Sudden death: most cases can be avoided if the earlier signs are treated

We tend to think that the cases of sudden death These are fortuitous or unavoidable events. However, it is a false belief. in addition to 80% of cases, there were previous signs that were not treated or risk factors that were not detected in time due to lack of controls. This is called sudden death because the person dies suddenly and without a clinical history of known disease.

According to global data, some 3 million people die each year from this cause, implying a global incidence of 1-2 events per 1,000 population. In the case of Argentina, 40,000 cases of sudden death are recorded each year and 70% occur outside the hospital setting.

The acute images that precede sudden death in many cases can be reversed if the necessary resources are available and if the patient’s entourage knows how to act and do it in time.

“Sudden death is an unexpected death, which surprises because the victim was not ill. Although there are many definitions, the most important thing in understanding this condition is knowing that it is sudden and in seemingly healthy people,” the cardiologist said. Fernando Scazzuso (MN 83.184), Chief of Electrophysiology and Arrhythmias at ABC, Cardiovascular Institute of Buenos Aires.

Doctor Scazzuso explained that “the autopsies of these people show the presence of heart disease between 80% and 90% of the cases. This shows that sudden death does not occur in healthy people, but in people with heart disease that was unknown before the event happened,” he argues.

The ICBA expert pointed to another distinction: sudden death and resuscitated cardiac arrest do not refer to the same concept, since in the second case the victim is assisted in cardiopulmonary resuscitation and restores the heart rhythm. “It would be desirable from a health point of view that there is never again a sudden death despite the fact that we continue to observe cases of cardiac arrest. In other words, our utopia should be: be able to recover all cardiac arrests and prevent them from degenerating into sudden death“, he pointed Scazzuso.

Several clinical studies indicate that half of reported sudden death cases had symptoms within the previous 24 hours. But these symptoms were not specific which decreases the chances of speaking of a premonitory sign. “However, the presence of chest pain, sudden shortness of breath, and/or loss of consciousness should prompt a physician to seek medical attention to rule out or confirm disease severity,” Scazzuso said.

Sudden death has two mechanisms: it is generated by a lack of oxygen in the heart muscle or by an electrical instability of the heart. In the first case, the myocardium stops functioning in a coordinated manner and generates an arrhythmia, which in a few seconds causes the heart to stop, cardiac arrest. “The heart stops contracting and therefore pumping blood. There is no pulse, there is no pressure. There is no life,” Scazzuso explained. In general, these cases occur after the age of 45.

The obstruction of the coronary arteries is the cause of the lack of oxygen. “It happens in 80 to 90% of cases. SO, coronary heart disease is the leading cause of cardiac arrest. More specificly, atherosclerotic coronary artery disease: the deposition of fats generates a progressive obstruction of the arteries of the heart through which the blood must circulate, which transports oxygen and nutrients,” explained the ICBA specialist.

In case of electrical instability“the person suffers from a genetic alteration which manifests itself from birth and which puts his life in danger, causing the arrhythmia which leads to cardiac arrest. These diseases are: the long QT syndrome and the Brugada syndrome Other genetic alterations cause diseases of the heart muscle itself, such as hypertrophic cardiomyopathy or arrhythmogenic right ventricular dysplasia (ARVD), which in a small percentage of cases present with cardiac arrest,” he specifies.

These cases usually result from adolescencehowever it is important to note that the genetic alteration can be detected earlywhich allows the development of prevention strategies in patients once they are diagnosed.

In cases potentially caused by a lack of oxygen in the myocardium, it is important to control the 5 coronary risk factors: smoking, high blood pressure, obesity, diabetes and high cholesterol. For the second group, what is essential is routine consultation with the pediatrician to detect in time the alterations that can cause electrical instability of the heart.

“The best prevention strategy is assess populations at riskwho are the people with uncontrolled coronary risk factors, known coronary artery disease, electrocardiogram changes, or a history of sudden death in the family,” the ICBA cardiologist pointed out.

Asked about the link between sudden death with physical activity and sport, Scazzuso stressed that “knowing your state of health before starting physical activity is mandatory. Each physician will assess whether the activity will be recreational or competitive. On the other hand, the different sports federations have their evaluation protocol for each case”.

The time during which a victim of cardiac arrest can be without assistance is 4 minutes. “This is because neuronal death increases exponentially over time due to lack of oxygen and is irreversible. Hence the importance of anyone close to the victim initiating the cardiopulmonary resuscitation pending the arrival of the professional rescue team,” said the specialist.

In addition to starting resuscitation, in Argentina you must call 107 to request urgent medical assistance. It should be clarified that the emergency number is 107 and not 911, a common confusion usually linked to the use of this number in films and series in the United States.

“If the victim is inside a cardio-protected zone, the automatic external defibrillator (AED) must be used because the rate of resuscitation increases considerably. For example, if the device is used within three minutes, the probability of the victim arriving alive at the hospital is 70%,” he added.

The availability of defibrillators is one of the great advances of the recent regulation in Argentina of Law 27,159, which was approved in 2015 and regulated this year. The automatic external defibrillator (AED) is a portable electrical device capable of automatically identifying and treating ventricular arrhythmias by means of an electric shock in order to restore a normal heart rhythm. Its main advantage is that it is safe and effective in the hands of untrained personnel.

The public or private spaces that must have an AED are those where competitive and/or recreational physical activity is practiced; prisons (including police stations and police stations) and fire stations; health effectors with certain characteristics; spaces with a capacity, concentration or circulation of more than 1,000 people per day and long-distance planes, boats or trains with a capacity of 100 people or more.

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