Monday, February 26, 2018

Sridevi’s untimely death brings to forefront sudden cardiac death in women

Dr KK Aggarwal
Recipient of Padma Shri
The tragic and very untimely death of actor Sridevi, a Padma Shri Awardee, brings to forefront the topic of sudden cardiac death (SCD) in women. The passing away of a talented actor reiterates the need to identify women at risk and to manage these risk factors for better outcomes.

SCD is an unexpected death that occurs due to a cardiovascular cause. While those with heart disease are at a greater risk of sudden cardiac arrest leading to sudden cardiac death, it is the asymptomatic person, who appears healthy and has no known heart disease, who is most at risk of sudden cardiac arrest. SCD can be the first manifestation of coronary artery disease (CAD). Lifestyle factors that influence CAD risk might also have an impact on the risk for SCD. Hence, adherence to a low-risk lifestyle is associated with a low risk of SCD (JAMA. 2011 Jul 6;306(1):62-9).

According to a 38-year follow-up from the Framingham Heart study, which examined the incidence of sudden cardiac death in women in comparison to men, women are at lower risk for SCD than men. In women with underlying coronary heart disease (CHD), the risk of SCD is 50% less than in men with CHD. But, in the absence of prior overt CHD, the incidence of SCD is higher in women compared to men; 63% vs 44%, respectively. Among patients with heart failure, the absolute risk in women is only one-third that of men.

Phobic anxiety is associated with an increased risk of SCD in women. Some, but not all, of this risk can be ascribed to CHD risk factors associated with phobic anxiety such as diabetes, hypertension and high serum cholesterol.

Sudden cardiac arrest may not be as sudden as is usually thought. About 50% of victims of sudden cardiac arrest have some tell-tale warning signs that their heart is in danger of stopping in the month preceding their attack, which include any combination of chest pain and pressure, shortness of breath, heart palpitations, and flu-like sensations (such as nausea, back pain and/or abdominal pain). While less than 20% of those who experience symptoms actually reach out for potentially lifesaving emergency medical assistance.

Cardiac arrest is not the same as a heart attack. A cardiac arrest occurs when electrical activity of the heart is disturbed and the heart stops working, while a heart attack is the result of arterial blockage that cuts off blood flow to the heart. Heart attacks can increase the risk of cardiac arrest; however, heart attacks do not lead to sudden cardiac arrest but when sudden cardiac arrest occurs, heart attack is the most common cause.

Sudden cardiac arrest (SCA) and sudden cardiac death (SCD) are same. If an intervention such as CPR or defibrillation, cardioversion restores circulation, it is called sudden cardiac arrest. But if the patient dies, it is referred to as SCD.

Ventricular tachycardia (VT)/ventricular fibrillation (VF) account for most such episodes, while bradycardia or asystole (no heart beat) make up the remaining.

CPR is a life-saving procedure in the event of a sudden cardiac arrest. 

Screening for heart disease

A heart attack in women presents differently compared to men. Women are less likely than men to have typical features of a heart attack. Women have more chances to present with angina than heart attack but when they present with heart attack it is more fatal. Many cases of heart attack in women go unrecognized, particularly at younger ages or in patients with diabetes.

lSix minutes walk test: You do not have significant blockages, if you can walk more than 500 m in six minutes or if you can walk 2 km or climb two flight of stairs.
lNever ignore unexplained weakness, tiredness, first onset chest burning or first onset breathlessness after the age of 40.
lIf any member of your family has had heart disease before the age of 55 years (male) or before 65 years of age (female), this is a strong positive family history.
lIf the SCD of Sridevi is found to be associated with heart blockages, this would be a strong family history for her family for future generations.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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