Don’t Underestimate the Risk: The Truth About Sudden Cardiac Arrest in Young People

Unravelling the Mystery of Sudden Cardiac Arrest 

Imagine a seemingly healthy young person suddenly collapsing, unconscious, and fighting for their life. This frightening scenario is the reality of Sudden Cardiac Arrest (SCA), an unexpected and life-threatening event that occurs when the heart abruptly stops beating. In these critical moments, survival hinges on the swift actions of bystanders and emergency responders, employing crucial life-saving measures like CPR and automated defibrillators.

What sets Sudden Cardiac Arrest apart from a heart attack? 

Sudden Cardiac Arrest (SCA) occurs when the heart’s electrical system goes haywire, causing an erratic heartbeat. This dangerous, rapid pace prevents the heart from pumping blood effectively, leaving the rest of your body starved for blood supply, resulting in death. 

Contrastingly, heart attacks strike when a blockage in one or more coronary arteries disrupts the flow of oxygen-rich blood to your heart. This can result in heart damage if oxygen-deprived blood can’t reach the heart muscle. While heart attacks can trigger a SCA, it’s crucial to understand that these two terms are not interchangeable. 

Unravelling the Causes of Sudden Cardiac Arrest 

Overall, almost  80% of sudden cardiac arrest cases stem from coronary artery disease. However, for the younger population (<35 years old), congenital heart defects or genetic abnormalities in the heart’s electrical system play a greater role. In individuals aged 35 and older, coronary artery disease is the more common culprit.

Is SCA common in young people?

When we think of heart disease and cardiac arrest, we usually picture older individuals. But did you know that younger people can also experience sudden cardiac arrests? It’s true that we’re hearing more and more stories of young people unexpectedly collapsing after an intense workout or even without any obvious cause. While sudden cardiac arrest is rare among the young, it’s important to acknowledge that it can happen.

What makes SCA such a devastating health crisis for young people? 

There are several unique factors that contribute to the vulnerability of young people when it comes to SCA. 

• Some young individuals who experience SCA may have had prior heart-related symptoms like shortness of breath, chest pain, or fainting, which may have been overlooked. However, others might not even show any signs of heart issues until the SCA occurs, making it challenging to recognize, treat, and prevent.
• Although SCA is more prevalent among young athletes, it can also affect those not engaged in intense sports. It can strike during exercise, at rest, or even while sleeping. In some instances, young people can die days or weeks later from brain damage sustained during the SCA, adding to the confusion in identifying the issue.
• Importantly, individuals under 25 years old are not typically considered high risk for heart-related health problems, leading to potential early warning signs being disregarded.
• The fact that lifestyle-related conditions like an unhealthy diet, being sedentary, obesity, smoking, poor sleep hygiene, substance abuse, use of stimulants and stress can precipitate atherosclerosis and coronary artery disease even in young people is often overlooked.

These factors emphasize the need for increased awareness and understanding of SCA as a critical health emergency in young people, but for which underlying factors can be picked up early by proactive health checks and lifestyle modification.

Causes of sudden cardiac arrest in young people 

While the exact cause of sudden cardiac arrest (SCA) in young adults can sometimes never be known, several causative factors exist, such as: 

Hypertrophic cardiomyopathy 

Often inherited and undiagnosed, hypertrophic cardiomyopathy is the most common cardiovascular cause of SCA in young people. Thickened muscle cells in the heart’s lower chambers can lead to abnormal heart rhythms, particularly during intense exercise. 

Coronary artery abnormalities 

Defects in the coronary arteries’ connection to the heart may result in decreased blood supply to the heart muscle during exercise, causing cardiac arrest. Usually congenital, young people with this condition may not experience symptoms until they are older. 

Primary arrhythmias 

In those with structurally normal hearts, SCA can sometimes be caused by undiagnosed genetic conditions affecting the heart’s electrical impulses. These include inherited conditions like: 

• Long QT syndrome – a heart rhythm condition causing rapid, chaotic heartbeats. 
• Wolff-Parkinson-White syndrome – extra electrical pathway in the heart creates rapid pumping. 
• Arrhythmogenic right ventricular dysplasia (ARVD) – is an inherited condition where heart muscle tissue gets replaced with scar tissue. 

