Since sudden cardiac death occurs about 150,000 times a year in Germany, it is one of the most common causes of death. Especially in young people, sudden cardiac death is tragic and also affects healthy people, such as athletes. In the following, sudden cardiac death is described in more detail, what causes it can have, how it is diagnosed, and how it can be treated and prevented.
What is sudden cardiac death?
Sudden cardiac death is defined as a death that occurs unexpectedly and is caused by the heart. It is often associated with heart disease and is accompanied by loss of consciousness. Sudden cardiac death occurs in 80% of cases after a strong physical stress. According to statistics, sudden cardiac death is ahead of cancer and strokes in terms of the most common causes of death. However, this cause of death is underestimated too much by the public. Sudden cardiac death occurs more frequently with increasing age, with men being affected more often than women. In most cases, a cardiovascular disorder or a cardiac arrhythmia is already present before sudden cardiac death. The heart can no longer receive regular impulses and can increase to an abnormally high number of beats per minute (up to 500). This leads to ventricular fibrillation, which in turn causes heart failure. Without treatment, the circulation collapses after a few seconds and unconsciousness occurs after about one minute. After about 10 minutes, the patient can be declared brain dead.
Causes
Sudden cardiac death has a wide variety of causes. Most commonly, the cause is cardiac arrhythmias. Risk factors that could promote sudden cardiac death are, for example, coronary heart disease, past myocardial infarctions, cardiac output weaknesses under stress or even at rest, a previous cardiovascular arrest, (in addition) older age, high blood pressure, diabetes mellitus, smoking and heavy alcohol consumption, and insufficient exercise. In young adults, however, other causes tend to be more prominent, for example hereditary factors or myocarditis. If the aforementioned risk factors already exist, too much stress can also trigger sudden cardiac death, even though the person is sufficiently physically active. Such cases are well known from the media. Well-known soccer players or ice hockey players fall down in the middle of a game and cannot be resuscitated. The reason is usually insufficient bed rest or recovery from simple colds with fever, which in combination with additional physical stress (e.g. training despite flu) can lead to myocarditis. If this heart disease is not detected or not taken seriously, sudden cardiac death may occur sooner or later.
Symptoms, complaints, and signs
In sudden cardiac death, the affected person loses consciousness and dies within a few minutes. Before this happens, however, warning signs appear that indicate a serious condition. In half of those affected, cardiac arrest is heralded by chest pain. Shortness of breath, severe palpitations and flu-like symptoms are also possible signs. People who have already suffered a heart attack often experience a strong palpitations in the hours and minutes before the cardiac arrest. Many sufferers notice an unusual feeling of tightness in the chest, accompanied by shortness of breath and general weakness. Dizziness and fainting round out the symptom complex of sudden cardiac death. The symptoms usually become apparent several hours to days before sudden cardiac death. In most cases, the signs occur several times, increasing in intensity and duration. If these warning signs are ignored, cardiac arrest eventually occurs. At this point, a pulse can no longer be felt and the affected person no longer responds to external stimuli. The pupils are dilated and the skin on the mucous membranes and fingernails takes on a dark gray color. Respiratory arrest and eventual secondary death occur after only 30 to 60 seconds.
Diagnosis and course
Because sudden cardiac death is associated with arrest from the cardiovascular system, diagnosis can be made on the basis of unconsciousness and absence of a pulse. Thus, an emergency is present in which immediate resuscitation must be performed.If sudden cardiac death occurs, it is very rare for an ECG machine to be nearby to detect a cardiac arrhythmia. According to statistics, sudden cardiac death shows a rather unfavorable course. The survival rate is about 3 to 8%. The course depends above all on how quickly immediate measures can be taken to save life. Since there are defibrillators in many public facilities in America, for example, the survival rate there is much higher.
Complications
As a rule, sudden cardiac death is itself a complication and usually leads to the death of the affected person if there is no rapid and immediate treatment of the patient. In this case, the affected person suffers from severe heart pain and also a feeling of anxiety. It is not uncommon to experience dizziness or shortness of breath. Disturbances of consciousness can also accompany cardiac death, so that the affected person completely loses consciousness and possibly injures himself in a fall. Similarly, cardiac death without treatment results in respiratory arrest. If the affected person continues to receive no treatment, death usually occurs or the internal organs and brain are irreversibly damaged. The patient’s skin appears pale and the affected person no longer moves. In case of cardiac death, it is mandatory to use a defibrillator to save the patient’s life. Furthermore, an outpatient treatment takes place, which usually ends in a surgical intervention. It is usually impossible to predict whether this will result in a positive course of the disease.
