Tuesday, March 15, 2011
The difference between being awake or not can be just a single heartbeat away or a fleck of clotted blood or even a stray bit of electrical current. It takes almost nothing to change the life of a seemingly healthy person and remind people bow fragile life can be. The news this week is filled this week with the tragedy that is sudden death. Rick Martin, 59 years old, and former hockey star as part of the Buffalo Sabres French Connection, slumped over while driving his car and was found dead when it crashed into a building. Robert Garza, 16, collapsed at a high school basketball game in Austin, Texas. Matthew Hammerdorfer, 17, died playing rugby in Denver. Sara Landauer,, also 17, died at a track practice in Florida and Wes Leonard was 16 when he died after making the winning basket for his Michigan high school team.
The heart is a two stage electrical pump that gathers blood from the body, pushes through the lungs to load it with oxygen and then pumps it back to the body to nourish the cells that make up all the organs of the body. For whatever reason, if the electrical supply to the ventricles, the lower pumping chamber of the heart, short circuits, the heart stops beating and sudden death occurs. The electrical system failure can be due to a variety of reasons whether it is due to abnormal heart muscle development called cardiomyopathy, or atherosclerotic heart disease that decreases blood supply to the heart muscle. Drugs can make it irritable and so can abnormal electrolyte levels in the body. The heart can stop because of a blow to the heart, like when a kid gets hit with a baseball in the chest, and sudden death can happen just because, with no cause at all.
There can be warning signs. Patients can have a syncopal or passing out spell that might be due to an abnormal or irregular heartbeat, and though there are many other reasons for a patient to lose consciousness, there are two important things that need to happen to appreciate the potential danger. First the patient needs to recognize that being unconscious is not normal and second, the doctor needs to be able to explain why the patient passed out before giving the all clear.
Sometimes, the answer is pretty easy. People pass out at the sight of blood. Medical students pass out watching their first operation and the elderly can pass out when they strain to have a bowel movement in the bathroom. These are examples of vasovagal episodes where blood vessels dilate and the heart rate slows momentarily because the vagus neve is overstimulated. Blood rushes away from the brain for a moment or two, the patient may get sweaty, lightheaded or pass out. While the mechanism can be explained, damage can occur because people who pass out tend to fall and hurt themselves.
Sometimes significant time, effort and testing may be needed to find the answer and that answer can be elusive. Patients can wear heart monitors for months to find that one time when an abnormal heartbeat or electrical impulse can give a clue that the passing out is no big deal or perhaps life threatening. Patients can become frustrated because medicine is not always like ER or House on television, where medical answers are revealed within just minutes.
In many cases, sudden death has no warning. A person collapses playing ball or driving a car or shopping. Bystanders start CPR and find an AED (automatic external defibrillator) since the best way of fixing an electrical short circuit is by using electricity to shock the heart back into a normal rhythm. Television also gets this part wrong. Most people with sudden death cannot have their heart restarted and waken to live a normal life.
Knowing what to do and actually doing it gives the victim the best opportunity to survive. Statistics only apply to large groups of people, but don’t matter for that one patient in front of you. Either the heart will restart or it won’t. And just like the lottery, you can’t win if you don’t buy s ticket. You never know when you can cheat death.