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Sudden Cardiac Arrest claiming about 4,280 lives from every 1 lakh of population annually

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WHO census statistics mortality due to cardiac causes has overtaken mortality due to all cancers put together. 

Dr Balbir Singh, one of the leading interventional cardiologists in India, has exhorted the Indian population to beware of the dangers of Sudden Cardiac Arrests (SCA) that can lead to death of an individual within a few minutes. As per WHO census statistics mortality due to cardiac causes has overtaken mortality due to all cancers put together. Approximately 4280 out of every one lakh people die every year from SCA in India alone. 

Dr Balbir Singh, Senior Consultant, Electrophysiotherapy & Interventional Cardiology, Indraprastha Apollo Hospital, said “After a cardiac arrest there are four to six minutes before brain death and death occur. Chances of survival reduce by 7-10 percent with every passing minute. It is a silent epidemic and the Indian population should beware!” 

Sudden cardiac arrest (SCA) is a sudden, unexpected failure of heart function occurring due to fast fluttering action of the ventricles, which does not allow enough blood to be pumped out to the organs which include the brain and the heart itself. SCA is a medical emergency, which can be fatal if not treated immediately. Cardiac arrest is reversible if the victim is administered prompt and appropriate emergency care. This generally involves administration of cardiopulmonary resuscitation (CPR), shock treatment to the chest to reset the heart's rhythm (defibrillation) and advanced life support. 

SCA being the result of a disturbed rhythm pattern the only effective treatment is the delivery of an electrical shock. 

The risk factors for developing heart disease also put one at risk of suffering sudden cardiac arrest; 

* Family history of heart disease, smoking, high blood pressure, high blood cholesterol, obesity, diabetes, a sedentary lifestyle, pre existing cardiac diseases like heart rhythm disorders, congenital heart defects, congestive heart failure and cardiomyopathy. 

* Poor heart function, previous episode of cardiac arrest or heart attack, electrolyte imbalances, hyperthyroidism, pulmonary hypertension, certain medications that affect the heart function and use of illicit drugs, such as cocaine or amphetamines. 

While some drugs are used to try and suppress fast heart rates, none have been able to ward off all episodes of SCD. Automated External Defibrillators (AEDs) are devices that are used to deliver the shocks. An AED is extremely easy to use by trained laypersons, with voice-activated instructions and is critical for rapid response to a cardiac arrest. This device can save lives if made available within 4 to 7 minutes of the onset of Ventricular fibrillation. With the healthcare infrastructure and system in India being a lot behind that in the USA, such devices are not freely available in public or even most ambulances. It is also not always convenient to carry one around and connect whenever required. Thus more than 99% of Indians who experience Sustained Ventricular fibrillation face certain death. 

Last year, a 12 year old class VII student in Delhi collapsed on her school's football field and died within minutes due to cardiac arrest. Smitu Kothari, 59, one of India’s leading social and environmental activists, died of a cardiac arrest at Delhi in March 2009. Shiv Charan Mathur, Governor of Assam died of cardiac arrest in Delhi at the age of 83 in June, 2009. Kishore Sarja, a noted film director from South India died of cardiac arrest in June, 2009 at Bangalore at the age of 50. A 27-year-old pilgrim from Punjab died of cardiac arrest at the 3,880 metre high cave shrine of Amarnath a couple of weeks ago. And just a couple of weeks ago, millions of music lovers across the world were left grieving the loss of pop icon Michael Jackson, who is said to have died due to cardiac arrest induced by painkillers. 

“The tragic cases mentioned above might have been unexpected, however, the fact is sudden cardiac arrest is not uncommon. These cases are painful reminders that sudden cardiac arrest (SCA) can strike almost anyone and at any age and is a leading cause of death both in India and worldwide,” said Dr Balbir Singh. “Sudden cardiac arrest can strike men, women and children of all ages, and for many reasons. Indians are at even higher risk because of the sedentary lifestyle, food habits and growing stress levels amongst the urban population. As such, it is mandatory that we are aware of this silent epidemic and have a plan ready to counter SCA if it ever strikes someone around us.” 

An Emergency Room Inside Your Chest:
As a treatment option following a sudden cardiac arrest, once the patient’s condition stabilizes, Implantable cardioverter-defibrillator (ICD) maybe recommended. Studies have proved that people who are at high risk of SCA can be identified using certain routine diagnostic tests. An ICD (implantable Cardioverter Defibrillator) is a device that can be implanted into these patients is the only fool proof solution available today. The ICD also called “an emergency room in the chest” is a battery-powered unit that is implanted near the collarbone. One or more electrode-tipped wires run from the ICD through veins to the heart. It constantly monitors the heart rhythm. If a rhythm that is too slow is detected it paces the heart as a pacemaker would. If it detects ventricular tachycardia or ventricular fibrillation, low- or high-energy shocks are sent to reset the heart to a normal rhythm. ICDs now also collect information for the physician to use by remotely diagnosing and programming the device to the exact needs of the patient, without the need for repeat surgery or hospitalization. For patients with ICDs, the first-year recurrence rate of sudden cardiac arrest has been reduced to 1 to 2 percent. While ICDs are a recent invention (10 to 15 years globally) it is necessary to identify patients at high risk for SCA and get them ICDs to help then jump back to life whenever they encounter one. Prevention is better than Loss. 

About Dr Balbir Singh
Dr Balbir Singh is one of the leading interventional cardiologists in India today. In the field of coronary interventions, Dr Balbir Singh has performed nearly 2500 angioplasties including stenting procedures. He is one of the pioneers in the field of Radiofrequency ablation in India, a new modality for cure of arrhythmias – rapid beating of the heart, which was introduced in US and Europe in the early 1990s. Dr Balbir Singh has performed over 600 radiofrequency ablation procedures. Over the period of last 5 years, he has to his credit over 25 publications in complex coronary procedures. He is presently working on intravascular ultrasound imaging from within the coronary arteries. Dr Balbir Singh’s area of special interest is Angioplasty during acute phase of Myocardial Infraction (heart attack). 

Dr Balbir Singh started his career in interventional cardiology and electrophysiology at the prestigious All India Institute of Medical Sciences (AIIMS) as a faculty member in cardiology. Dr Singh has held a number of senior positions in various prominent hospitals including Maulana Azad Medical College, LNJP Hospital, G.B. Pant Hospital, All India Institute of Medical Sciences (AIIMS), Batra Hospital and Escorts Heart Institute & Research Centre, New Delhi. Dr Singh has many awards and accolades to his credit, which include the prestigious Padamshree, Medical Excellence Award and Recognition Award in Interventional Cardiology, Sujoy B. Roy Best Young Investigator Award for research work in interventional cardiology.

First Published: Mon, July 20 2009. 16:02 IST