If a doctor tells you about CV, he doesn’t mean curriculum vitae but rather he is referring to cardiovascular. “For the longest time, cardiovascular causes remain the leading cause of death in our country and many parts of the world,” says Dr. Rafael D. Castillo, one of the country’s noted cardiologists and former president of the Philippine Heart Association.
“One out of three deaths are due to a CV cause which include coronary artery disease, heart failure, fatal arrhythmias, as well as strokes and other vascular causes,” points out Dr. Castillo, who writes a regular column for a national daily and published a monthly health magazine.
Let’s take a closer look at heart diseases alone. The statistics are quite alarming: one out of five deaths are due to heart causes, based on figures released by the Department of Health. Health experts estimate that around eight to 11 Filipinos are suffering from cardiac arrest every hour.
“A big number of them may have this fatal event in the church, malls, markets, bus stations or in the streets while walking,” Dr. Castillo says.
The big question among lesser mortals: is cardiac arrest the same as heart attack?
“People often use these terms interchangeably, but they are not synonyms,” explains the American Heart Association (AHA). “A heart attack is when blood flow to the heart is blocked, and sudden cardiac arrest is when the heart malfunctions and suddenly stops beating unexpectedly. A heart attack is a ‘circulation’ problem and sudden cardiac arrest is an ‘electrical’ problem.”
The Mayo Clinic has this to say: “Cardiac arrest is different from a heart attack, which occurs when blood flow to a portion of the heart is blocked. However, a heart attack can sometimes trigger an electrical disturbance that leads to sudden cardiac arrest.”
AHA agrees as these two distinct heart conditions are linked. “Sudden cardiac arrest can occur after a heart attack, or during recovery. Heart attacks increase the risk for sudden cardiac arrest. Most heart attacks do not lead to sudden cardiac arrest,” the US heart association says.
Unlike other muscles in our body, which rely on nerve connections to receive the electrical stimulation they need to function, our heart has its own electrical stimulator – a specialized group of cells called the sinus node located in the upper right chamber (right atrium) of your heart. “The sinus node generates electrical impulses that flow in an orderly manner through the heart to synchronize the heart rate and coordinate the pumping of blood from your heart to the rest of the body,” the Mayo Clinic explains.
Now, if something goes wrong with the sinus node or the flow of electric impulses through your heart, an arrhythmia can result, causing your heart to beat too fast, too slow or in an irregular fashion. Often these interruptions in rhythm are momentary and harmless. But some types of arrhythmia can be serious and lead to a sudden stop in heart function, which medical science calls as cardiac arrest.
Heart attack is one of the causes but the Mayo Clinic says that a life-threatening arrhythmia usually develops in a person with a pre-existing heart condition, such as:
Coronary artery disease: Most cases of sudden cardiac arrest occur in people who have coronary artery disease. In coronary artery disease, the arteries become clogged with cholesterol and other deposits, reducing blood flow to the heart. This can make it harder for the heart to conduct electrical impulses smoothly.
Enlarged heart (cardiomyopathy): This occurs primarily when the heart’s muscular walls stretch and enlarge or thicken. In both cases, the heart’s muscle is abnormal, a condition that often leads to heart tissue damage and potential arrhythmias.
Valvular heart disease: Leaking or narrowing of the heart valves can lead to stretching or thickening of the heart muscle or both. When the chambers become enlarged or weakened because of stress caused by a tight or leaking valve, there’s an increased risk of developing arrhythmia.
Congenital heart disease: When sudden cardiac arrest occurs in children or adolescents, it may be due to a heart condition that was present at birth (congenital heart disease). Even adults who’ve had corrective surgery for a congenital heart defect still have a higher risk of sudden cardiac arrest.
Electrical problems in the heart: In some people, the problem is in the heart’s electrical system itself instead of a problem with the heart muscle or valves. These are called primary heart rhythm abnormalities and include conditions such as long QT syndrome, which affects repolarization of the heart after a heartbeat.
Because sudden cardiac arrest is so often linked with coronary artery disease, the same factors that put a person at risk of coronary artery disease may also put him or her at risk of cardiac arrest.
The Mayo Clinic identifies them as follows: a family history of coronary artery disease, smoking, high blood pressure, high blood cholesterol, obesity, diabetes, a sedentary lifestyle, and drinking too much alcohol (more than two drinks a day).
Other factors that may increase a person’s risk of cardiac arrest include: a previous episode of cardiac arrest or a family history of cardiac arrest, a previous heart attack, a personal or family history of other forms of heart disease (such as heart rhythm disorders, congenital heart defects, heart failure and cardiomyopathy), age(the incidence of sudden cardiac arrest increases with age), being male (men are two to three times more likely to experience sudden cardiac arrest), using illegal drugs (such as cocaine or amphetamines), and nutritional imbalance (such as low potassium or magnesium levels).
The Mayo Clinic says cardiac arrest symptoms are immediate and drastic and include: sudden collapse, no pulse, no breathing, and loss of consciousness. “Sometimes other signs and symptoms precede sudden cardiac arrest,” it says. “These may include fatigue, fainting, blackouts, dizziness, chest pain, shortness of breath, weakness, palpitations or vomiting.”
But cardiac arrest often occurs with no warning. That’s why you need to see a doctor immediately. “If you have frequent episodes of chest pain or discomfort, heart palpitations, irregular or rapid heartbeats, unexplained wheezing or shortness of breath, fainting or near fainting, or you’re feeling lightheaded or dizzy, see your doctor promptly,” the Mayo Clinic advises. “If these symptoms are ongoing, you should seek emergency medical help.”
Dr. Raul L. Lapitan, immediate past PHA president, claims about 70% of cardiac arrests happen out of the hospital and they occur mostly in public places. “Of those successfully brought to the hospital, only 4-6 percent come out alive with minimal mental and physical defects,” he laments.
AHA says death occurs within minutes if the victim does not receive treatment. But cardiac arrest can be reversible in some victims if it’s treated within a few minutes. And the best chances of a person stricken with heart seizure starts with how long emergency responds, according to Dr. Lapitan. That’s why he urges bystanders to conduct a hands-only cardiopulmonary resuscitation (CPR) to the victim.
“Every minute that a CPR is delayed reduces the chances of survival and recovery by 10 percent,” reminds Dr. Castillo. “If it’s delayed by five minutes, a 50% chance of recovery shall have gone down the drain. If it’s delayed by more than ten minutes, the prospect of recovery is nil.”
Here’s how to perform CPR. “Quickly check the unconscious person’s breathing,” the Mayo Clinic instructs. “If he or she isn’t breathing normally, begin CPR. Push hard and fast on the person’s chest – at the rate of 100 to 120 compressions a minute. If you’ve been trained in CPR, check the person’s airway and deliver rescue breaths after every 30 compressions.
“If you haven’t been trained, just continue chest compressions. Allow the chest to rise completely between compressions. Keep doing this until a portable defibrillator is available or emergency personnel arrive.”
As there’s no sure way to know your risk of cardiac arrest, reducing the risk is your best strategy. Among the steps most doctors recommend which you can do include regular checkups, and screening for heart disease.
The May Clinic also suggests to live a heart-healthy lifestyle with the following approaches: avoid smoking and drink alcohol in moderation (no more than one to two drinks a day). Eat a nutritious, balanced diet. Stay physically active.
If you know you have heart disease or conditions that make you more vulnerable to an unhealthy heart, consult your doctor. He may recommend that you take appropriate steps to improve your health, such as taking medications for high cholesterol or carefully managing diabetes. (Next: Stroke)
