Sudden Death is Preventable

“Sudden Death, by medical defi nition, is when the time from the onset of symptoms to death is less than an hour.î Hualien Tzu Chi Medical Center Cardiology ... ADiscussiononSuddenDeathand SuddenCardiovascularDisease   Notlongago,adirectorofacorporationreturnedtohisseatafterasplendidperformanceonstageduringayear-enddinner,onlytofellunconsciousonthetableandneverwokeup. Seeingpeoplepassawayunexpectedlyattheirprime,doesitmakeyounervousandponder:ìWillIbenext?îOrdoyousimplygiveasentimentalsighatasuddenandunanticipateddeathofayoung,healthylife. But,havethebodiesoftheseunfortunateyoungmenreallygivennowarningsatall? Didyouknowthathavingchestpainandchestdiscomfortmaybethewayyourbodyisgivingyouwarningsigns?!Justasopportunitytendstojumpatthosewhoareprepared,luckfavorsthosewhotendtotheirhealth.Cherishyourheartthroughmaintaininghealthylifestylewithgooddiethabitsandregularexercises,tosignificantlyreducethechanceofviolentattacksofcardiovasculardiseases.Peoplewithchronicdiseasesmustpayattentiontothemaintenanceofyourbodyondailybases,takingyourmedicationsontime,topreventyourheartfromshortcircuit.   WrittenbyChiu-HuaHuang&Ching-FangTsengTranslatedbyDannyLu Fineasecondago,anddeadthenext!Lethalaccidentsalwayscatchpeopleoffguard;unforeseendeathduetointernalcausesisevenmorepuzzlingandfrightening.SuddendeathtakesthousandsofTaiwanesesílivesintheirprimeannually.   SuddenDeath,Who’sNext? “SuddenDeath,bymedicaldefinition,iswhenthetimefromtheonsetofsymptomstodeathislessthananhour.îHualienTzuChiMedicalCenterCardiologyAttendingPhysicianYu-ChihChenexplains. Woulditbemenext?îWhenDeathshowsupatyourdoorstep,isitreallynoroomforbargain?Asnewsofsuddendeathoccuroverandoveragain,itcanbereallystartling.     Fearisderivedfromtheunknown.Cardiologistsencountersuddendeathoften,andtheyarenostrangerstothecauseofit.Becausetheyunderstanditscauses,theyremaincautiousbuthavenofear. Lookingbackathismedicalcareerfromresidencytrainingtonowaseniorattendingphysician,Dr.Chenhas encounterednumerousemergentcases.Ashespeaksofhisfirstsuddendeathpatient,eventhoughitwas11yearsago,herecallsitasitjusthappenedyesterday ìItwasduringmyfirstnightshiftinthemedicalwardasaresidentphysician.ApatientwasadmittedtothegastroenterologyservicefromtheER.Hevomitedbloodandcomplainedofintensechestpain.Thenurseinformedmetomeasurehisbloodpressure.Irememberitwas160/90mmHg,slightlyhigherthannormal.JustasIfinishedthemeasurementandwasabouttoleavetocontacthisgastroenterologist,thenursenoticedthepatientfellunconscious.Shescreamed:ëThepatienthasnopulseandstoppedbreathingWerushedtoperformresuscitation.Theentireeventlastednomorethan10seconds. Suddendeathhappen whenstrolling,whenexercising,andevenduringhospitalization.InlateFebruary2008,MaZhao-jun,amusicproducer,48,passedoutonhiswaytoashoppingmallandwaspronounceddeadafterbeingrushedtothehospital.Itwassuspectedhissuddendeathwastriggeredbyaheartattack. EarlyMarch,LiaoWei-der,36,youngerbrotherofnewsanchorLiaoHsiao-chun,faintedonthebasketballcourtandwassoonpronounceddeadafterarrivalatthehospital.Hewasadmittedonceforchestdistress.AlsoinTaichungCounty,abusdriverdiedsuddenlyduringa20-secondwaitatatrafficlight.MidAugust,abusdriverinTaipeiCounty,notyet50yearsold,experiencedintensechestpain.Hequicklyevacuatedthepassengersandplannedtoseekmedicalattention,butitwasalreadytoolate. Statisticsshowsapproximately300,000to400,000Americansdieannuallyofsuddendeath.Notcountingsuddendeathinnewborns,thepeakageofsuddendeathrangesfrom45to75yearsoldandhappensoneineverythousandpeople.InBritain,50,000peopledieofsuddendeatheveryyear.InEuroAmericancountries,theincidenceofheartdiseasesfarsurpassesthatofTaiwan,butitisstillestimatedthatfewthousandsTaiwanesewilldieofacuteheartdiseaseseveryyear. 