Sudden cardiac death

Sudden cardiac death supposedly occurs out of the blue. He meets people who have just felt comfortable. According to the definition, doctors speak of sudden cardiac death when a seemingly healthy person suddenly passes out, has no pulse, no longer breathes and dies within an hour of the onset of symptoms. Sudden cardiac death is also called second death or second cardiac death. In medicine it is also abbreviated as PHT. But sudden cardiac death usually does not occur that unexpectedly. Often there are warning signs that the person concerned has ignored.

According to statistics, sudden cardiac death is not uncommon in Germany. Every year at least 66,000 people die of seconds, explains the German Heart Foundation. That is about 20 percent of all cardiovascular deaths. Men die in seconds about three times as often as women. Most people in middle and older age are affected, but younger people also die from it.

Sudden cardiac death can set in in many situations: while walking, standing or doing sports. But it can also "catch" people suddenly while they are asleep.

Sudden cardiac death: The causes are usually cardiac arrhythmias

Cardiac death is usually not as sudden as it appears. The majority of those affected have a heart condition that has gone undetected until then. This can trigger dangerous cardiac arrhythmias . Usually it is ventricular fibrillation, which can lead to cardiac arrest and death within a short time. If a person dies of sudden cardiac death, they have usually suffered from heart disease. In principle, any heart disease that causes cardiac arrhythmia can be the cause of sudden cardiac death.

The following causes are common:

• Coronary artery disease (CHD): This condition plays the largest role in sudden cardiac death. In CHD, the coronary arteries are narrowed due to deposits ( arteriosclerosis ). The blood flow to the heart is disturbed and if one or more vessels are blocked, a heart attack occurs . This is linked to cardiac arrhythmias. In 70 to 80 percent of cases with sudden cardiac death, people suffer from coronary artery disease.
• Heart muscle diseases : The heart muscle is diseased in ten to 15 percent of those affected. For example, you suffer from a structural change ( cardiomyopathy ) or inflammation of the heart muscle ( myocarditis ).
• Heart valve diseases : These can also trigger cardiac arrhythmias.
• Congenital heart defects : They are responsible for around five to ten percent of sudden cardiac death.

There are also other rarer causes, such as a disturbed electrical conduction system of the heart. These include ion channel diseases such as long QT syndrome . In this disease, the transmission of electrical signals in the heart muscle cells is impaired. The Brugada syndrome is a rare heart disease, cardiac conduction interfere with the damaged heart muscle cells in the heart.

However, sudden cardiac death can set in even if you have no previous illness. International studies show that in 40 percent of cases an autopsy does not reveal any previous heart disease. Sometimes other factors also play a role, such as smoking, high alcohol consumption or substance abuse. Another underlying disease that does not affect the heart can also be responsible.

 

Sudden cardiac death in sleep

Sudden cardiac death often overtakes young people at night while they are asleep or when they are at rest. Diabetics in particular are at risk. Sudden cardiac death occurs twices as often in their sleep. Doctors refer to it as "dead-in-bed syndrome". The cause of this is low blood sugar (hypoglycaemia), which can cause life-threatening cardiac arrhythmias. 

Sudden cardiac death: Exercise can be risky

Sudden cardiac death sometimes occurs during intense physical exertion, such as when exercising. It happens again and again that a fit competitive athlete suddenly collapses during a competition or shortly afterwards and dies. This was the case with swimming world champion Alexander Dale Oen or footballer Piermario Morosini.

However, it is usually not sport that is to blame, but a congenital heart defect, a previously undetected heart disease or an acute viral infection, such as a cold . The pathogens can spread to the heart and cause inflammation. 

