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Two young footballers, one Indian and the other Italian, collapsed and died of heart attacks on the pitch in the past month. As the name suggests, sudden cardiac death never comes with a warning. But it can be prevented, say doctors.
Football fans across Europe watched in horror as their favourite Italian player Piermario Morosini fell to the ground barely 30 minutes into a match at Pescara last week and did not get up. The 25-year-old died of a sudden cardiac arrest.
This was not a stray incident. Last month, 27-year-old D Venkatesh, a striker for Bangalore Mars collapsed and died during an A-League match. In October 2010, Spanish soccer player Miguel Garcia and Belgian player Anthony Van Loo succumbed to heart attacks on the pitch.
These incidents put the spotlight on the prevalence of sudden cardiac death (SCD) in the young. Though such on-field demises get more attention, experts say the incidence of SCD is quite high in India about 10 per cent of all cardiac-related deaths are sudden while the mean age of the patients who die is lower than 60 years. Studies have showed that one-third of the patients who die of SCD had heart attacks in the past and 80 per cent of them were smokers or had risk factors like hypertension and diabetes.
So what exactly is SCD and what causes it? According to chief cardiologist at Medanta Medcity Dr R R Kasliwal, it is a condition in which the heart unexpectedly stops beating - this is called Sudden Cardiac Arrest (SCA). When this occurs, blood stops flowing to the brain and other vital organs. If not treated, the sufferer dies within minutes.
Our heart has an electrical system that controls the rate and rhythm of the heartbeat. Abnormal functioning of this electrical system can cause irregular heartbeats called arrhythmias. During an arrhythmia, the heart can beat too fast, too slow or with an irregular rhythm. Some arrhythmias can cause the heart to stop pumping blood to the body and this leads to SCA. This, however, is not the same as a heart attack. A heart attack occurs when the blood flow to part of the heart muscle is blocked, but the heart usually doesn't stop beating.
People who have heart disease are at higher risk for SCA. However, people who appear healthy and have no known risk factors can also fall prey to this killer. Take the case of Ranjan Das, the 42-year-old CEO of SAP India who collapsed with cardiac arrest and died at his Bandra home in December 2009, shortly after returning from the gym. He was fit, did not suffer from any chronic diseases and did everything right, be it getting good nutrition or exercise.
As far as sports players are concerned, doctors say the increased heart rate while playing the game may be leading to the trouble. "The body suddenly needs excess oxygen which the arteries can't supply due to pre-existing blockages. It could also happen to people having an inherent defect in the heart muscle, " says Kasliwal.
Doctors therefore advise individuals with a family history of heart disease to undergo regular check-ups to monitor their heart-health. Dr Aparna Jaswal, senior electro-physiologist at the Escorts Heart Institute says Indians face a higher risk of SCD due to high prevalence of risk factors for coronary artery disease (CAD) - a condition in which the arteries supplying blood to the heart are narrowed or blocked. She however adds that SCD can be prevented "if the population at large understands the need for risk stratification. "
"It is extremely important for individuals older than 35 years, especially those with diabetes, hypertension and family history of CAD, to undergo stress tests, " she says. "It is important to identify underlying heart problems and see whether the person has symptoms or not. Young athletes pursuing competitive sports must have a thorough examination and should be enquired for any family history of SCD. "
According to Dr Jaswal, high-risk individuals - those with a previous history of heart attack and poor pumping ability - should be put on effective medication.
Rapid treatment of SCA with a defibrillator can also be lifesaving. A defibrillator is a device that sends an electric shock to the heart to try to restore its normal rhythm. "Implantable Cardioverter Defibrillators are the most effective therapy for prevention of SCD in a high-risk group. It is like an Emergency Room in your chest wall. It monitors every heart beat and immediately treats the rhythm disorder, " says Jaswal, adding that ICD may have to be implanted in young patients who have very thick heart muscles - a disease known as Hypertrophic Cardiomyopathy.
A 2010 study by doctors from the All India Institute of Medical Sciences showed that myocardial diseases such as dilated cardiomyopathy and hypertrophic cardiomyopathy play a role in causing SCD. Genes too are involved in determining risk for common arrhythmias. Several genes have been identified for rare arrhythmias such as Brugada Syndrome which increase risk. But more understanding of the genetics behind SCD is needed, say experts.
Dr Paul S Thoppil, cardiologist at Fortis Hospitals in Bangalore, says in India the annual incidence of SCD is 0. 55 per 1000 population. Around 80 per cent of sudden cardiac arrest victims have coronary artery disease. The survival rate of a sudden cardiac arrest is even less than one per cent. Sudden cardiac deaths constitute 40-45 per cent of cardiovascular deaths and out of this almost 80 per cent are due to heart rhythm disturbances or arrhythmia.
Dr Purushottam Lal, chief cardiologist at Metro hospitals, says there are a number of signs that may indicate that a person is at increased risk for SCD. These include an abnormal heart rate arrhythmia, an unusually rapid heart rate (tachycardia) that comes and goes, even when the person is at rest, episodes of fainting called syncope and low ejection fraction - measurement of how much blood is pumped by the ventricles with each heart beat.
A healthy heart pumps 55 per cent or more of its blood with each beat. People at highest risk for SCD have ejection fractions of less than 40 per cent, combined with ventricular tachycardia, an abnormally fast heart rate in the lower chambers of the heart.
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