Sudden Cardiac Death in young individuals

It is fair to say that our understanding of Sudden Cardiac Death in the younger age group still has many gaps in it.

Heart disease is one of the leading causes of death in older individuals. Our knowledge of this is well established.

Persons typically die as a result of coronary artery disease, where the arteries slowly narrow over time, depriving the heart muscle of sufficient blood.

Another cause of heart disease associated with advancing age is left ventricular hypertrophy (LVH). In this condition, thickening of the heart muscle means it beats less effectively and eventually stretches past the point of no return, a bit like an elastic band that has been pulled too far.

The risk factors for these conditions are often linked to lifestyle choices, although healthy individuals do suffer them too.

We are aware that a healthy diet, stopping smoking, alcohol in moderation (if at all) and regular light exercise are all good for heart health as we get older.

Yet in those individuals with sudden cardiac death before the age of 35, there typically has not been the time for the heart to be affected by these diseases associated with aging.

More concerningly, those who succumb tend to be in the prime of their lives. They may be into fitness. There is a higher risk of sudden cardiac death in the young for those who are professional athletes. Many American studies have shown that black African Americans are at higher risk.

What can be said is that it is often difficult to work out who is at risk, making the phenomenon even more scary.

Our limited knowledge of Sudden cardiac death in the young has identified that those who succumb may have the following issues with the heart. The heart muscle may be overly thickened, a condition called Hypertrophic Obstructive Cardiomyopathy (HOCM). In this case blood flow is often disorganised and the heart is less able to pump blood out of the heart. Yet many cases of HOCM are entirely benign and the individual will lead a long and healthy life.

Young persons can suffer narrowing of the coronary arteries, known as accelerated coronary artery disease.

There may be a fault with the electrical activity of the heart.

Although many of these cannot be prevented, one of the biggest risk factors for sudden cardiac death in the younger age group is recreational cocaine use.

In terms of red flags for sudden cardiac death in the young it is important to be aware of the following.

Like a car engine, when the heart is stressed during exercise, problems are likely to become more evident.

Exercise related chest pain, palpitations (where you feel your heart is racing away), shortness of breath, and passing out or feeling that you are about to pass out, are all concerning symptoms.

Any of the above should have you stopping the exercise immediately and seeing your GP as a matter of urgency.

To reassure, many of the above will have a less serious cause, but should never be ignored.

Your GP will take a history of your problem, examine your heart, and organise a set of bloods and an ECG (electrical reading of the heart).

If there is sufficient worry, you will be referred to a cardiologist (heart specialist).

If you are found to be at risk, one of the treatments is the insertion of a defibrillator which aims to restart the heart if it stops.

At the moment there is not sufficient evidence to support a screening programme in the UK. Incorrect reassurance, i.e. where the condition is missed, and false positives, i.e. where you are told you have the condition when in fact you do not, still need to be ironed out.

First degree relatives of those who die of sudden cardiac death are likely to get an ECG and echocardiogram (jelly scan of the heart), but often no more at the present unless these show abnormalities.

Despite the above, it is important to realise that most of us will have healthy hearts, and looking after these through gentle exercise, healthy lifestyle choices, and indeed reducing stress, will hopefully allow us to lead long happy lives.

“Our understanding of Sudden Cardiac Death in the younger age group still has many gaps in it.”

“One of the biggest risk factors for sudden cardiac death in the younger age group is recreational cocaine use.”

“Exercise related chest pain, palpitations (where you feel your heart is racing away), shortness of breath, and passing out or feeling that you are about to pass out, are all concerning symptoms.”

Useful Websites

https://www.c-r-y.org.uk/sudden-cardiac-death/

https://www.bhf.org.uk/

https://firstaidforlife.org.uk/cardiac-arrest/

Dr. Zakariya Waqar-Uddin, General Practitioner