Why do sportsmen who appear to be fit and healthy die suddenly?

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Similarly, why do non-sportsmen who seem to enjoy good health, experience sudden death?

In most cases, sudden death is caused by sudden cardiac arrest, which is a swift and unexpected loss of heart function. Sudden cardiac arrest disrupts the normal pumping of blood throughout the body, and can lead to sudden cardiac death.
An estimated 1,000 Singaporeans die from sudden cardiac death (SCD) every year. About half of these people are below the age of 60, according to a 2003 study carried out by the National Heart Centre Singapore (NHCS) in collaboration with the Health Sciences Authority. The study found that about 91 per cent of the people who died from sudden cardiac death were males with a mean age of 46 ±9 years.
Sudden cardiac arrest is usually caused by an abnormality in the heart rhythm, known as arrhythmia.
"Sudden cardiac arrest is not the same as a heart attack. A heart attack happens because the heart’s blood supply is cutoff, while sudden cardiac arrest is usually caused by electrical issues within the heart," says Adjunct Associate Professor Ching Chi Keong, Senior Consultant, Department of Cardiology and Director, Electrophysiology and Pacing, National Heart Centre Singapore (NHCS), a member of the SingHealth group.
Related article: How to survive a heart attack when alone
When something goes wrong with the ‘electric circuitry’ of the heart, it can cause the heartbeat to be irregular, fast or slow. Ventricular fibrillation, an arrhythmia which causes the lower chambers of the heart to beat too fast, is the most common cause of sudden cardiac arrest.
During ventricular fibrillation, the heart rate can be as fast as 400-500 beats per minute, compared to the normal 60-100 beats. The heart’s lower chambers, which pump blood and oxygen to the body, do not effectively pump blood out of the heart. As a result, insufficient blood is delivered to the brain and the person loses consciousness. It is a medical emergency and the victim is likely to die within minutes without treatment. Even if the victim survives, there is a high chance of brain damage leading to poor quality of life.
“An extremely slow heart rate can cause sudden cardiac death but it is usually not drastic and sudden, and presents with prior symptoms of giddiness or fainting,” says Adj Assoc Prof Ching.
Related article: What to do if you see someone faint?
Often, a life-threatening arrhythmia is linked to a heart condition such as:

• Coronary artery disease: The Singapore study found that 81 per cent of all sudden cardiac deaths were caused by coronary artery disease (hardening and narrowing of the arteries supplying the heart).
• Heart attack: Almost 75 per cent of all sudden cardiac arrest patients show signs of a previous heart attack.
• Hypertrophic cardiomyopathy: An abnormal thickening of the heart muscle can cause ventricular fibrillation, especially during exertion.
• Electrical disorders of the heart: One of these disorders is Wolff-Parkinson-White syndrome, characterised by an extra nerve connecting the heart chambers. This can cause an 'electrical short-circuit' in the heart, resulting in a rapid heartbeat. Brugada's and long QT syndromes are also examples of electrical disorders.

Risk factors for sudden cardiac arrest

• Personal or family history of coronary artery disease, cardiac arrest, heart attack, heart rhythm disorders, congenital heart defects, poor heart function and heart failure
• Recurrent chest pain or fainting spells during physical exertion
• Smoking
• High blood pressure
• High cholesterol
• Obesity
• Diabetes
• Excessive alcohol consumption

“A typical patient of sudden cardiac arrest is likely to be male, more than 35 years old and has a family history of early heart attack,” says Adj Assoc Prof Ching.
Related article: What can you do to reduce your risk of sudden cardiac arrest?
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By Anjana Motihar Chandra for HealthXchange.
Articles on HealthXchange.com.sg are meant for informational purposes only and cannot replace professional surgical, medical or health advice, examination, diagnosis, or treatment.


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