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FAQs on sudden cardiac death
Dr. Padma Kumar, Cardiologist, answers some questions on sudden cardiac death

What causes Sudden Cardiac Death (SCD)?
A majority of Sudden deaths can be attributed to the heart. In general, the commonest cause of SCD beyond the age of 40 years is blockages in the blood vessels of the heart (atherosclerotic coronary artery disease). However, in younger individuals, inherited cardiovascular conditions are primarily responsible for “Sudden Cardiac Death”. Many of these conditions don’t cause symptoms in the early stages of the disease and, therefore, are not diagnoses. Unfortunately, the first symptom of many of these conditions can be “Sudden Cardiac Death”.

What are the common conditions which lead to SCD?
The most common conditions contributing to SCD are Hypertrophic Cardiomyopathy (HCM), anomalies of the coronary arteries (blood vessels supplying the heart muscle), Myocarditis (inflammation of the heart muscle), and Arrhythmogenic Right ventricular cardiomyopahty (ARVD, a type of heart muscle disease which causes abnormal electrical activity).

Once diagnosed, can these conditions be cured or controlled?
Early diagnosis can save lives. While these diseases cannot be cured, many medical, surgical & non-surgical interventions are available to control symptoms and prevent sudden death.

a family history of heart disease
who have relatives who have had sudden deaths
sports persons who take part in physically intensive competitive sports should get screened for cardiac causes of “sudden death

Preventing Sudden Cardiac Death
In the young, many may not necessarily have symptoms; diagnosis is only through a proper cardiac evaluation using state of the art technology handled by a competent team.

Screening tests
ECG, Echocardiogram, and a Treadmill Stress Test (for those above 40 years), when used judiciously, can pick up cardiac problems in many people. Of course, an astute Cardiological evaluation is priceless.

In some people, in addition to the non - invasive tests, invasive tests like Coronary Angiogram and EP (Electrophysiological) Tests to evaluate the electrical activity of the heart may be indicated on a case to case basis.

“Hypertrophic Cardiomyopathy” is a condition in which the heart muscle becomes abnormally thick in the absence of an obvious cause like hypertension, valve disease, etc. The thickening ca often cause obstruction to the normal flow of the blood from heart (left ventricle) to the body. HCM can also cause abnormal and dangerous heart rhythms called arrhythmias, which can result in sudden death. In fact, HCM is the most common cause of Sudden Cardiac Death (SCD) in young people, including trained athletes and is present in 1 out of every 500 to 1000 people and is likely to be passed down through generations in a family often without their knowledge.

Symptoms
A majority of patients with HCM don’t have and symptoms. However, when symptoms are present, they can be:

Shortness of breath on effort
Chest discomfort
Dizziness
Fainting, especially during exercise

These symptoms often worsen during hot, humid weather. They can also be more prominent after eating a large meal or after drinking alcohol.

Treating HCM
Medical Management: Medicines are available to treat the mild to moderate cases and to ensure symptom free periods.

Surgical Option
When blood flow out of the heart is severely blocked or obstructed, and when there are severe symptoms which do not respond to medications, a surgical myectomy (removal of the portion of the thickened heart muscle) may be done.

Non surgical option
This procedure, done in a Cathlab, is called a ‘Septal Ablation’ where a small quantity of alcohol is injected into the arteries that feed the thickened part of the heart. This procedure is often effective in reducing the obstruction to blood flow.

“Prem now lives knowing he had a brush with sudden death”
Prem (name changed), a 39 year old, had recently developed breathlessness on exertion. He initially attributed it to being ‘unfit’ due to his sedentary office job. On Echocardiography, he was detected to have an obstructive HCM. On further assessment, he was found to be an ideal candidate for alcohol ablation. The procedure reduced the thickness of the heart muscle and relieved him of the breathlessness. He underwent an evaluation to decide whether he was at high risk of SCD and hence would benefit from an implantable pacemaker. It was determined that an AICD was not needed at this stage. He is under regular monitoring by the doctors. “HCM cannot be cured or reverted to normal, but we can certainly control the symptoms and constantly evaluate the need to intervene,” says Dr GirishGodbole.

Medical Technology to the Rescue
Abnormalities of the electrical activity of the heart (’arrhythmias’) can result in sudden stoppage of the heart and result in instantaneous death. The occurrence of this abnormal electrical activity is unpredictable. An Electro Physiological (EP) study is very useful and is often required to understand the conditions which can lead to SCD. For those at high risk of sudden cardiac death, an automated defibrillator (AICD) is implanted. This AICD is a pacemaker - like device which is implanted under the skin in the chest under local anesthesia. This device helps in automatically detecting dangerous ventricular arrhythmias and promptly delivers a small electric shock which terminates the arrhythmia and thus prevents death. All High Risk patients need an AICD implantation to prevent sudden death.