When should one go to the doctor?
Sudden cardiac death is a dramatic acute event that belongs in the hands of a physician immediately. However, even after successful resuscitation, there are reasons for numerous visits to the doctor. First, the defibrillator used in many cases after sudden cardiac death undergoes regular checks for functionality. In addition, a visit to the doctor is also always important if unusual symptoms are felt, especially if they are new or massive. In this context, the contact persons are the family doctor, but also the treating internist or cardiologist. In acute cases, the emergency room of the nearest hospital should be visited. In many cases, surviving sudden cardiac death is also a great psychological burden for the patient. Therefore, psychological support is necessary in many cases to restore the quality of life of those affected. Talking to the family doctor can be just as helpful as a referral to a psychotherapist. It can also help to regain confidence in the performance of one’s own body with dosed training. This can be done with sports and physical therapists or in a special rehabilitation group. Hearts that are structurally ill are particularly susceptible to infections. Therefore, the flu or a similarly severe infection is also a reason to see the doctor to detect or avoid heart involvement.
Treatment and therapy
Sudden cardiac death requires immediate life-saving therapy. This is the only way to prevent subsequent death. The defibrillator briefly puts the victim under a strong electric shock, which causes the heart to “restart” and normal electrical heart activity can take place again. Another option is chest compressions, which everyone should perform in an emergency. If sudden cardiac death can be prevented by this, the following therapy depends on the underlying disease. Often, a stent or bypass operation is performed, which should widen the narrowed vessels again.
Prevention
Sudden cardiac death can be prevented by paying special attention to early symptoms and recognizing risk factors, even if there is no known heart disease. After all, those who eat a healthy diet and exercise sufficiently and appropriately are less likely to suffer sudden cardiac death. Those who already suffer from heart disease should therefore pay even more attention to risk factors such as smoking or an unhealthy diet. There are also treatment options such as the implantable defibrillator, which can be considered in the event of a cardiac arrhythmia. However, such a method can also offer relatively great protection from a fatal outcome for patients who have already suffered a cardiovascular arrest.
Aftercare
If medical help reaches a cardiac death patient in time and resuscitation succeeds, then follow-up care must be provided. There is a risk that the life-threatening cardiac arrhythmias will cause sudden death again. The doctor orders an ECG and uses X-rays to look for changes in the heart and lungs. The question of surgical correction arises. Heart disease leads to regular follow-up checks to prevent possible complications at an early stage. Physician and patient determine an individual rhythm according to which a resting and stress ECG is performed. In principle, the patient bears a high degree of personal responsibility to prevent a renewed life-threatening situation. The physician informs the patient to what extent he or she has to change his or her life. Conceivable measures include a change in diet and the reduction of excess weight. But also the renunciation or reduced consumption of cigarettes and alcohol contributes to recovery. Sometimes even a change of profession is indicated.
This is what you can do yourself
Sudden cardiac death is an event that the patient can hardly predict or influence. Even after surviving sudden cardiac death, self-help options are very limited because a protective effect is usually provided by an implanted defibrillator. Nevertheless, there are some self-help options that the patient can take to heart. They should always be discussed with the treating cardiologist in the case of a serious condition such as PHT. Self-help around heart disease has a lot to do with a healthy lifestyle. This includes exercise, the intensity of which is determined by the cardiologist. Sports and stress should be stopped immediately if a febrile infection develops. This could damage a heart, and structural heart disease can promote sudden cardiac death. Infections must also be cured in terms of fitness for work. After surviving a PHT, the function of the defibrillator, which is inserted into the patient’s chest, must be checked regularly. In addition, cardiac examinations by a cardiologist should be carried out conscientiously. Psychological recovery after PHT is as important as the physical component. The awareness of having survived a cardiac death can be stressful. Psychotherapy can help with processing. In addition, relaxation techniques or yoga can effectively accompany self-help in everyday life. Exercise not only strengthens the body. It also serves to rebuild self-confidence in one’s own body.
