Sudden Cardiac Arrest and Death: Being seemingly healthy is no insurance against heart disease. Those who appear healthy, and are particular about diet and exercise, seem to be succumbing too.

Nowadays, heart attacks are striking at a younger age, making those in their 30s and 40s the new high-risk categories, possibly due to high-pressure lifestyles. There are other potential causes as well.

Remember! Sudden Cardiac Death occurs without warning signs or symptoms. Even if some vague signs or symptoms manifest, they often go unnoticed by many.

Let us first try to answer the following few questions:

Are there any potential warning signs or symptoms that coaches, parents, your friends and colleagues must be on the lookout for which indicate that you are at high risk of sudden cardiac death.

Yes, for instance: If fainting or syncope occurs during sports, running or any physical activity, then it could be a potential sign of heart issues.

Another potent sign includes shortness of breath and sudden chest pain.; extreme weakness or fatigue suddenly after starting a physical activity, exercise or high-intensity workouts can also indicate heart problems.

Why is it important to know the potential high-risk factors – which can make an individual prone to sudden cardiac arrest and death

The answer is straight forward – a relatively healthy-looking individuals could have been living with undetected or hidden heart disease or with some blockages (coronary artery disease) in his or her artery for a long time – which could lead to sudden cardiac arrest and heart attack at times.

In India, non-detection of heart disease is a very serious problem as it has been noted that one in four people with up to 70% blockages don’t exhibit any symptoms or may be presented with some common symptoms like weakness or fatigue.

It has become a routine thing for us to detect or diagnose heart disease or serious arterial blockages of up to 70% or more in individuals as young as 30 years age.

This sort of diagnoses is a bit surprising as they usually come for a routine health check-up or for a mandatory testing prior to any major surgery – as major surgical profile. Surprisingly these individuals would have never experienced any symptoms before as they were living healthy and active life.

Who are at increased risk of sudden cardiac arrest and death?

Those who are leading high-pressure lifestyle are at risk of developing Heart Problems. Don’t take anything to the heart is an apt saying as far as keeping your heart healthy.

High-pressure lifestyle and stress have nowadays become a potential risk factor for heart attacks.

Though stress is not directly linked to cardiac arrest or heart attacks, it can lead to stress cardiomyopathy (broken heart syndrome).

Therefore, managing stress is as important as managing cholesterol and triglycerides levels.

Sudden Indulgence in High-Intensity Exercise

If you are not accustomed to exercise and then indulge in excess exercise, then it could prove very dangerous for your heart and your life as well.

Some youngsters intrinsically get motivated and passionately do heavy body-building activities such as weight-lifting.

Excessive exercise (heavy weight-lifting) in a short time can cause heart troubles.

Which category of young people should consult a cardiologist prior to starting exercise?

Individuals who have a strong family history of sudden cardiac arrest and death; individuals with an undetected heart defect and individuals with congenital and inherited heart disorders (hypertrophic cardiomyopathy - HCM) and those who smoke should also consult a cardiologist before starting any physical activity, sport or high-intensity exercise.

Individuals with HCM should avoid highly competitive sports and those with implantable cardioverter-defibrillator (ICD) must avoid impact sports.

For further details about the condition and the restrictions on the activity levels one should consult their cardiologist.

What cause a sudden Cardiac Arrest and Death?

Nowadays many youngsters in their 30s and 40s are becoming prone to heart attacks after suddenly starting high-intensity exercises.

The reason for this is rupturing of plaque in the arteries due to heavy exercise – which triggers or stimulates rupturing of plague and sudden formation of clots in the arteries and thus leading to heart attacks.

Therefore, A comprehensive medical check-up is important.

A thorough medical examination and check-up is recommended for high-risk individuals based on their lifestyle, past history, family history and other comorbid conditions.

Atherosclerosis and Coronary artery disease can go unnoticed and undetected for years or even for decades.

Smokers Beware!

