Oct
07
2023

Sudden Cardiac Death in Athletes

By | heart attack, Mortality

This article is about sudden cardiac death in athletes. Dr. Robert A. Harrington and Dr. Manesh Patel reported from the European Society of Cardiology 2023 Congress in Amsterdam. Notably, this congress took place from August 25-28, 2023 with 30,000 participants.  Another key point is that one of the important topics was sudden cardiac death in athletes. In general, you normally assume that athletes are healthy, and their hearts would support their peak athletic activities. It is important to realize as Drs. Harrington and Patel reported that under certain circumstances athletes can suddenly die.

Bronny James, a high school basketball player was rescued from a cardiac arrest as this article shows.  Apparently, he has a congenital heart condition, which makes him more vulnerable to get an irregular heartbeat. It must be remembered that his can cause his heart to stop beating. Fortunately, he was revived at the Mount Sinai Hospital in New York. To clarify, there are a number of non-invasive procedures that interventional cardiologists use to correct abnormalities in a heart. Specifically, following such procedures the person’s heart is more stable.

Ventricular fibrillation

To explain, irregular heartbeats leading to ventricular fibrillation is one cause of death in athletes. Another key point, often there can be other underlying conditions that lead to this. Examples are a long QT interval on an ECG, a big thick heart (medical term: hypertrophic cardiomyopathy), and dilated aortas in tall people.

Success stories of reviving people and athletes with sudden cardiac death

In other words, over the years two methods showed success in rescuing athletes with sudden cardiac deaths. The first is CPR (cardiopulmonary resuscitation).   This keeps the blood flowing and delivers oxygen to the lung capillaries. Next the emergency medical team is called in who provide an automated external defibrillator to the chest. This can revive up to 100% cases of athletes with sudden cardiac deaths. The key is to do CPR right away and to have the emergency medical team use the automated external defibrillator (AED) right away.

Screening methods to prevent sudden cardiac death in athletes

With this in mind, the medical profession has started to do preventative tests of athletes. First, Italy is one of the countries that has persistently done standard screening. Physicians order ECG’s and echocardiograms. They can readily diagnose hypertrophic cardiomyopathy with these tests. Second, a new stethoscope can get sounds and some ECG signals at the same time. This helps to diagnose several abnormal cardiac conditions.

Third, another point is that there have to be enough people around a sports event who have experience in performing CPR (cardiopulmonary resuscitation). Certainly, the sooner you start CPR, the more successful is the outcome with respect to a full recovery. Next medical personnel with the AED equipment are necessary to bring the heart rhythm back to a sinus rhythm. When the patient’s heart beats normally again, the patient needs transportation to the nearest hospital for further monitoring and stabilization.

Commotio cordis

When there is a lower chest impact from a hockey puck, baseball or lacrosse ball the heart can suddenly come to a standstill. Physicians call this commotio cordis. These athletes need immediate CPR to keep them alive followed by timely administration of an automated external defibrillator. Often the heart beats normally after this. If immediate medical help is not available, these young athletes die and it becomes an upsetting newspaper story.

Sudden Cardiac Death in Athletes

Sudden Cardiac Death in Athletes

Conclusion

Dr. Harrington interviewed Dr. Manesh Patel, a cardiologist from Duke University regarding sudden cardiac death in athletes. A thump to the chest from a hockey puck or a baseball can cause the heart to stop beating. In order to save this athlete from dying bystanders have to start CPR right away. This helps to continue blood circulation and brings oxygen into the tissues. Next medical personnel apply electrode pads from an automated external defibrillator (AED) to the chest wall. One or two electric shocks are administered. This often revives the heart or converts irregular heart contractions to the normal sinus beats, and the athlete recovers. The emergency medical team transports the patient to the nearest hospital for observation and further treatments. CPR and AED in combination can save up to 100% of cases that would otherwise turn into sudden cardiac deaths.

Apr
22
2017

Only Moderate Alcohol Consumption Benefits Your Heart

By | alcohol, Cancer, Cardiovascular disease, heart attack, Heart Disease, Stroke

A new study from England finds that only moderate alcohol consumption benefits your heart. The study appeared on March 22, 2017 in Great Britain. 1.937 million people (51% women, 49% men) had participated in this investigation over 6 years. The lead author, Dr. Steven Bell is a genetic epidemiologist. He said that the purpose of this study was to clear up some of the confusion from previous studies. He wondered why the control group without alcohol exposure had more cardiac problems than the moderate group. It did make sense though, that the high alcohol group had worse cardiac problems.

But he and researchers from Cambridge University and University College London did this study to get more detail. They were curious why the current non-drinking group serving as a control did not undergo more scrutiny. It consisted of a mix of lifelong abstainers; people who drank formerly, but then gave it up. And the other group was those who drink on an occasional basis.

