The news of the sudden collapse and death of three young, apparently healthy individuals, all doctors, in Kochi last month, has yet again triggered anxiety amongst the general population if the incidence of Sudden Cardiac Death (SCD) has been rising amongst the young and if these deaths could have been prevented.
Doctors, however, point out that young onset coronary artery disease (CAD) and SCD are not uncommon. In fact, an estimated seven million lives are lost every year globally to SCD, which is responsible for at least 50% of deaths due to CAD.
The first study on SCD in India by Rao et al in 2012 put the overall mortality due to SCD in India at 10.3% (roughly estimated at 7 lakh cases of SCD annually) with 21% of the deaths in people who were below 50 years of age.
In Kerala, the ACS (acute coronary syndrome) registry estimates the incidence of young CAD (in people less than 40 years of age) at 1.2%.
“In two of those sudden deaths, autopsies revealed that there was significant CAD, which had previously remained undetected because there were no obvious symptoms,” says a senior member of the medical fraternity.
“We have seen that it is a collection of low-level multiple risk factors which make south Indians more susceptible to CAD, which goes undetected till a catastrophic event occurs. Most of the traditional risk factors — blood sugar levels, blood pressure, body weight — would be on the borderline and because these are not prominent, these youngsters would not consider themselves to be at risk. They might have been apparently active but would have never actually got themselves checked. Regular screening would have definitely given some clues on CAD setting in,” says Tiny Nair, a senior consultant in cardiology.
In many instances of out-of-hospital cardiac arrest/SCD, the event itself is often the first expression of cardiac issues in that individual, he says
Hidden CAD
About 50% of sudden cardiac arrests are indeed triggered by hidden or undetected CAD . The Indian study in 2012 had reported that unevaluated ischemic heart disease was the predominant cause of SCD in the general population.
Blockages in the coronary artery, hypertrophic cardiomyopathy and dilated cardiomyopathy, ventricular arrhythmias, baseline electric abnormalities in the heart ( long QT syndrome and Brugada syndrome), any of these situations can trigger a
The trend toward increasing SCD events in developing nations is thought to reflect a change in dietary and lifestyle habits in these nations.
But simple investigations like a surface ECG (TMT is not for everyone), can give valuable clues to these conditions. Cardiologists suggest that in Kerala, everyone over 30-35 years have routine cardiac evaluation, especially if there are small elevations in risk factors , if there is a history of sudden death in the family or or any episodes of unexplained fainting
Promoting CPR as a life skill
When someone collapses suddenly, he has to be revived in flat two-and-a-half minutes. Instead, people waste time crowding around and trying to wake the person.
“One of those doctors was jogging when he collapsed suddenly and he might have been saved if someone around him had the presence of mind to do CPR on him. Doing CPR is one of those essential skills that should be taught to every individual,” says Rajeev Jayadevan, a senior member of the Indian Medical Association. IMA has conducted extensive training programmes on performing CPR amongst schoolchildren
An AED is a light, portable and interactive device, which will “de-fibrillate” the heart or restore its normal rhythm by delivering an electric shock through the chest. AEDs are now found in many public places like airports and any person can be trained to use the device to save lives.
Screening from adolescence
All said and done, it is extremely unlikely that a person with CAD would remain totally asymptomatic. In all likelihood, there would have been some warning signs, which might have been ignored.
“People should understand how important sleep and work-life balance are for good cardiac health. And no medical curriculum seems to teach doctors how to handle stress, “ Dr. Nair says.
“When we talk about early screening for CAD, it is not about popularising executive check-ups after the age of 40 but about screening individuals right from adolescence,to pick up early indicators. Lifestyle modifications, good diet and exercise should be popularised from school and not when one turns 40,” S. Harikrishnan, Professor of Cardiology, SCTIMST, points out.