Sudden Cardiac Death: Risk Factors

A previous heart disease does not necessarily lead to threatening cardiac arrhythmias and sudden cardiac death. Often an acute trigger or existing risk factors are added. Some examples:

• old
• Previous heart attack : Anyone who has ever had a heart attack has an increased risk of sudden cardiac death afterwards.
• Survived sudden cardiac death - afterwards the likelihood of cardiovascular arrest is increased.
• Sudden cardiac death due to stress and stressful emotional experiences is possible.
• vigorous physical exertion , such as playing sports
• Drugs that affect the conduction system in the heart. Examples: antiarrhythmics, psychotropic drugs such as phenothiazines or tricyclic antidepressants
• Medicines that significantly change the level of potassium in the blood, such as water tablets (diuretics), ACE inhibitors and aldosterone antagonists
• Drugs (e.g. alcohol, cocaine), opioids
• Electric shock , such as when doing electrical work or from lightning
• Genes : The risk of sudden cardiac death is not hereditary. However, hereditary predisposition does play a role in cardiomyopathy. This heart disease is more common in some families. A genetic test will show whether you are affected. If this is the case, you should be examined regularly by a heart specialist (cardiologist).

Sudden cardiac death: interpreting signs correctly

Cardiac death usually does not happen as suddenly as it seems. Half of all those affected already have previous heart diseases. In addition, sudden cardiac death often shows harbingers, but those affected usually do not interpret them correctly, as researchers from the Cedars-Sinai Heart Institute in Los Angeles found out in a study.

• For example, 53 percent of people experienced typical symptoms such as chest pain and shortness of breath in the days or weeks before sudden cardiac death (sometimes up to four weeks before).
• 93 percent of those affected also had these harbingers the day before the sudden cardiac arrest , but ignored them - this almost always meant death.
• Of those who called an ambulance about these signs, around 32 percent survived the sudden cardiac arrest.

It is therefore important to take the symptoms seriously and to notify an emergency doctor immediately - this increases the chances of survival in the event of sudden cardiac death. Relatives can also contribute by immediately calling the emergency services on 112 at the first sign.   

The symptoms of sudden cardiac death are:

• Cardiac arrhythmias that manifest themselves as a pulse that is too fast ( tachycardia ) or, less often, a pulse that is too slow ( bradycardia )
• Chest pain
• Feeling of pressure or tightness in the left chest - especially when exercising
• Shortness of breath (the feeling of being unable to breathe properly), acute shortness of breath
• dizziness
• Unconsciousness, fainting

Relatives or outsiders can recognize sudden cardiac death by the following signs - the person concerned:

• suddenly falls over, for example while standing, running or doing sports; some simply collapse in a chair
• does not respond when you speak to him or shake his shoulders
• no longer breathes
• has no pulse

Sudden cardiac death: the process takes place in quick steps

Sudden cardiac death is mostly due to heart diseases that are associated with cardiac arrhythmias . In most cases this is ventricular fibrillation . This is a life-threatening cardiac arrhythmia in which the heartbeat is completely out of step, reaches a very high frequency and the heart can no longer pump blood into the circulation. Sudden cardiac death is much less often triggered by a slow heartbeat (bradycardia), in which the pulse is below 40 beats per minute.

What happens in the event of sudden cardiac death?

With ventricular fibrillation, the transmission of electrical signals in the heart is disturbed - a kind of "short circuit" arises. In the case of sudden cardiac death, the process can be described as follows:

• The electrical signals spread chaotically and at high speed through the heart muscle cells.
• The heart beats more than 350 times per minute, the heart muscle no longer contracts in a coordinated manner, but only trembles - the heart "flickers".
• As a result, the left ventricle can no longer pump blood into the body - a circulatory standstill occurs.
• The brain is now no longer receiving oxygen. Brain cells die after just five minutes, brain functions fail and automatic breathing (so-called spontaneous breathing) fails.
• The affected person becomes unconscious, he no longer has a palpable pulse, his pupils are dilated and light-free (indication of brain death).
• The lack of blood makes the skin pale and pale, and the lips may turn blue.

If he is not resuscitated immediately, death usually occurs within ten minutes.

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