Young death, sudden, and unexpected, instils fear in even the bravest of men and women. Sudden death from cardiac arrest, also known as Sudden Cardiac Death (SCD) has many synonyms including Sudden Death Syndrome, Cardiac Risk of the Young or Sudden Nocturnal Death.
It is a little known and even less publicised health problem. Yet it strikes down apparently fit and healthy children and adults under the age of 40. Victims often have no prior symptoms or “mild” symptoms, prior to death. These symptoms include shortness of breath, palpitations, mild chest pain, fainting spells, or light headedness.
Although difficult to diagnose, SCD is not a new phenomenon. It has been with humankind since our earliest days and is now woven into our collective history and specific beliefs. The first recorded example of it was in 490 BC when the Greek Soldier Pheidippides ran 40 km from the battlefield of Marathon to Athens, uttered the words “We have won” and died on the spot.
In Asia, SCD was first reported in Philippines in 1917. According to Philippine folklore, sudden death in young men was attributed to Batibat. She a vengeful and obese female demon that sat on the faces of unsuspecting young men, suffocating them to death in their sleep.
Most recently, the media frenzy following the spate of the high profile deaths of several famous United States basketball stars(Hank Gathers in 1990 and Reggie Lewis in 1993) sparked renewed medical interest in this condition.
Defining the condition
There is no universally accepted definition for Sudden Cardiac Death. It may be defined as death due to natural causes within an hour of the onset of symptoms, in the absence of any other cause, and assumed to have a cardiac cause.
Or Sudden cardiac death is a dramatic and/or spontaneous death that is thought to be (and usually is) caused by a heart condition and may have been brought on by exercise
On the other hand, SCD may be indicated by a sudden death that is non-cardiac in origin. Examples of non-cardiac SCD include respiratory arrest (such as due to airway obstruction, which may be seen in cases of choking or asphyxiation), toxicity or poisoning, anaphylaxis, or trauma.
Essentially, SCD is a composite term for natural, rapid and unexpected death resulting from about fifteen or more different conditions.
Causes of SCD
Medical researchers have established that there are several common causes of SCD including Structural Heart Disease, Chanellopathies and a few miscellaneous causes.
Most causes have a genetic component. Therefore family history is critical to determining those at high risk. In cases with strong family history, screening with full clinical examination and ECG’s is essential. However, ECGs could also be normal, making diagnosis a huge challenge.
Structural Heart Disease, most notably Hypertrophic Cardiomyopathy is the single most common disorder causing cardiac death in people under the age of 35. The prevalence is 1 in 500.
The channelo-pathies describe a group of disorders which include Wolff-Parkinson-White Syndrome (WPW), Long QT Syndrome (LQTS), Short QT Syndrome, and Brugada Syndrome. With this group of disorders, the electrical functioning of the heart is affected in the setting of a structurally normal heart. Detection is possible only in life, if screened. Post -mortem diagnosis is difficult if not impossible, as the architecture of the heart is essentially normal.
Most of the causes of SCD described above may be treatable if diagnosed early through drugs, surgery and/or implantable defibrillators.
Miscellaneous causes that have been cited are coronary artery heart disease in individuals less than 35 years old, Viral Myocarditis following a viral disease, dilated cardiomyopathy, Commotio Cordis (death following a sudden blunt blow to the chest, resulting in ventricular fibrillation), and illicit or prescription drugs that cause fatal arrhythmias.
How common is SCD?
Several studies have now established that, although prevalence is low, the condition is more widespread than previously thought. In the US alone it is estimated that the incidence of sudden cardiac death is 3 per 100 000 from birth to age 34 years. The US National Federation of State High School Association estimates that in individuals younger than 30 years there are ten to 25 cases of SCD each year, per million of the population.
In the United Kingdom experts estimate that at least eight young people die suddenly each week due to SCD
However, these statistics may be inaccurate for various reasons namely:
Recommendations and conclusion
The empirical evidence on the incidence of SCD in South Africa is limited. Since there is no hard data on which to benchmark, measure outcomes and make recommendations the most obvious for the present would be:
Most causes of SCD is familial, therefore family history is critical in determining those at high risk. Medical doctors who conduct insurance medicals and underwriters should be suspicious of individuals with a first degree relative who has died of a cardiac-related cause under the age of 40. These clients should be considered high risk until proven otherwise.
Additionally, there should be careful consideration of otherwise healthy young patients that have a history of palpitations, fainting and inexplicable chest pain on health questionnaires.
In these cases, it is suggested that a comprehensive risk assessment is requested that includes an ECG and consultation with a cardiologist.