THE HEART AND ITS �SUDDEN DEATH�

FAQs on sudden cardiac death Dr. Padma Kumar, Cardiologist, answers some questions on sudden cardiac death What causes Sudden Cardiac Death (SCD)? A majority of Sudden deaths can be attributed to the heart. In general, the commonest cause of SCD beyond the age of 40 years is blockages in the blood vessels of the heart (atherosclerotic coronary artery disease). However, in younger individuals, inherited cardiovascular conditions are primarily responsible for “Sudden Cardiac Death”. Many of these conditions don’t cause symptoms in the early stages of the disease and, therefore, are not diagnoses. Unfortunately, the first symptom of many of these conditions can be “Sudden Cardiac Death”. What are the common conditions which lead to SCD? The most common conditions contributing to SCD are Hypertrophic Cardiomyopathy (HCM), anomalies of the coronary arteries (blood vessels supplying the heart muscle), Myocarditis (inflammation of the heart muscle), and Arrhythmogenic Right ventricular cardiomyopahty (ARVD, a type of heart muscle disease which causes abnormal electrical activity). Once diagnosed, can these conditions be cured or controlled? Early diagnosis can save lives. While these diseases cannot be cured, many medical, surgical & non-surgical interventions are available to control symptoms and prevent sudden death. Who should get screened for possible SCD? People who have a family history of heart disease who have relatives who have had sudden deaths sports persons who take part in physically intensive competitive sports should get screened for cardiac causes of “sudden death Preventing Sudden Cardiac Death In the young, many may not necessarily have symptoms; diagnosis is only through a proper cardiac evaluation using state of the art technology handled by a competent team. Screening tests ECG, Echocardiogram, and a Treadmill Stress Test (for those above 40 years), when used judiciously, can pick up cardiac problems in many people. Of course, an astute Cardiological evaluation is priceless. In some people, in addition to the non - invasive tests, invasive tests like Coronary Angiogram and EP (Electrophysiological) Tests to evaluate the electrical activity of the heart may be indicated on a case to case basis. Common causes and their understanding “Hypertrophic Cardiomyopathy” is a condition in which the heart muscle becomes abnormally thick in the absence of an obvious cause like hypertension, valve disease, etc. The thickening ca often cause obstruction to the normal flow of the blood from heart (left ventricle) to the body. HCM can also cause abnormal and dangerous heart rhythms called arrhythmias, which can result in sudden death. In fact, HCM is the most common cause of Sudden Cardiac Death (SCD) in young people, including trained athletes and is present in 1 out of every 500 to 1000 people and is likely to be passed down through generations in a family often without their knowledge. Symptoms A majority of patients with HCM don’t have and symptoms. However, when symptoms are present, they can be: Shortness of breath on effort Chest discomfort Dizziness Fainting, especially during exercise These symptoms often worsen during hot, humid weather. They can also be more prominent after eating a large meal or after drinking alcohol. Treating HCM Medical Management: Medicines are available to treat the mild to moderate cases and to ensure symptom free periods. Surgical Option When blood flow out of the heart is severely blocked or obstructed, and when there are severe symptoms which do not respond to medications, a surgical myectomy (removal of the portion of the thickened heart muscle) may be done. Non surgical option This procedure, done in a Cathlab, is called a ‘Septal Ablation’ where a small quantity of alcohol is injected into the arteries that feed the thickened part of the heart. This procedure is often effective in reducing the obstruction to blood flow. “Prem now lives knowing he had a brush with sudden death” Prem (name changed), a 39 year old, had recently developed breathlessness on exertion. He initially attributed it to being ‘unfit’ due to his sedentary office job. On Echocardiography, he was detected to have an obstructive HCM. On further assessment, he was found to be an ideal candidate for alcohol ablation. The procedure reduced the thickness of the heart muscle and relieved him of the breathlessness. He underwent an evaluation to decide whether he was at high risk of SCD and hence would benefit from an implantable pacemaker. It was determined that an AICD was not needed at this stage. He is under regular monitoring by the doctors. “HCM cannot be cured or reverted to normal, but we can certainly control the symptoms and constantly evaluate the need to intervene,” says Dr GirishGodbole. Medical Technology to the Rescue Abnormalities of the electrical activity of the heart (’arrhythmias’) can result in sudden stoppage of the heart and result in instantaneous death. The occurrence of this abnormal electrical activity is unpredictable. An Electro Physiological (EP) study is very useful and is often required to understand the conditions which can lead to SCD. For those at high risk of sudden cardiac death, an automated defibrillator (AICD) is implanted. This AICD is a pacemaker - like device which is implanted under the skin in the chest under local anesthesia. This device helps in automatically detecting dangerous ventricular arrhythmias and promptly delivers a small electric shock which terminates the arrhythmia and thus prevents death. All High Risk patients need an AICD implantation to prevent sudden death.