90percentofsuddendeathiscausedbyheartattack.Dr.Chensays. Heemphasizedthatsuddendeathasaresultofheartattack,inmedicalterms,isknownasìSuddenCardiacDeath(SCD)î.Whichheartdiseaseisthemostfrequentcauseofsuddenandunexpecteddeath?Acutemyocardialinfarctionisananswerthatmostwouldagreewith.Butinreality,thesestealthassassinsalsoincludeaorticdissectionandpulmonarythromboembolism.MajorityoftheSCDiscausedbyìacutemyocardialinfarctioncomplicatedbymalignantcardiacarrhythmiasî.Inclinicalexperience,80percentofthepatientswhoareadmittedtoERduetoacutemyocardialinfarctioncomplicatedbycardiacarrhythmiasareinducedbysupraventriculartachycardia.   Heartbeat,NotTooFastorTooSlow Cardiacarrhythmias,inlaymanísterm,meansirregularheartrate;heartbeatstoofast,tooslow,orsuddenchangesof pace,isconsideredabnormal. Whydoestheheartbeat?CardiologistJen-JerHsiehposesafundamentalquestionregardingthefunctionoftheheart.ìAllofourorgansaremadeofflesh,sowhydoesonlytheheartbeats?     Perhapshehasexplainedtohispatientsfewthousandtimesalready,Dr.Hsieh,withafluentandhumorousTaiwanesedialect,provideshisownquestionwithasimpleanswer:Becauseofelectricity!Incomparisonwithinternalorganslikeliver,stomach,andkidney,theheartbeatsbecauseithasapowerplantandapairofhighvoltagecables,causingthehearttobeatthroughelectricalstimulationandcurrentconduction.îPatientsarethenenlightenedbyhisstraightforwardanswer! Specializeinelectrophysiology,Dr.HsiehisadeptinRadiofrequencyAblationî(orìcatheterablationî)totreatarrhythmia.Theenginethatbeatstheheartisconcealedintherightatrium,generatingelectricityjustasifapowerplantwould,andthroughconductingpathwaysitstimulatestheheart.Undernormalcircumstances,anindividualonlyhasonesetofconductionpathways.Inthecasesofarrhythmia,80percentofthepatientshaveìRe-entryarrhythmiaî,andwithappropriatetreatment,90percentwillmakeafullrecovery. Tachyarrhythmiameansthenormalandextraconductingpathwaysinthebodyshort-circuits,leadingtorapidheartrate.Thishappensinapproximatelyonethousandthofthenormalpopulation.ìToomanyhighvoltagewirescauseshortcircuit,leadingtoirregularheartbeat,andhencearrhythmia.Dr.Hsiehsays. Havingalpitationsisthemain symptomofarrhythmia,îDr.Hsiehsays,Butmostpalpitationarebenign. Patientswitharrythmiaswouldfirstsensepalpitations,feelchestdiscomfort,andseekmedicalcare.EKGisusuallydoneintheE.R.forpalpitations.ìBut,arrhythmiaislikeachildplayinghideand-seek.Bythetimethediscomfortisgone,thearrhytmiaalsohidesaway.îAsuddenattackthatquicklyself-resolvestonormalrhythmisthenatureofarrhythmia.Todiagnosearrhythmia,cardiologistwouldaskthepatienttocarrywiththemaportabledevice,providingìtwenty-fourhoursofHoltermonitoringthatrecordstheheartrhythmforanentireday.      Ifyouexperiencepalpitations,youcanmeasureyourownpulse.Ifyourheartrateisaround60to70perminute,itismostlynormal.Ifitisirregular,orasfastas150or160perminute,orifyouhaveahardtimegraspingforairandfeelingnauseated. Orifyoumeasurewithabloodpressuremonitor,andthereadingofyourpulseisaround160,thechanceofacardiacarrhythmiaisincreasedconsiderably,Dr.Hsiehexplains, Thenwecanproceeddirectlywithelectrophysiologicalstudy(EPS),andatthesametimeperformradiofrequencyablation. Conductingpathwaysoftheheartisinvisibletothenakedeyes;itreliesonEPStorevealitspresence.TheoperatorexecutingEPSandtreatmentrequiresvigoroustraining;itmustbeperformedinthecardiaccatheterizationlabandisconsideredaninvasivesurgery.  Whenaskedaboutthefrequencyofcasesandeffectsofablationtreatmentforcardiacarrhythmia,Dr.Hsiehrespondsimmediately:Alot!Eveninourownhospitalsmanypeoplesufferfromarrhrythmia,fromcustodianstotechnicians.TheaveragesuccessrateofEPSis95percent. DuringEPS,ablationisperformedtoremoveextraconductingpathways,andtheproblemofarrhythmiaissolved.   