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Building awareness of a major killer: sudden cardiac death
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Heart rhythm specialist Dr. Bruce Wilkoff shows patient an implantable defibrillator which can automatically restore normal rhythm. A programmer on the patient's left shoulder reads data.
PHOTO/CLEVELAND CLINIC FOUNDATION
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Sudden cardiac death, which is preventable, is often confused with heart attack and stroke.
By SALLY HENDERSON
Leah R. is a lively, young Cleveland mother who is deeply involved in her kids' lives and activities. While attending her son's basketball game recently, she felt momentarily dizzy and then collapsed. If Emergency Medical Services had not arrived very quickly, Leah would not be alive today.
She is one of the lucky ones.
Leah survived an episode of sudden cardiac death. She could easily have been one of the more than 250,000 people in the United States who die each year from this phenomenon. Some believe the death level may be as high as 400,000. In fact, each year, sudden cardiac death accounts for more deaths than breast cancer, lung cancer and AIDS combined.
Why isn't sudden cardiac death better known and understood by the public?
"People are easily confused by different heart disease terms - stroke, heart attack, and sudden cardiac death - each of which is a specifically different ailment and requires different medical treatment," explains Dr. Elizabeth Kaufman, cardiologist and heart rhythm specialist at MetroHealth Medical Center.
"People need to understand that successful treatment for a heart attack does not protect against future risk for sudden cardiac death." says Dr. Bruce Wilkoff, cardiologist and heart rhythm specialist at Cleveland Clinic Foundation. "Even those who have never had a heart attack may still be at risk for sudden cardiac death.
"A heart attack," adds Wilkoff, "results from a blockage of one or more vessels that supply blood to the heart. In other words, the 'plumbing' of the circulatory system is affected. Sudden cardiac death instead results from an overly fast heart rhythm, a problem with the heart's electrical conduction system."
To raise awareness among people in Northeastern Ohio, cardiologists who are also heart-rhythm specialists have joined together to create a public information campaign called Fast Heart Beat Ohio. The facts about sudden cardiac death can be seen on www.fastheartbeat-ohio.org.
A person of any age is vulnerable for sudden cardiac death, explains Dr. David Rosenbaum of MetroHealth Medical Center. "It affects men and women, people who are active and less active, even those with no personal history of heart disease. A previous heart attack is only one of the risk factors."
Unfortunately, there are no warning signs before sudden cardiac death: A person can be feeling fine one minute and collapse the next. However, Rosenbaum says clinical research shows that heart-attack survivors are often at much higher risk for sudden cardiac death than the average person.
"The good news is that there are effective ways to evaluate risk for sudden cardiac death," noted Dr. Martin Wiseman, cardiologist and heart rhythm specialist at Robinson Memorial and Hillcrest hospitals.
A simple, non-invasive test - an echocardiogram - determines a patient's ejection fraction - a measurement of how effectively the heart pumps blood, he says. This factor, along with results from other tests, indicates how much a person is at risk for sudden cardiac death.
Treatment equals prevention
Treatment to prevent sudden cardiac death involves receiving an implantable defibrillator, also called an ICD. This is a small electronic device placed under the skin that monitors the heart's electrical rhythm automatically.
With an ICD, a patient's heart is monitored 24 hours a day. If an abnormal, overly fast heart rhythm develops, the device automatically restores a patient's heart function to normal rhythm.
Restoration to normal rhythm - when sudden cardiac death emerges - can occur while a person is sleeping, driving or going about the activities of daily life. An ICD is like a "safety belt" protecting a person wherever he is, whatever he's doing.
"Treatment for heart disease and sudden cardiac death is a complex process," notes Dr. Bruce Stambler, cardiologist and heart rhythm specialist at University Hospitals of Cleveland. "Various drugs can reduce risk for a heart attack. But medications alone may not fully protect against sudden cardiac death."
"People are easily confused by the fact that they 'feel fine' or have felt fine for some time after their heart attack," adds Wiseman. "This makes them think they don't need an evaluation or treatment to protect against sudden cardiac death.
"Feeling fine doesn't have anything to do with protection for the future," he says.
What can people do to protect themselves against sudden cardiac death? - If you or someone you know has had a heart attack, ask the doctor whether your/their ejection fraction is in the danger zone of 30% or less.
- If you have a history of sudden cardiac death in your family, ask the doctor whether an evaluation by a heart rhythm specialist can be arranged.
- If it has been some time since your heart attack, ask the doctor whether a new measure of your ejection fraction is appropriate (ejection fraction can change over time).
- Lifestyle factors such as healthy diet, regular exercise and stress reduction are all helpful factors in extending life, but they will not protect against sudden cardiac death.
For more information, visit www.fastheartbeat-ohio.org.
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