Sunday 24 / November / 2024
Muscat: The news of a 38-year-old Indian expat working in Oman collapsing midair during his flight to the southern Indian city of Chennai from Muscat on September 10 has sent shockwaves across the society.
The sad incident comes days after a Pakistani amateur cricketer collapsed on the ground in Muscat.
The incidents of young people and sportspersons succumbing all of a sudden also sent a stark reminder about another incident of a badminton player dying while playing on indoor courts earlier this year.
Physical activity is considered a faithful reflection of the state of health and quality of life of a society, which is why public opinion finds it hard to understand how an apparently healthy young person can die while showing great vitality in his or her usual athletic activities.
Cases of sudden death fill the headlines of the press, especially when they occur in well-trained athletes or with healthy recreational athletes or young people.
These unfortunate incidents are not uncommon and in recent times, we have heard of many incidents where a person has collapsed all of a sudden and passed away.
It has happened on sports grounds, offices, roads, in air and at homes. And the common term for such an incident is Sudden Cardiac Death (SCD).
Renowned Muscat-based cardiologist Dr K P Raman told Times of Oman: “In middle aged and elderly people, the commonest cause of SCD is atherosclerosis which means cholesterol (fat) blocks in heart arteries.
“It is also known as Coronary Artery Disease (CAD). But in young adults (age 35 or less) the cause is often genetic and congenital heart diseases.
“A disease called Hypertrophic Cardiomyopathy (HCM) in which there is a genetic defect, resulting in disorganised overgrowth of heart muscles, seems to be the commonest cause of SCD in young people with reports of 36 out of 100 deaths. The other causes are heart arteries arising from abnormal locations in the aorta and taking abnormal courses (17 out of 100 deaths). Only about 4 out of 100 deaths are due to abnormal electrical generation and propagation.”
Dr Raman, who is also chairman of Al Hayat International Hospital in Oman, said: “SCD comes as a bolt from the blue and does not give you time or chance to even go to a doctor for evaluation. The only chance one gets is that someone in the vicinity performs a CPR (cardio pulmonary resuscitation) and shocks the victim with an AED (an electrical device which gives a mild shock and kicks the heart back into normal beating.)”
He added: “In older people the commonest cause of cardiac arrest and SCD is CAD (blocks in heart arteries) and so the survivor after resuscitation needs to be immediately transported to a centre where PCI (per cutaneous intervention) is available to remove the block.
“It is possible that patients who suffer SCD experienced on the previous days some warning signs such as dizziness, chest heaviness or palpitations and may have been ignored by the patient. Most people including doctors ignore chest heaviness as gas or gastritis and delay seeking medical attention. Once you survive SCD the chances for next SCD is even higher particularly if the heart function (EF) on echo is below 35 percent.”
On the steps to prevent SCD, Dr Raman said: “Young athletes and people should do screening physical examination and ECG. In those with abnormal ECG or family history of SCD, they should be referred to the cardiologist for more advanced cardiac tests. In amateur athletes this kind of screening is not necessary unless there is a family history of SCD or some hints to genetic heart diseases.
“To prevent SCD in older adults we need to improve overall lifestyle in society, treat risk factors for CAD, such as high BP, diabetes, smoking and high cholesterol aggressively and proactively look for CAD in people with high probability.”
Among the other measures that need to be taken is to have an AED available in all sports complexes, gyms and even public places.
Dr Raman said: “The staff working in these areas should be trained in giving chest compressions and use of AED. Bystander-initiated CPR leads to the best chance of survival and ambulance services should be quick and efficient.”
The cardiologist added: “The success rate of CPR for cardiac arrest happening outside hospital in the general population (mostly this happens in middle aged and elderly people having known heart disease) is only 10 percent. But this increases 2 or 3 times if the cardiac arrest is witnessed by a person who knows how to do CPR and he initiates it within a few minutes. If it happens in the sports arena, then there are generally people trained for CPR and AED use and if AED is available, the chances for successful CPR is 90 percent and chances for successful discharge from hospital is 75 percent because most athletes are young.”
Another renowned Muscat-based sports medicine expert, Dr E B S Ramanathan, also echoed the same line of action in case of SCD.
‘Pre-participation evaluation’
In his remarks to Times of Oman, Dr Ramanathan, senior consultant at the Muscat Private Hospital, said: “Today we live in an age of ‘Sports for All’ as exercise is associated with beneficial change in most heart conditions, control of blood pressure, diabetes, cholesterol, and weight reduction. Sports are clearly health-promoting for the large majority of individuals. On the flip side, in a small number of individuals exercise can be associated with the risk of sudden death. SCD is the most frequent medical cause of sudden death in athletes and its occurrence in athletes, who are often young and presumably healthy, has a large emotional and social impact on the surrounding community.”
Dr Ramanathan, who is also the secretary general of the Asian Federation of Sports Medicine (AFSM), added: “In younger athletes (under 35 years of age), mainly competitive athletes, inherited cardiac (heart) conditions namely Hypertrophic Cardiomyopathy (HCM) predominate as cause of death. In older athletes who are mainly recreational athletes, acquired atherosclerotic coronary artery disease is the most common cause of SCD. With increasing numbers from this age group participating in sports today, SCD during sports is far more common in older athletes. In general, SCD with exercise is more common in men, older participants who are not regularly active and may have known cardiac disease.”
Dr Ramanathan said: “One of the best prevention methods is pre-participation evaluation (PPE) of every individual who wishes to participate in sports. This is ideal for the competitive athlete and also for the recreational athlete.”
However, Dr Ramanathan said that in spite of these elaborate screening programmes it is highly unlikely that SCD could be eliminated totally among sports persons or people.
He said: “In addition to these PPE measures, increased access to emergency treatment like automated external defibrillators (AED) as well as training in CPR at the community level are important means of reducing SCD in athletes.
“In this context, world football governing body, FIFA, has introduced aggressive preventive measures and protocol for urgently managing SCD on the football field through F-MARC FIFA Medical & Research Centre. They have made it mandatory for Automated External Defibrillators (AED) and the FIFA Medical Emergency Bag to be present on the field in all competitive matches and training in recognition of SCD.”
The top sports medicine expert said, “These measures should be followed in all sports and in all sports/training institutes if one has to see substantial reduction in SCD."
“SCD of an athlete is a traumatic event that has a large impact on society and every individual who wishes to participate and continue in sports must get themselves medically evaluated.”