Smokers are immensely vulnerable to heart attacks if they start exercise or suddenly get themselves indulge in high-intensity exercise.

All cardiologists unanimously agree on the fact that youngsters who smoke and have blockages as little as 10% are at increased risk of massive heart attacks if they indulge in heavy or high-intensity exercises.

The reason smoking makes blood thick, triggers plague formation; heavy exercise leads to rupture of plaque and formation of blood clots – which may lead to heart attacks.

Undetected Heart Abnormalities

Coronary Artery Disease: It is the most common cause of sudden cardiac death accounting up to 80% of all cases related to cardiac arrest and deaths. Cardiomyopathies related to smoking, fibrosis, alcoholism and obesity are the most common causes of non-ischemic sudden cardiac deaths.

Genetic channelopathies [Catecholaminergic polymorphic ventricular tachycardia (CPVT), Early repolarization syndrome, Brugada syndrome, Short QT syndrome (SQTS), Long QT syndrome (LQTS)] and cardiomyopathies account for the remaining causes.

Congenital abnormalities: The primary or most common cause of heart problems in children from their birth to 13 years is congenital heart abnormality.

In children between ages 14 to 24 years, the cause of heart-abnormality related death can be due to congenital coronary anomalies, Marfan syndrome, Wolff-Parkinson-White syndrome, myocarditis, genetic channelopathies, arrhythmogenic right ventricular cardiomyopathy and hypertrophic cardiomyopathy (HCM).

Hypertrophic cardiomyopathy (HCM) is an inherited heart abnormality in which the walls of the heart muscles thicken and thus interfere with the electrical system of the heart.

This leads to abnormal or irregular heartbeats (arrhythmias) – which in turn lead to sudden cardiac death.

In some individuals under age 30, hypertrophic cardiomyopathy (HCM) is the most common cause of sudden death – related to heart abnormalities.

Though not usually fatal, but it is the most detectable cause of sudden death in sportspersons. Hypertrophic cardiomyopathy often goes unnoticed and undetected or undiagnosed.

Fatal arrhythmia: In people younger than 35 fatal arrhythmia accounts for the most common cause of sudden cardiac death even if they have structurally normal heart.

Coronary artery abnormalities: Abnormalities in the coronary artery can also disrupt proper blood flow to the heart and thus cause heart attacks.

Some individuals are born with abnormal coronary arteries that connect abnormally. During exercise or any other physical activity their artery constricts and obstructs proper blood flow – which may lead to heart attack.

The risks

A strong family history of sudden death. If it is the case in your family, then it is better to talk to your cardiologist for the early heart disease screening tests.

If you have breathing issues or feel shortness of breath or chest pain with some activities like walking, climbing stairs or while doing any other physical activity, then you should consult a cardiologist – this could be a potential risk factor – which can be managed if heart disease is detected early.

Can sudden death in young people due to cardiac arrest be prevented?

If you think that you are at high risk of sudden cardiac arrest and death, then you must consult a cardiologist for a thorough physical and medical examination and evaluation.

The cardiologist if deems necessary will order a few tests; based on family history, personal medical history, existing symptoms, existing comorbid conditions and other risk factors – your cardiologist will address your concern.

Sudden cardiac arrest treatment

Depending on the health status and other underlying health conditions, the doctor will prescribe medicines or suggest surgical intervention, which could be appropriate to reduce the risk of sudden cardiac arrest and death.

Cardiologist would also suggest whether to avoid high-intensity exercise, contact sports and other highly competitive sports.

Can sudden cardiac arrest and death be prevented by any other means

Some people with hypertrophic cardiomyopathy can have another option in the form ofimplantable cardioverter-defibrillator (ICD).

This small implanted device in the chest works just like a pager. It continuously monitors heartbeats – and, in case, any abnormal heartbeats manifest or life-threatening arrhythmia occurs, the ICD sends electrical shocks to restore normal heart rhythm.