SeekTreatmentwithChestPainorDistress InsidethewaitingareaofCardiacFunctionExaminationRoom,gentlemusicwithcomfortabledisplaysrelaxesthetensedmood;theinteriordesignwasdoneandpaidbyDr.Hsiehoutofhisownpocket. Proceedfurtherandbehindanotherdoor,apatienthasjustcompletedhiselectrocardiogram.Grandpa,haveyouhadheartsurgerybefore?Dr.Hsiehasks,lookingattheEKGathand. No,Ihavenít.Grandpaanswers. Doyousmoke? Yes,butnotasmuchnowadays.  IcanítfinishapackintwodaysGrandpaiseagertoexplainhiseffortincombatinghislastingaddiction. AfterabriefdiscussionwithtechnicianHsiu-hsiang,Dr.Hsiehturnshisheadtowardsthepatient,Grandpa,thebloodvesselsinyourhearthasbeenblockedbefore,causingoldinjuries! Michael,IamHsiehJen-jer,Mr.JienísECGindicatesoldMI(MyocardialInfarction)ok,andIíllaskhimtogobackdirectly. AfterspeakingwithDr.ChenYuchih,a.k.a.Michael,throughthephone,Dr.Hsiehconfirmsthatthepatientisunfitforanexerciseelectrocardiography,soheasksthepatienttoreturntotheclinicforfurtherexamination. Injuredbloodvessels,howcanitbe?Grandpaconsultsthedoctor,puzzledabouthisheartcondition. Mr.Jien,notyetinhis70s,cametocardiologyduetooccasionalchestdistressandpains.Throughapageofstaticelectrocardiogram,thecardiologistaccuratelydeterminedtheconditionsofpatientíscardiovascularsystem.Thesubsequentstepwouldbetoinformthepatientoftheappropriatetreatmentplan. EventhoughMr.Jienonlyrealizedthathishearthasalreadysufferedsomeinjuryoncehecametomedicalattention,butatleasthehadminimizedthechanceofasuddendeath!   AvoidanceofSuddenDeathThroughtheWindowofOpportunity Forthepreventionofsuddendeath,Dr.ChenísfirstadviceisforeveryonetolearnCPR.DirectorHuSheng-chuanofE.R.hasbeenpromotingthisvigorously.Dr.Chensays. Ifchestdistressandpainspersistformorethan15minutes,anambulancemustbecalled,becausethismeansapossiblecongestioninthebloodvessel,andmyocardialinfarctionmayoccur!BothDr.ChenandDr.Hsiehemphasizethatthepatientshouldnotoperatevehiclesontheirown,sinceiftheyfellunconsciousonthewayduetoarrhythmia,theymightcausecaraccidents,injuringthemselvesandothers. Whenmalignantcardiacarrhythmiaoccurs,rapidheartbeatcannotefficientlypumpbloodtothebrainandothervitalorgans,leadingtocerebralhypoxiaandorganfailure.Youhaveonlya4minutewindowtoresuscitateandpreventpermanentbraindamage.Withinthese4minutesCPRmustbeperformedortheheartdefibrillatedwithautomatedexternaldefibrillator(AED).Dr.Chenpointsout,internationalairports,publicspaces,andambulancesareallequippedwithAEDtoraceagainsttime,toimmediatelyapplycardioversiontoconvertrhythmbacktonormal. Dr.Chenmentionshalfofhisclinicpatientscomplainofchestpains,butthemajorityofcauseisnotfromblockageofcoronaryvessels.Thecausesofchestpainscanbeassevereasmyocardialinfarction,aorticdissection,pulmonarythromboembolism,andanginapectoris.However,ifoneseeksoutpatientserviceupontheonsetofsymptoms,therecoveryraterangesfrom50percentto100percent. Asformyocardialinfarction,ìwemustseizetheopportunitytotreatwithin12hoursoftheonsetofsymptoms.Ifthepatientdelaysmedicalattentionforoneortwodays,bythattimetheheartmayhavesufferedirreversibledamageandnotreatmentwillbecurative.îDr.Chen,aspecialistininterventionalcardiology,remindsthepatientstobeawareoftheirsymptoms.   ReliefandRegulateStressesinLife ListeningtothemusicplayedintheCardiacFunctionExaminationRoom,Dr.Hsiehhumwiththemusicandsays:ìThemusicisplayedforthepatients.Somepatientsstartaskingëwhenismyturnínotlongaftertheyareseated.Peoplewithimpatientpersonalityareverysusceptibletoheartproblems! Thoughwithoutstatisticalsupport,histheoryseemslogical. ìWhataboutcardiologist? Oh,weareevenmoreimpatient,ofcourse.Otherwisehowwecanmanageasacardiologist!Themusicisalsoforme.îApparently,whileremindingthepatientstoslowdowntheirpace,cardiologistsarealsoregulatingtheirownpressure. Tostayawayfromsuddendeath,donítsmoke,developgoodhabits,domoderateexercises,reliefstressregularly,andseekmedicalattentionwhensymptomatic. Prev Next