I just came home from a bike ride. It was a great fall day and I was feeling good. After I came home, the phone rang and the caller ID was from a college friend of mine. He called to tell me that our friend John had been out cycling that day at the same time as I was. John collapsed from his bike with a cardiac arrest and did not survive. My friend said he had a massive heart attack. I see this scenario often at work, but this was one of my friends who was the same age as me. I am not impervious to the anxieties that this can cause.
John was 52. He was a 4 year varsity college soccer player back in the day and continued to exercise regularly. I saw him a year ago and he looked like he was younger than stated age. He was vigorous and full of life.
So what happened and why did it happen? What can be done to prevent this from happening to the rest of us?
Statistically, in people over age 35 with a cardiac arrest, the number one cause of sudden cardiac death is from coronary disease. It is thought that the mechanism of action that coronary disease causes sudden death relates to acute plaque rupture causing a heart attack. Most of the time that a plaque ruptures and causes a heart attack, the plaque is not a severe narrowing but a mild to moderate narrowing,<70% narrowed, that gets unstable and breaks open. If a plaque is less than 70% narrowed it usually does not cause symptoms and there is no warning for the patient. Once the integrity of the plaque is compromised by the rupture, a thrombus (clot) forms in the plaque and can shut the artery off causing a heart attack. During a heart attack, the heart muscle beyond the blockage does not receive blood or oxygen and the heart muscle starts to die. The dying or dead heart muscle can become electrically unstable. This electrical instability can lead to lethal heart rhythms that cause the cardiac arrest.
Because 70% of cardiac arrests are caused by patients having heart attacks, many patients will have symptoms in the hour prior to a cardiac arrest. Those symptoms are those of a heart attack: chest pressure, shortness of breath, nausea, sweatiness, fatigue or a sense of impending doom. Obviously, it is important not to ignore these symptoms. Sadly, in at least 30% of cardiac arrest victims their first symptom is their last symptom and they present with sudden death.
I am not sure why my friend had a cardiac arrest and died. The last time I saw him he looked fit. His weight was good and he exercised regularly. The best way to survive a cardiac arrest is to prevent it from happening. How do you do that? By avoiding the things that promote coronary disease. First, I recommend that keep your weight down; within 15% of your ideal body weight and for men a waist size less than 36 inches. Second, people should exercise everyday for at least 40 minutes. Exercise includes walking and more strenuous activities. Third, no smoking. Smoking is the single worse thing that a person can do for their overall health. When people stop smoking, this lowers their risk by almost 35% of a heart attack and we see improvements in their blood vessels almost immediately. Fourth, a high quality diet is important with lots of fruits and vegetables and less processed food. Lastly, no more than 2 alcoholic drinks a day and some days none. Alcohol is inflammatory and theoretically play a role in plaque rupture.
You can see your physician for further evaluation of blood pressure, lipids and when appropriate possibly further testing. However, there is currently no test that predicts sudden cardiac death. Trying to find the “vulnerable” plaque is one of the remaining holy grails of cardiology.
For those that “do everything right” and still suffer a cardiac arrest, I do not have an answer as to why it happens. I do recommend to all of us to live a little in the present and not the future all of the time. Don’t take life’s little pleasures for granted. Enjoy your family and friends a little more.
I am comforted that John did not suffer, as there is immediate loss of consciousness with cardiac arrest. But, he left us way too early. Rest comfortably my friend, we will miss you.