Myocarditis 

Triggered by infection, myocarditis causes inflammation of the heart walls. Most cases occur when a virus affects the heart, but bacterial, fungal, or parasite infections and allergic reactions to medications can also cause Myocarditis. 

Marfan syndrome 

This connective tissue disease can result in tears in the aorta. 

Commotio Cordis 

This is caused by a blow to the chest directly over the heart and  can occur in people with entirely normal hearts. It is more common in people who play sport with projectile objects, such as baseball. 

Coronary atherosclerosis 

While the reasons above are more likely causes of SCA in younger people, it’s also essential to recognize the rising incidence of coronary atherosclerosis in young people. It is no more a disease of the elderly . Heart attacks and SCA among youngsters are increasing due to sedentary lifestyles, diabetes, alcohol consumption, substance abuse, smoking, obesity, irregular sleep cycles, high-stress work environments, and hypertension. These factors can heighten the risk of SCA or also lead to other medical conditions and complications.

Electrolyte Imbalances

Electrolytes are vital for body chemistry to function correctly. Potassium, calcium and sodium are the most important electrolytes. Electrolyte abnormalities are commonly associated with cardiovascular emergencies. These abnormalities may cause or contribute to cardiac arrest.

How can we prevent Sudden Cardiac Arrest in young people? 

By taking proactive measures, families and communities can decrease the risk of sudden cardiac arrest (SCA) in young individuals: 

1. Recognizing warning signs, understanding risk factors and obtaining accurate medical & family histories can significantly help in prevention efforts. Gathering  blood relatives’ heart health history and sharing it with your doctor is crucial. This information can guide essential questions during check-ups and sports physicals, ensuring nothing is overlooked. 

• Conducting heart health diagnostics for those at higher risk can be helpful in prevention of SCA.. Heart health evaluation should include ECG , Echocardiogram and (in high risk individuals) TMT or Exercise stress test .

Risk factors for sudden cardiac death that should prompt comprehensive heart checks, even among younger individuals, include:

• A family history of sudden death in an otherwise healthy family member under 50 years of age, which is unexpected or unexplained.
• Having a family member with an inherited heart muscle or electrical problem.
• Experiencing chest pain during exercise.
• Having an abnormal heart rate or rhythm of unknown origin.
• Fainting, passing out, or having a seizure without warning or during exercise.
• Being born with a congenital heart defect, as well as those that have been surgically repaired.

Apart from the above situations, it is always advisable to undergo a complete heart check if you are an individual who lives in a high-stress environment or does high-intensity workouts so that any underlying or asymptomatic heart condition can be diagnosed before severe cardiac damage happens.

• Medical consultation and check-ups are essential for all children and adolescents as well. These appointments provide an opportunity for thorough physical exams and health history assessments, helping to identify SCA risk factors much earlier. This is particularly crucial before starting any organized, competitive, or recreational sports or activities.

The American Association of Pediatrics has developed a policy statement recommending four screening questions for all children. These screenings should ideally be included into a child’s regular exam at least every two to three years, starting as they enter middle school. The simple yet vital questions ask if a child or teen has ever fainted, had an unexplained seizure, experienced chest pain or shortness of breath, and if family members have a history of cardiac conditions or death before age 50.

Since sudden cardiac death is a complex multifactorial event, we recommend that it is best to undergo a baseline health screening and continue to have an annual evaluation of your health status. This would help identify and mitigate health risks and prevent catastrophic events such as sudden cardiac death. Individuals with risk factors, family history, inherited conditions stressful lives, and those who are about to embark on high intensity exercise must be extra cautious in evaluating their heart health. 

Apollo’s ProHealth Program is an innovative, proactive approach that combines predictive risk analysis, doctor-curated individualised health packages, state-of-the-art diagnostics, expert evaluation, and a personalized wellness plan – all designed to help you make healthy shifts in your life. 

Conclusion 

Sudden cardiac arrest in young people is an often overlooked condition, mainly due to lack of awareness. While the causes in younger individuals differ from those in older age groups (in older age groups, coronary artery disease and atherosclerosis are more common), lifestyle factors are increasingly putting young people at risk of coronary artery disease as well. To protect yourself from sudden cardiac arrest, it’s essential to prioritize regular heart check-ups from an early age as well as lifestyle management.