Monday, May 31, 2010

SUDDEN CARDIAC DEATH, REVISITED

I have written on this earlier, and because of popular enquiry, I would like to post it again.

One of the most often topic of conversation at the golf club, is " you know Doc, my friend who is ....... so young suddenly collapsed and died". This happened again last Saturday.
I will try and do this one in a question and answer manner, hoping that it will be easier to understand.

1. What is sudden cardiac death ( SCD )?
Sudden cardiac death ( SCD ) is death whithin 24 hrs upon presentation of symptom. In this case, the presentation is sudden collapse. Barring foul play, the majority of deaths occurring within 24 hrs of presentation is due to cardiac causes, ranging from an acute heart attack, to sudden prolonged irregular heart rhythm causing the heat to beat so chaotically that it seizes to function normally. We call this life threatening heart rhythm irregularity, ventricular fibrillation.

2. Can a young person, who appears hale and hearthy, playing golf, exercising regularly, suddenly collapse and die?
The simple answer is " Yes ". Many may appear hale and hearthy and perfectly normal, but that does not mean they ARE hale and hearthy, especially in the case of heart disease, that can be silent, and only picked up or uncovered through a good cardiac checkup. I will take up the issue of good cardiac checkup later.

3. What actually happen, for an apparently healthy guy / or gal for that matter, to suddenly collapsed and die?
Many who have stable coronary artery disease may appear hale and hearthy. Coronary artery disease is disease of the arteries of the heart, due to cholesterol piling up in the walls of the artery. The cholesterol usually built up in the space between the middle layer of the heart artery and the innermost layer ( also called the endothelium ). As long as the inner lining, the endothelium, is intact, the plaque ( cholesterol built up ) is stable and does not cause any problem apart from maybe chest pains, when the built-up is critical. If the bulit-up is non-critical in proportion, the whole process is silent and the subject appears hale and hearthy and normal ( including some famous athletes and sportmen ).
However, should the inner lining of the artery wall crack ( unstable plaque ), or rupture, as a result of many factors, including stress, excitement, hypertension, cigarette smoking, cocaine abuse, etc, the pile of cholesterol below the endothelium, is exposed to the blood flowing pass. This contact of blood with the cholesterol is a fatal combination, as blood clots quickly when it touches the cholesterol. The sudden blood clotting obstructs the heart artery lumen completely, resulting in NO BLOOD flow to the heart muscle, causing a heart attack, or chaotic irregular heart rhytm and sudden cardiac death.
Medical science have yet to have a reliable means to see which of the many plaques in our artery is stable, and will remain so, and which is potentially unstable, with the tendency to heart attacks and sudden cardiac death. Much work has been done and we are getting there but not yet. Therefore the strategy is to identify all with coronary artery disease, especially the silent majority, and treat them so that SCD become a thing of the past.

4. How do I know if I have heart disease?
The first thing is to see your family doctor who will help you to identify your cardiac risk profile and who would give you a thorough cardiac check. If he cannot perform all the test himself / herself, you may be refered to a cardiologist.
Cardiac risk factors include cigarette smoking, high clolesterol, hypertension, diabetes mellitus, obesity, males above 40yrs, females above 50 yrs, a family history of heart disease, stressful lifestyle.
As a general rule, we would advise all males above 40 yrs and females above 50yrs, to go and see your favourate GP and get a checkup done. A consultation with some blood test and ECG may cost about RM200-300 and if he includes a stress ECG, it may come to RM500-600. I think that money is well spend. If the check up is normal, an annual consultation with annual blood test ( RM200 ), is sufficient and a stress ECG every 2-3 years.
By going for a ckeck-up, we hope to pick up most of the silent CAD cases and treat them so that SCD can be prevented.

5. What else can I do, to protect myself?
As always, a healthy cardiac lifestyle, is important. Eat in moderation, low fat and low salt. Keep onto green veges, fruits and white meat. Use vegetable oil for cooking and avoid fast foods ( with all the transfats ), watch your weight and DO NOT gain weight. Exercise regularly, at least 3 times a week.

We will write about other forms of cardiac testing, pros and cons later. I need to start my clinic.