Sudden cardiac death strikes women too - HealthLINK (Women)

Prevention the key in war against sudden cardiac death

Sudden cardiac death—the sudden, abrupt loss of heart function—is an unpredictable condition that appears instantly and unexpectedly. Also known as sudden cardiac arrest, it's one of the leading causes of death among American adults. About three-quarters of these deaths are caused by arrhythmias—abnormal heart rhythms—including ventricular fibrillation or tachycardia.

“Sudden cardiac arrest [is] one of the leading causes of death among American adults.”

The symptoms are immediate. During an SCD event, the victim first loses his or her pulse, then becomes unconscious and finally stops breathing. Without immediate intervention, death follows.

Treating sudden cardiac arrest
Few people, only about 10 percent, survive SCD. Immediate emergency treatment with CPR and an external defibrillator can return the heart to its normal rhythm. The more quickly a normal rhythm is restored, the better the victim's chance of full recovery.

A recent New England Journal of Medicine study found that 40 percent of those who were treated quickly at the scene with defibrillators were released from the hospital in good condition. If you ever witness someone collapse suddenly and lose consciousness, call 9-1-1 at once. If you know how to perform CPR and no pulse is detectable, begin immediately after making that emergency call.

“If you ever witness someone collapse suddenly and lose consciousness, call 9-1-1 at once.”

Causes
When we talk with people who have survived an incident of cardiac arrest, we try to determine if they have symptoms that precipitated the event. Sometimes, individuals describe palpitations, sudden breathlessness or chest pain, but very often victims are not able to remember much of what happened just before their collapse. We often rely on what onlookers are able to report. Most often an arrhythmia is the primary cause of SCD, but heart attacks may also precipitate abnormal heart rhythms and result in SCD.

Good primary care: the best prevention
The Nurses' Study data underscore the importance of good primary care for everyone, but especially women. A large percentage of the women who experienced cardiac arrest in this study had no documented history of heart disease, no heart attacks, no chest pain to warn them that they could be at risk. What they did have in overwhelming numbers were risk factors—modifiable risk factors that can be controlled to some degree with changes in lifestyle.

“Stop smoking. Visit your doctor at least once a year so that you are aware if you have high blood pressure, diabetes or high cholesterol.”

Smoking was by far the most dangerous risk factor. Moderate to heavy smokers were four times as likely to have cardiac arrest. High blood pressure, diabetes, obesity—all were significant risk factors. The messages we can take from this are clear. Stop smoking. Visit your doctor at least once a year so that you are aware if you have high blood pressure, diabetes or high cholesterol. If you do, find out what medications and/or changes in diet and exercise might help you reduce those risk factors.

Know the symptoms: if you are experiencing unusual breathlessness; heart palpitations; chest or arm pain or pressure, don't procrastinate. Seek medical attention to find out the cause of these symptoms.

The female factor
We do know that once women are diagnosed with heart disease, they do less well than men. We don't know exactly why this is the case, but there are several factors, which could play a significant role. Women are smaller and, consequently, have smaller vessels that are more difficult to work with. Also, since women are usually older at the onset of heart disease and time of treatment, they may have more advanced disease or more associated medical problems.

Major studies also reveal that women may not be diagnosed or treated as aggressively as men. Women may also procrastinate. Rather than going to the doctor, they may decide they just need more rest or a healthier diet.

More diverse disease
Another reason women may do less well is that younger women present with more diverse kinds of heart disease that may include congenital abnormalities, Long Q-T syndrome, hypertrophic cardiomyopathy, nonischemic cardiomyopathy and many others. Our treatments for some of these conditions may be less effective or different than for the more common conditions men are more likely to experience such as clogged coronary arteries.

Talk to your doctor
If you have heart disease, talk to your doctor about what tests might be appropriate to further determine your risk for a cardiac event. If you've had a heart attack and your heart's pumping ability is impaired, you might be a candidate for an implantable cardioverter defibrillator (ICD). Recent studies indicate some patients significantly reduce their risk of SCD by having an ICD implanted.

You might want to ask your physician if you should be monitored to determine if you're experiencing any irregular heartbeats. If you are, further studies of your heart rhythm, known as electrophysiology studies, might be appropriate.

Heart disease kills more women than any other disease. Find out if you have risk factors, learn the symptoms of heart disease, be vigilant and proactive about your health.

Dr. Rosenfeld is an attending cardiologist at Yale-New Haven Hospital and associate professor of medicine and pediatrics at the Yale University School of Medicine.

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