With this in mind the researchers designed their study. They also used larger numbers to increase the reliability of the study.

Details of English study

The data comes from the Clinical Practice Research Datalink providing anonymous patient records from general practices in England. The patients upon entry into the study had to be older than 30 years, but have no evidence of cardiovascular disease. A total of 1,937,360 patients qualified to be part of the study.

Based on patients’ records and patients recollections people, researchers looked at 5 classes of drinkers:

  • Non-drinkers (14.3%)
  • Former or ex-drinkers (stopped drinking at one point, 3.7%)
  • Occasional drinkers (drinking rarely, 11.9%)
  • Moderate drinkers (drinking within sensible limits, 61.7%)
  • Heavy drinkers (hazardous alcohol use, 8.4%)

Various cardiovascular diseases apart from heart attacks

The end point of the study researchers concentrated on the frequency of cardiovascular diseases like angina, heart attack, sudden cardiac death, stroke, peripheral arterial disease, abdominal aortic aneurysm and others. I only listed 6 of the 12 cardiovascular diagnoses as otherwise it would get too technical.

More information: Most study participants were non-smokers, their BMI was within normal limits, and they also did not have diabetes.

Findings of the study

There were significant differences among subclasses of alcohol consumption and the development of cardiovascular diseases over 6 years.

U-type dose response curve

The findings were in line with a number of previous similar studies that showed a U-type dose response curve between developing cardiovascular diseases and alcohol consumption. The group of non-drinkers (without former and occasional drinkers ) often had a 20% to 56% higher risk of developing cardiovascular disease, while moderate drinkers had no added risk.

Sudden cardiac deaths

On the other hand the heavy drinkers were at risk of developing cardiac arrest (50% increased risk) or heart failure (22% increased risk). A death from a sudden heart attack occurred in heavy drinkers with a 21% increased risk. A former drinker had a 40% increased risk for this, but a non-drinker a risk of 56% increased risk!

Smaller amounts of alcohol help to clean out arteries

A non-drinker had a 32% increased risk of getting a regular heart attack, a former drinker had a 31% increased risk, an occasional drinker 14%, a moderate drinker no added risk, and a heavy drinker had a 12% reduced risk! This seemed to show that drinking alcohol keeps the coronary arteries open and clean. I have had pathology demonstrations with Professor Dr. Adalbert Bohle at Tübingen University during my medical training in 1969. At that time he pointed out how clear and wide open the coronary arteries were in chronic alcoholics. It was not heart disease that killed those patients; they had died from end stage liver cirrhosis, and we saw pathological slides of that.

Strokes in heavy drinkers

Heavy drinkers get more ischemic strokes (33% risk increase) and more intracerebral hemorrhages (37% risk increase).

Lower leg arterial obstruction

Obstruction of blood vessels in the lower legs (peripheral arterial disease) is common with heavy drinkers (35% risk increase) and even former drinkers (32% risk increase). Non-drinkers have a 22% increased risk while moderate drinkers have a 0% risk (no increased risk).

Aortic aneurysms

There was no association between heavy drinking and aortic aneurysm. On the other hand, non-drinkers (32% increased risk) and former drinkers (23% increased risk) showed an increased risk of aortic aneurysm formation.

Other effects of alcohol consumption

The study above did not take into consideration that alcohol consumption has many other consequences beside cardiovascular effects. One for instance is the effect on the brain and the increase of serious car accidents. Another effect is the causation of cancer.

The American Cancer Society clearly states that alcohol consumption has been causatively associated with cancers in the following locations:

  • Mouth
  • Pharynx (throat)
  • Larynx (voice box)
  • Esophagus
  • Liver
  • Breast
  • Colon
  • Pancreas

The conundrum of alcohol benefit for heart attacks versus alcohol cause of cancer

Many studies have shown a dose-response curve between alcohol consumed and the development of these cancers. In other words there is never a safe low dose, below which no cancer risk would occur over time.

These authors conducted a metaanalysis of 16 prospective cohort studies including 6,300 patients. It showed that alcohol caused cancer of the colon and rectum. High intake of alcohol showed a 50% increased risk of causing colon cancer. With regard to rectal cancer the risk was 63% higher. In both cases the highest alcohol intake was compared to the lowest category of alcohol intake.

More on cancer risk from alcohol consumption

These authors concluded their discussion by pointing out that 6% of the worldwide cancer deaths are attributed to alcohol intake. They also stated that colorectal cancer risk increased by 50% in the heaviest alcohol users. Among the group of heavy drinkers the cancer death rate would likely be 9%. There would a reduction of mortality from cardiovascular disease by one third in middle and old age. The end result would be 6% mortality again; essentially there is no change.

