Sudden death in simple terms is death that occurs unexpectedly. In the first article on this topic, we focused on coronary heart disease (CHD) as a major cause of sudden death.  Still utilizing case scenarios, further attempts will be made to bring to light more causes of sudden death.

Case 1: John is a well built man in his early fifties. His health had been pretty good. He noticed that sometimes he feels his heart ‘racing’ for a short while and then it corrects itself. He assumed that it was the coffee he liked to drink that caused it, so he stopped. The problem did not completely resolve itself despite him giving up drinking coffee.  On some of the occasions, that he experienced the racing heart, he felt somewhat funny, but was unable to really explain the feeling.  Another day he felt lightheaded when the problem occurred. He wanted to wait for his vacation time to do a full check up as he was too busy to skip work. One day at work  he felt the heart racing so fast that it scared him and he called 911; unfortunately he collapsed before EMS arrived.  Could John have been saved?

Answer: Yes, it might have been possible for John to be saved. He had abnormal heart rhythm known as cardiac arrhythmia. The heart has both a pumping and conducting function. The heart conducts electrical activity that travels from the upper part (atrium) to the lower part (ventricles). Abnormal electrical activity can result in the heart beating fast (tachycardia) or slowing down (bradycardia).  The subjective feeling of the heart beating fast is called palpitations.  When the electrical activity is abnormal to the point at which it compromises the pumping function of the heart, the person may have symptoms. Serious compromise of the heart function can result in sudden cardiac death.

Symptoms and signs of cardiac arrhythmia

1. Feeling of the heart going too slow or fast

2. Irregular heart beat

3. Lightheadedness, dizziness or feeling faint

How is cardiac arrhythmia detected?

History is one of the most important things in the diagnosis of arrhythmia. It is important to let the doctor know if you become aware of your heart beat for any reason. A lot of arrhythmias can be detected by simple electrocardiogram (EKG).  EKG can be done at your primary physician’s office. The cardiologist can do more testing to detect abnormal rhythm. The heart rhythm can be monitored with different devices. A Holter monitor can be given to you to monitor the heart rate for twenty four hours while you go about your routine activity. If underlying cause is identified it can be corrected to avoid sudden death. People who have CHD and low pumping function of the heart are at risk of sudden death.

Case 2: Doe arrived from a long trip early part of the week. He noticed he had mild swelling and pain of his right leg, which he attributed to the trip. At work he felt he needed a little more effort to breathe. He thought it was from the exhaustion of his trip. He decided to go home early. On the train his breathing became more labored. Some who noticed him called 911. He was rushed to a very good hospital near the train station. As the EMS pulled into the emergency room he stopped breathing. All efforts to resuscitate him were painfully unsuccessful. He was pronounced dead in ER. An autopsy was later done. Doe had blood clot in his lungs. He had pulmonary embolism.

Pulmonary Embolism can occur in an isolated manner or as a complication of blood clot that travels from the leg into the lungs. Doe’s leg swelling was a blood clot in his leg, also known as Deep Venous Thrombosis (DVT). Unfortunately  the clot  travelled to his lungs. DVT can occur after prolonged non utilization of the leg or sedentary style. Doe’s long trip to his native country was the trigger to the blood clot. DVT can also occur as a complication of estrogen containing hormonal contraceptives in certain women. It is important when you travel long distances to make sure your stretch your legs to keep the circulation flowing well.

Case 3: Jane suddenly developed a severe headache. She took Tylenol like she normally did anytime she had headache. There was no relief whatsoever. She decided to rest from the day’s work. She could not have a peaceful rest because of the headache. She never had high blood pressure. She had to get up from her bed because she started to vomit. Suddenly she collapsed. She was intubated by EMS and taken to the hospital. She had massive bleeding into the brain from a ruptured aneurysm.

Aneurysms are like out pouching of blood vessels. The walls are thinner and weaker than the normal vessels itself. They can rupture at anytime and cause bleeding. Aneurysm is not limited to the brain. They can occur in the big vessels that take blood from the heart to the body (aorta). Rupture aneurysms are more often than not fatal.

Take Home message

Many causes of sudden death can be prevented if adequate care is taken.

If anyone dies in a family of ruptured brain aneurysm, the other family members should be screened with MRI to prevent any more sudden death.  Sudden cardiac death in young people with abnormal heart enlargement requires screening of other family members also.

When you take long trips, make sure you stand up at intervals to exercise your legs.

If you have symptoms, do not rationalize, seek attention immediately.

Dr. Oluwatoyosi Dairo can be contacted at Amazing Medical Services, 110-16 Sutphin Blvd, Jamaica NY 11435 or by phone at (718) 526 7600. The health columns are for educational purposes only and are not intended to replace the advice of your doctor.

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