medications etc. In presence of underlying predisposition, a lot of abnormal heart rhythms are precipitated by exercise, stress, exertion etc and explains sudden on-field deaths in some athletes. If you speak to the family members of patients who suffer from untimely sudden deaths, there is usually history of episodes of transient loss of consciousness particularly related to exertion and this was put down to tiredness, dehydration or over-exertion.

Sudden transient loss of consciousness in a young adult which is related to exertion should be looked into with seriousness if we are to prevent sudden death in predisposed individuals and be investigated properly. As a gold standard, sudden cardiac death in a young person should automatically trigger family and 1st degree relative screening for heart electrical system issues. The screening is usually with resting ECG and echocardiogram +/- other tests. Any members of the family identified to have such issues must be treated promptly with medications and devices to prevent and treat life threatening heart rhythms. The management also involves lifestyle modifications which are as critical as medication and device therapy.

Dr Fahad ul Islam Mir moved to the UK for higher studies after completing MBBS degree from GMC Srinagar