No matter how you try to solve this equation, there is a risk of cancer deaths from exposure to alcohol. There is also a risk that heavy drinking can cause significant cardiovascular diseases mentioned.

Only moderate alcohol consumption benefits your heart

Only moderate alcohol consumption benefits your heart

Conclusion

Everything we do in life has consequences. With regard to drinking you know that accidents are more common in drinkers; with prolonged exposure to higher alcohol consumption you can get dementia. Moderate amounts appear to have significant protection from heart disease, but the risk for several cancers is not negligible. This point was not mentioned in the study I discussed in the beginning of my blog. In the latter part I included some data about cancer risks from alcohol consumption.

Heart attack prevention with small amounts of alcohol

The paradox remains that non-consumption of alcohol is associated with a significant cardiovascular risk because of a U-shape dose response curve. Moderate alcohol use is associated with the lowest cardiovascular risk. The question is whether we can balance moderate drinking with staying in the low cancer risk area. The recommendation of 1 glass of wine for women and 2 glasses of wine for men has been confirmed by the above study. This is considered a healthy preventative dose with respect to cardiovascular risk. It is the official recommendation for cardiovascular disease prevention. The cancer literature clearly states that there is a small cancer risk from moderate alcohol intake. This is particularly true for the 8 cancers discussed. The last word may not have been spoken yet about reduction of cardiovascular risk.

You can prevent heart attacks without the use of alcohol

Dr James Nicholls, the director of research and policy development at Alcohol Research UK had this to say. He pointed to the fact that there are other ways to prevent cardiovascular disease. For those who do not drink at present it would not make sense to take up drinking. You can strengthen your heart by starting a Mediterranean diet and starting to exercise regularly. The beneficial substance for your heart in red wine is resveratrol. Taken it as a supplement. Resveratrol has no side effects and does not have the cancer risk like an alcoholic drink does. Dr. Nicholls added, “If you drink within the existing guidelines it is unlikely that alcohol will either lengthen or shorten your life.” It is really up to every individual to balance the wine glass with personal health!

Dec
01
2003

Bystanders Become Lifesavers: Immediate CPR Improves Survival

By | Health, Heart Disease

Cardio-pulmonary resuscitation (=CPR) is known to save lives, but it has been known for some time that it has to be applied as early as possible to save lives on the longterm. In a recent study in Ottawa/Ont., which was published recently in the medical journal Circulation, the OPALS study checked out survival data.

OPALS is an acronym for Ontario Prehospital Advanced Life Support Study. One of the lead authors, Dr. Ian Stiell, emphasized that CPR done by bystanders (such as immediate family members) right in the beginning of a cardiac arrest will double the probability of having a survivor with quality of life that is very good.

Here are some detailed figures from that study. Only 14% to 15% of patients who suddenly collapse and are in need of CPR actually receive CPR. There were 8,091 cases of cardiac arrest that occurred between 1995 and 2000 in Ontario. Only 5.2% (418 patients) survived until the time of discharge from the hospital. 4% (324 patients) survived until the timeline of 1 year after the event. Of these the researchers were able to interview 268 survivors.

Bystanders Become Lifesavers. Immediate CPR Improves Survival

CPR saves lives

The following are a few observations from the OPALS study:

1. 85% of cardiac arrests happen at home.

2. 43% of cases are witnessed by bystanders, so if they all would know CPR about 3-times more unconscious patients could receive CPR (14% to 15% times 3 equals about 43%).

3. 65% of cardiac arrests in the OPALS study occurred in men. The authors recommended that women over 40 should get trained in CPR.

4. Women usually play a more pivotal role in taking care of elderly parents, of their spouse and of children, which puts them more likely into a situation where bystander CPR is required.

5. Family members of heart attack survivors should be encouraged to take a CPR course as the probability of a cardiac arrest is higher in these patients.

6. All 4 links to successful resuscitation are important: CPR by a bystander; defibrillation; rapid access to care; early advanced cardiac life support.

7. Contrary to rumors the long term outlook of successfully resuscitated patients is good and after 1 year the survivors have a quality of life as good as their healthy peers. However, without CPR initially the quality of life is only half as good as those who had someone provide CPR on them. The authors found it difficult to dispel some of the misconception surrounding CPR. Some of the myths are the notions that a person could do some harm by administering CPR or not performing CPR it correctly. They said it is important to be decisive and administer CPR to an unconscious person and call for an ambulance.

Summary: The OPALS study re-emphasized the importance for everybody to learn CPR. You never know when you need this skill. The more people know it, the more lives will be saved.

Here is a link to the University School of Medicine site entitled “Learn CPR – you can do it!”

Last edited December 8, 2012