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
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care
Foundation of India
Immediate Past National
President IMA
