How not to die suddenly

In most cases, death is the expected conclusion to a difficult illness. Sometimes, though, it comes unpredictably and swiftly. Doctors define sudden death as an abrupt, unexpected natural death that ends life less than an hour after final symptoms first develop in a person who does not have a condition that seems rapidly fatal.

In the United States, about 460,000 sudden deaths occur each year. About 90 percent are due to coronary artery disease and 75 percent of the victims are men. Today, doctors can actually rescue people from sudden cardiac death, often permitting years of productive life.

Prevention

A healthy lifestyle is the key to a healthy heart. That’s doubly true of preventing sudden cardiac death, but there are a few twists that may surprise you.

• Exercise. The impact of exercise may be one of those surprises. Exercise is good for your heart; it improves cholesterol levels, lowers blood pressure and blood sugar, reduces body fat, and fights stress and depression. But Harvard’s Physicians’ Health Study of 21,481 men demonstrated that when it comes to sudden cardiac death, exercise can be a double-edged sword. First, the scary news: The risk of sudden death was about 17 times higher during and up to 30 minutes after a bout of vigorous exercise than during a similar time span with little or no exercise. Now, the good news: Exercise-induced sudden death was rare, occurring only once per every 1.51 million exercise sessions. In addition, people who work out regularly are 85 percent less likely to die during exercise than those who exert themselves without first getting into shape. Similarly, research from Seattle suggests that people who exercise have a 60 percent lower risk of sudden cardiac death than sedentary people, even including the temporary rise in risk that occurs during exercise. And another Seattle study tells us that even modest exercise, such as gardening and walking, can cut the risk of sudden death by up to 73 percent. The moral: Get in shape gradually and exercise with care – but exercise regularly.

• Diet. If exercise is a pillar of prevention, diet is its twin. A proper diet is the best way to reduce your overall risk of coronary artery disease, but two specific items may help prevent sudden death.

The first and better established is fish. In 1998, the Physicians’ Health Study reported that people who eat fish at least once a week are 52 percent less likely to suffer sudden cardiac death than those who eat fish less than once a month, even after other risk factors are considered. And in 2002, the study reported why fish seems so helpful: People with the highest blood levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the omega-3 fatty acids from fish, were 72 percent less likely to be sudden death victims than those with the lowest levels.

Experiments from Harvard demonstrate that EPA and DHA can reduce the occurrence of ventricular fibrillation, the rapidly lethal disorder of the heart’s pumping rhythm that is the leading cause of sudden cardiac death. These animal studies fit nicely with the observation that people who eat fish are protected from sudden death, but can fish oil supplements also help? To learn the answer, scientists in Italy administered fish oil, vitamin E, or placebo to 11,323 volunteers. Disappointingly, vitamin E had no effect. But fish oil, in the low dose of 1 gram a day, reduced the risk of sudden death by 53 percent. Because the effect was rapid, occurring within four months of treatment, it is likely that the fish oil worked by reducing serious arrhythmias.

It may sound nutty, but researchers also identified a second food that may help. Over a one-year observation period, people who ate nuts two or three times a week enjoyed a 47 percent lower risk of sudden cardiac death than those who eschewed nuts. Without specifically evaluating sudden death, other research also indicates that nuts are good for the heart.

If fish and nuts reduce the risk of sudden death, are there any foods that increase the hazard? Trans fatty acids, the partially hydrogenated vegetable oils found in stick margarine, snack foods, and many commercially baked goods have harmful effects on blood cholesterol levels. They raise LDL ("bad") cholesterol and lower HDL ("good") cholesterol levels. And a new study has linked high blood levels of trans fatty acids to a 30 percent increase in the risk of sudden death.

Don’t fry your fish or nuts in stick margarine or butter. Better still, don’t fry them at all.

• Alcohol. Like exercise, alcohol is a double-edged sword. For exercise, a little is good, but more is better; for alcohol, a little is good, but more is harmful. Although some people get abnormal heart rhythms from just a drink or two (the "holiday heart" syndrome), low doses of alcohol appear to reduce the risk of sudden cardiac death for most people. In the Physicians’ Health Study, for example, people who averaged two to six drinks a week had a lower risk for sudden death than nondrinkers – but those who averaged more than two drinks a day had a higher risk.

Treatment

Most people who watch prime-time TV have witnessed the drama and tension of a cardiac arrest. When it occurs in a hospital, a code call team assembles instantly, so resuscitation can begin in minutes. The effort includes supporting the patient’s breathing (usually through a tube passed into the throat), administering medication (usually through intravenous tube), and supporting the patient’s circulation by compressing his chest to pump blood from the heart to the rest of his body. In most cases, though, success depends on external defibrillation: delivering a shock to the patient’s heart through paddles held on his chest.

A successful resuscitation requires teamwork and, above all, speed. Without cardiopulmonary resuscitation (CPR), brain damage will start to develop within four minutes, and death will occur a few minutes later. Even in a hospital, every minute that passes reduces the chances of success by 10 percent.

Cardiac arrest in a hospital is a critical event; even under the best of circumstances, fewer than half the victims survive long enough to leave the hospital, and many of the survivors have neurological impairments that may be severe. A cardiac arrest outside a hospital is a lethal event unless it is witnessed by another person who knows what to do.

The first thing to do is to call for help. If you encounter someone who has collapsed, try to rouse him with a quick shake and shout. While you’re waiting for help to arrive, you’ll need to initiate basic life support, CPR (see illustration). The process is as simple as A, B, C: A for being sure that Airway is open, B for mouth-to-mouth Breathing, and C for chest Compression to maintain the circulation. It may sound simple, but it takes instruction, thought, and practice to do it right under pressure. Take one of the many CPR courses sponsored by the Philippine National Red Cross. Anyone who lives with a cardiac patient should know what to do in a dire emergency, and learning the ropes is a good idea for other citizens, too.

Heartening Prospects

All good things come to an end, including one of the most precious things of all, life itself. But although death cannot be avoided, it can be delayed. To reduce your risk of sudden death, follow habits that will keep your heart healthy. Work with your doctor to learn your risk factors, then do whatever it takes to reduce them.

You can also help rescue people who suffer cardiac arrest when you are nearby. Learn about CPR and basic life support. It’s the best way to extend the chain of help to people you love and to other members of the community.

Death is inevitable, but one form, sudden cardiac death, can actually be prevented and – it’s true – treated. You don’t have to die so suddenly!