Thread by @epigiri

Sudden cardiac arrest & Sudden cardiac death (SCD) refer to the sudden cessation of cardiac activity with hemodynamic collapse, typically due to sustained ventricular tachycardia/ventricular fibrillation; mostly occur in patients with previously undiagnosed diseaes.
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Results from Framingham heart study suggests that more men are affected with increasing age.
Not rare, 15 percent of the total mortality in the United States & other developed nations is due to SCD. (pubmed.ncbi.nlm.nih.gov/11684624/)

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-It is the initial clinical manifestation of 15% of coronary heart diseases (CHD).
-SCD is the mechanism of death in over 60% of patients with known CHD.
-Risk increases by a number of factors: Age, underlying cardiac diseases, post-menopausal women, CHD risk factors
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The risk increases
-6- to 10 fold with heart disease
-2- to 4 fold with risk factors modifiable by specific preventive measures.

To reduce the risk of death,
- regular health checkups for heart disease
- Adopt better and healthy lifestyle (next)

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2/3rd of CHD is from tobacco, unhealthy diet & physical inactivity
9 risk factors
1. Smoking
2. Dyslipidemia
3. Hypertension
4. Diabetes
5. Abdominal obesity
6. Psychosocial factors
7. Diet
8. Regular alcohol consumption
9. Physical inactivity
sciencedirect.com/science/articl…
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Exercise —
-Regular exercise is associated with a lower resting heart rate and increased heart rate variability and reduced risk of SCD.
-The small transient increase in risk during exercise is outweighed by a reduction in the risk of SCA at other times.
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Risk of sudden cardia arrest (SCA) is transiently increased during and up to 30 minutes after strenuous exercise compared to other times. The actual risk during any one episode of vigorous exercise is very low (1 per 1.51 million episodes of exercise) .
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Do not stigmatize exercises and physical activity. -Magnitude of the transient increase in risk during acute exercise is lower among men who are regular exercisers compared with men for whom exercise is unusual.
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The lower overall risk associated with intensive exercise occurs in patients with certain, often unrecognized underlying heart diseases. (Hypertrophic cardiomyopathy, myocarditis & Arrhythmogenic right ventricular cardiomyopathy) Let the cardiologists decide and treat
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At the population level, there are two approaches to reduce the risk of SCA.
- Reduce SCA risk in every person: smoking cessation & other lifestyle modifications.
-Screening & risk stratification to identify individuals who may benefit from clinical treatment.

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There is strong advocacy, communication and services available for screening and risk stratification in persons who can afford or have health insurance. Since cardiac surgeries are covered under PMJAY an state health programs, there are efforts to utilize by hospitals.
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It is time primordial, primary & secondary prevention of heart diseases and related deaths take the centre stage of health services.
-Primoridial to is to get rid of risk factors.
-Primary prevention involves preventing the onset of disease in those who have risk factors.
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Secondary is to ensure people with diseases get adequate and timely treatment to prevent deaths or complications.
- 1 in 3 adults have high blood pressure
- 1 in 10 adults have T2 diabetes mellitus.
Nearly 50% of them are not diagnosed & present with complications/death.
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To help yourself and others, assess risk factors, seek or provide help. For example, inform those who use: smoking even 1 cigarette per day is associated with approximately 50% increased risk for CHD and approximately 25% increased risk for stroke.
pubmed.ncbi.nlm.nih.gov/29367388/
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On whom to screen?
Advanced obstructive coronary heart disease (CHD) can exist with minimal or no symptoms, with manifestations that can progress suddenly, often associated with significant morbidity and/or mortality.
Should everyone get screened? see next
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Screening with additional tests is appropriate for persons in certain high-risk occupations (eg, pilots, bus drivers) where an acute cardiac event could endanger large numbers of people, or for individuals with higher risk of CHD or those starting intensive exercises.
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Rationale for screening & detection of CHD during subclinical stages of disease is hope that appropriate treatment (medical or coronary revascularization) may improve prognosis. However, limited evidence that such screening actually improves outcomes at population level.
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Screening and taking actions are recommended to prevent sudden cardiac death in athletes and those who engage in strenuos, high intensity exercise schedule. It
Refert to Recommendations and Considerations here: ahajournals.org/doi/full/10.11…

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Screening should include a complete personal, family history, physical examination in all athletes of any age. Performing a screening ECG in athletes and exercise stress test in athletes age 35 years or older is recommended and should be repeated at periodic intervals.
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For all those who are concerned about sudden cardiac deaths, please refer to #uptodate for evidence based recommendations.

uptodate.com/contents/scree…

uptodate.com/contents/overv…

Do not heed to any uninformed advice on social media. Stop #misinformation.

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