sudden death

Monday, December 4, 2017

Citius, Altius, Fortius. Nowhere in the Olympic motto does it say higher, faster, stronger, suddenly die. And for that reason, when an athlete collapses on the court, our ability to understand the body is more than a little strained. For the basketball fans watching North Carolina State hosting South Carolina State, the collapse of Tyvoris Solomon was more than unexpected, it was not understandable. There is a happy ending because of the quick actions of the South Carolina medical staff and with CPR, Mr. Solomon was resuscitated, resting in hospital and able to talk about he cheated sudden death. Actually, he doesn’t remember…he remembers sitting on the bench and then nothing until he awoke in the ambulance. Other elite athletes have been less fortunate and have died on the court. Regardless of the success rate in television fiction, sudden death is often permanent.

There are a variety of causes of sudden death but most all revolve around the heart and its ability to pump blood to the body. Not only does the muscle have to work, but also there needs to be normal electricity to allow the electric pump that is the heart to squeeze in a coordinated fashion. If the brain loses blood supply for even a few seconds, it turns off and the victim can fall unconscious to the floor. The most common cause of this sudden in an athlete is hypertrophic cardiomyopathy, an abnormal thickening of the heart muscle that causes the fatal heart rhythm of ventricular fibrillation or V-Fib. Instead of sending a coordinated electrical signal to all heart muscle cells to squeeze at the same time, the electricity is chaotic, each cell squeezes to its own drummer, the heart quivers like a bowl of Jello-O and no blood gets pumped to the body.

                

Normal Heart Rhythm                                         Ventricular Fibrillation 9V Fib)

The question becomes, how do we find those at risk before sudden death becomes sudden? There has always been debate about how much time, effort and money should be spent on screening all high school and college athletes just to find the one person at risk. There is some debate by medical experts as to whether heart screening with EKGs and echocardiograms (heart ultrasound) would actually work, but there are guidelines on how to find athletes who might have a higher risk of heart abnormalities that could lead to sudden death.

This is where school administrator, parents and the medical community have to step up and realize the importance of the yearly pre-participation exam.

These findings that should trigger a more intense look for heart problems that could result in sudden death:

  • Family History
    • Family member who had premature sudden cardiac death
    • Heart disease in a family member who is younger than 50
  • Personal History
    • Heart Murmur
    • High Blood Pressure
    • Previous passing out event
    • Unexplained fatigue
    • Unexpected shortness of breath with activity
    • Chest pain with activity
  • Physical Exam
    • Listening for a heart murmur
    • Feeling for normal pulses in the groin
    • Blood pressure measurements
    • Assessing for Marfan Syndrome (a genetic disease that is associated with abnormal aorta)

Sudden death may not be completely preventable, but instead of blindly filling out paperwork and having a perfunctory physical exam in a school gym, taking the time and effort to actually have an athlete examined may be lifesaving.

And the last most important thing to do…learn CPR, know where the nearest AED is located, and come to the aid of somebody in distress. Don’t expect that somebody else will step up. There is no guarantee that there will be a trainer, nurse or doctor nearby to take the lead.

 

 

 

 

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sudden death: ventricular fibrillation: V Fib

Sunday, July 9, 2017

Sports terms make their way into our everyday world. From closing a slam dunk deal and being thrown a curve in a relationship to chasing a dream by keeping an eye on the ball, our language is peppered with sayings that aren’t to be taken literally. Then there is sudden death, a term that bounces back and forth from cardiology to sports overtime and back again. In medicine, sudden death is very black and white, marking the second when the heart stops beating, blood stops pumping and the brain and other organs stop working. While in sports, the final score ends the game, in medicine there is a chance at redemption, if the heart can be quickly restarted in minutes or less, the brain and body may recover. That is a big may and the final outcome may not be evident immediately.

Imagine being in the stands, cheering for your favorite team, when a player collapses. Imagine being in the stands when Dutch soccer team, Ajax, takes the field. Early in the game, a young 20-year-old player named Abdelhak Nouri collapses to the ground. Initially, there is little concern; after all it is soccer and players routinely dive to draw a penalty. Bu there was no foul and he lay motionless as the game quickly stops and medical staff rush on the field and start CPR. An automated defibrillator (AED) is used while screens are held around the scene to provide some privacy in a stadium filled with fans. But unlike television, Mr. Nouri doesn’t immediately stand up, he is unconscious and while his heart has been shocked and restarted, the brain and body haven’t yet recovered and he is placed on a ventilator, a machine that breathes for him, as he is helicoptered to the hospital and kept in a medically induced coma to hopefully allow his brain to recover.

The heart is an electrical pump. Sudden death occurs when the heart’s electrical system short circuits and the regular electrical pattern that signals heart muscle to beat is lost. Instead of normal sinus rhythm, a coordinated signal to every ventricle muscle cell to contract at the same time and pump blood to the body, the chaotic electrical rhythm causes each cell to contract randomly. The ventricles, the lower pumping chambers of the heart, sit their jiggling like a bowl of Jell-O instead of squeezing like it’s supposed to do. Ventricular fibrillation (V Fib) is not compatible with life and the only treatment that works is electricity, shocking the heart back into a regular rhythm,

normal sinus rhythm

ventricular fibrillation

 

With the advent of AEDs, bystanders can become lifesavers, if V Fib is the reason a person collapses and dies. CPR is the temporary stopgap that can provide some blood flow to the brain until the AED gets to the patient’s side, but CPR doesn’t fix what’s wrong. The AED is almost foolproof and walks the bystander through the steps of providing a shock if the cause of death if a shock is appropriate (some people have sudden death and the abnormal rhythm is not V Fib), delivering a shock is as easy as starting a car. And a reminder to those who are afraid of making a mistake…the victim is already dead, they can’t get any worse.

 

If the AED shock works and the heart restarted, hopefully, paramedics or EMTs are there to take over and then the hard work begins. Unless the person wakens immediately, the basic vital signs need to be controlled and stabilized, from breathing to blood pressure, the body needs help in getting regulated. Once at the hospital, an unconscious survivor of sudden death may be cooled just a little to help protect the brain and kept in a coma while the dust settles. Hopefully, the victim wakens and returns to normal function. That is not a given.

Sudden death happens suddenly without warning. Cheating death can only happen when bystanders are there to start CPR and find and use an AED. When elite athletes collapse, it is a reminder that anybody can become a victim and anybody can become a hero.

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A reminder that here are two type of fibrillation:

  • Ventricular fibrillation affects the lower chambers of the heart that pump blood to the body and is not compatible with life.
  • Atrial fibrillation is a common condition affecting more than 5 % of the population and describes the inability of the upper chambers of the heart to beat in a coordinated fashion. This is not an immediate life threatening condition, though long term complications do exist
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