World Heart Day

Dr. Bhavesh Wajifdar, MD, DNB, MNAMS, FACC, FSCAI, FSCI, FESC, Consultant & Interventional Cardiologist, in conversation with Kavi Bhandari, BW Businessworld.

1. What is difference between Sudden Cardiac Arrest (SCA) and Heart Attack?

There are several misconceptions among people that Sudden Cardiac Arrest (SCA) and a Heart Attack are one and the same thing. However, a heart attack (myocardial infarction) occurs when the blood supply to a part of the heart muscle is stopped due to a blockage in the coronary artery. A heart attack usually causes chest pain and/or breathlessness. The heart muscle becomes weak and the heart pumping reduces. The heart does not stop beating and the blood circulation is maintained.

When the heart stops beating, suddenly and unexpectedly, it is called ‘Sudden Cardiac Arrest’. SCA is a fatal condition. The most common cause of SCA is a very severe heart attack.

2. What are the consequences of suffering SCAs?

In cases of SCA, since the heart stops beating, there is no blood circulation in the body. Due to that, the patient usually loses consciousness within three to four seconds. In such situations, if the brain does not receive fresh blood for even two minutes, it starts getting irreversibly damaged. SCA can be fatal for patients if their heart is not restarted in a few minutes.

3. Is there any specific demographic that is particularly affected by SCA? What are some of the steps that they can take to prevent SCAs?

Sudden Cardiac Arrests usually affect people who are old and those who already have pre-existing heart conditions. However, it can also occur rarely in young and apparently healthy individuals - especially in those having risk factors like diabetes, hypertension, high cholesterol, and smoking, family history of heart disease.

The best way to prevent SCA is to take good care of your heart. If you already have pre-existing heart conditions, you should go for regular medical check-ups and take treatment as per your doctor’s advice. If you have risk factors then please get yourself evaluated by a cardiologist, for a possible underlying silent heart disease.

And even if you are a healthy young person, go for a basic health check-up; at-least once in five years to check your weight, BP, blood sugar and cholesterol. Keep yourself fit, by doing regular aerobic exercise, in the form of walking, jogging, cycling, swimming or playing sports. The exercise level should be tailored individually as per your age and physical fitness.

4. What kind of immediate measures can be taken by the general public while witnessing someone who is having an SCA episode?

In critical situations, every moment is precious and medical help needs to be provided with top-most priority. Otherwise, the situation can be fatal. When you witness someone fainting, the first step is to make the patient lie down flat on the floor. Do not try to make him/her sit-up or stand.

It could either be a simple fainting or a fatal SCA. Fainting or ‘transient loss of conscious’ usually occurs when the blood pressure is low. The heart continues to beat. The victim regains conscious spontaneously, within seconds. Common causes of fainting include – severe emotional stress, severe physical exertion, severe pain, loss of fluid volume (as in diarrhoea or acute bleeding), cerebral stroke, irregular heart-beat or epileptic fit. A person who has a simple fainting episode will usually regain conscious within 20 to 30 seconds.

If the victim remains motionless for more than 40 – 50 seconds, it is likely to be an SCA. First, shout for help from the people around. If alone, make a phone call to emergency services. Make sure the victim is lying flat on a hard surface. Give a firm tap on his shoulder and call out loudly, to make sure he is responsive or not. If there is no response, check his pulse. If you are unable to find his pulse, immediately begin resuscitation by means of Chest Compression. As illustrated in the figure, give chest compression, by firmly pressing on the mid to lower part of the sternum, at a rate of about 100/minute. The sternum should be compressed about 5 to 6 cm.

If the victim does not regain consciousness within two to three minutes, their heart will have to be restarted with an electric shock (defibrillation) using an Automated External Defibrillator (AED).

An AED is very simple life saving device. It is small, lightweight and easy to use. It has two electrodes (pads like stickers – shown in picture) which need to be connected to patient’s chest. The AED automatically analyses the cardiac condition of the patient and gives ‘step by step voice command instructions. Even a non-medical person can deliver a shock to restart the heart.

In SCA, to save the life of the victim, please follow the chain of events as per this diagram.

Sudden Cardiac Arrest chain of survival

5. Do you think that there has been an increase or decrease in the number of cardiovascular diseases in India during the COVID-19 pandemic?

During the pandemic, most people have stopped their walking and exercise. Several people are also experiencing a lot of anxiety and stress. People are not going for regular check-ups to doctors. Even patients who have symptoms avoid going to hospitals, for fear of COVID exposure. As a result, we are seeing patients coming to hospitals only after their health becomes very critical, and at times they lose their life due to this delay. Though there is no documented evidence, I am sure that the incidence of mortality and morbidity due to heart problems will increase during this long and severe pandemic.

6. Automated External Defibrillators are portable machines that can be used to restart the heart of someone who has suffered a SCA. Are these devices readily available and easy to use?

In a SCA, an AED can save the life of the victim. Without CPR, the survival from SCA is only about 1%. If chest compression is given by a bystander, the chance of survival improves to about 10 – 15%. If an AED is available and used in time, then the chances of survival increase to 25 – 30%.

Ideally, AEDs should be available at every public access area. In the developed countries, AEDs are usually kept at airports, hotels, railway stations, malls, sports complexes, etc. In India, AEDs are now slowly being made available at airports, railway stations and 5-Star hotels. An AED is not expensive. It can be easily purchased and kept in office complexes and residential societies.