Friday, October 09, 2009


This last two weeks, I have received news of two friends ( in their 50-60yrs ) who have just suddenly collapsed for no obvious reason and died. One was found in a bathroom dead. He was apparent hale and hearty ( in fact a health freak ), and the other an active bus-driver, with no known previous disease.
Sudden collapses resulting in death within 24 hours of collapse, is term sudden cardiac death ( of course I am excluding foul play or criminal assault ). 90-95% of sudden cardiac death is due to undetected coronary artery disease. The terminal event at the fatal moment is invariably primary ventricular fibrillation ( the heart just suddenly beating fast and so irregular that it cannot pump forcefully, for no apparent reason ). This primary VF ( short for ventricular fibrillation ) may or may not be due to a heart attack. Sometimes the heart just fibrillates without a heart attack.
Of course, of concern to us ( both from the point of understanding the disease and also from the point of prevention ) is why it happens. Much research has been done in this area. In fact, one of the early pioneer workers in this area of cardiology was one of our own Malaysian ( I remember ) called Dr Regius de Silva, who was working in USA, who was studying the effects of severe fear resulting in VF. He discovered that certain forms of culture bound behaviours like voodoo, works through this mechanism of VF. Severe fears induced, resulting in VF and sudden death. But sad to say, the research, till this day, did not lead to any meaningful application and we are still waiting to understand what triggers VF? Is it just bad luck? Is it severe stress at that point in time ( like in voodoo ), or a minor plague rupture causing an electrical heart attack, not necessarily with a physical heart attack? We just do not know.
Of course the next question must be, how then do we prevent this sad event from happening. A fatality at the prime of their life, with a family to support is a very sad, catastrophic event.
We always evocate that all males above 40 yrs and all females above 50 yrs, should go for a routine medical checkup, to make sure that they do not have coronary artery disease. 70% of coronary artery disease is silent, and so many just do not know. Of course, once they know then the cardiologist takes over and they will be under scrutiny and therapy will be given, to prevent VF. There are some drugs that have been shown to prevent sudden cardiac death, like beta blockers ( especially the older generation ones ) and fish oils. One of the benefits of fish oil that is well established is the prevention of sudden cardiac death.
Of course the third line of approach that we have suggested to the government and am waiting for implementation is the stationing of automated external cardiac defibrillators ( AECD ) in public places, so that should someone collapse next to me, I get then use the defibrillator to shock him back to life. Afterall, the treatment of VF is to defibrillate within 4 mins of the collapse, and 95% will survive. However, stationing AECD in public places does carry two other responsiubilities. Firstly the public or some of the public must be trained to use it. In this regards, I must appreciate the work of the St John Ambulance, to go around conducting basic life support classes for the public, so teach them the bacics of resuscitation and also how to use the AECD. I have been with them to lecture on the basics of VF and have seen their largely unapprecaited efforts. I think they are often aided by members of the Federation of Private Medical Practitioners Association of Malaysia, who have a program called the CARE program, to help teach resuscitation to the public. Secondly, to allow public to help public, the government may have to pass through Parliament, an Act called the " Good Samaritan Act ", so that no one who goes out of his way to help another, can be caught up in legal entanglements. No body wishes to be suit, when he is trying to help resuscitate and defibrillate? Such an Act will protect those who wish to help. Alas, although we have suggested to the Ministry of Health, it is yet to come.
For the moment, we are left to ourselves. Please all males above 40yrs and all females above 50yrs, go for a medical checkup. And by the way, I do not mean a MSCT scan ( it is largely useless for this purpose and the radiation harm, may outweigh their so called benefit ). Just a simple clinic consult and a stress ECG usually surfices. Eat plenty of fishes if you wish and take care of yourselves.
Sudden Cardiac Death is a major catastrophe and we must do our best to avoid it if possible. It is obvious that we have much more to learn, especially the triggers for sudden cardiac death.

1 comment:

msforty5 said...

Your last paragraph : I do not mean a MSCT scan ( it is largely useless for this purpose and the radiation harm, may outweigh their so called benefit ). Just a simple clinic consult and a stress ECG usually surfices.

Well I had Postive ECG Stress Test which turned out to be False Negative after MSCT scan result reveals my heart is perfectly fine, can last another 15yrs and cardiologist says scan is 99.9% correct. I read your earlier blog about risk outweigh benefit of MSCT but I had no choice. Now you mentioned it again, I feel doomed!