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Dr K K Aggarwal

Predicting sudden cardiac death

By Dr K K Aggarwal
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  • Normally people can walk a distance of 400-700 meters in 6 minutes.
  • A 6-minute walking distance of less than 300 meter is a simple and useful predictor of sudden cardiac death in a patient with mild to moderate heart failure.
  • Patients with interstitial lung disease who can cover less than 200 meters during 6-minute walk test are 4 times more likely to die than those who can walk greater distance.
  • People who can cover a distance of 200-300 meters need further evaluation.
  • A fall of SpO2 of more than 4% ending below 93% suggests significant desaturation.
  • An improvement of more than 70 meters or 10% in distance walked can make all the difference.
  • An improvement of 30 meters in any distance walked is the minimally important difference in any treatment.
  • Sudden cardiac death is linked to 15% of total urban mortality.
  • Risk factors for sudden cardiac death include abnormal lipid level, high blood pressure, cigarette smoking, physical inactivity, diabetic, obesity and family history of premature heart disease or heart attack.
  • Binge alcoholism can cause sudden cardiac death (6 or more drinks per day or five drinks in one session)
  • Risk of sudden cardiac arrest is transiently increased for up to 30 minutes after strenuous exercise (1/1.5 million of episode of exercise)
  • If you are at low risk for having a heart problem, you do not need a regular treadmill test.

Energy Drinks May Put Heart at Risk for Sudden Death

By Dr K K Aggarwal
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Energy drinks may raise blood pressure and prolong QT interval increasing the risk of sudden cardiac death. In a meta-analysis by Sachin A. Shah at University of the Pacific in Stockton, Calif, with a pooled analysis of 93 people who consumed energy drinks, the QT interval on an ECG was significantly prolonged by 10 ms. The threshold level of regulatory concern is around 5 ms. In another pooled analysis of 132 people by the same group, researchers found a significant increase in systolic blood pressure by 3.5 mmHg that was associated with the consumption of energy drinks. Doctors are generally concerned if patients experience an additional 30 ms in their QT interval from baseline. QT prolongation is associated with life-threatening arrhythmias. Most energy drinks have caffeine. Drinks such as Monster, Red Bull, Rockstar, Full Throttle and AMP have three times the amount of caffeine as colas. A 16-oz. can of Monster Energy, for example, contains 160 mg of caffeine, which is almost as much as 5 cans of soda.

ECG can be a marker for future sudden cardiac death

By Dr K K Aggarwal
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All school children enrolling for competitive games should have their ECG done.

Padma Shri & Dr. B C Roy National Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India, said that routine ECG, if read correctly, can be used as a marker for sudden cardiac death, especially in children.

Dr. Aggarwal who is also Senior vice President, Indian Medical Association, said that all children being recruited for competitive sports should have their resting ECG done. ECG consists of wave which need to be interpreted by the doctors.

The Width of the wave called QRS duration is something which can be picked up even by inexperienced doctors and  nurses. A QRS width duration of more than 120 micro seconds in adults and 100 micro seconds in children 4-16 years and more than 90 micro seconds in children less than 4 years of age should warrant a specialized opinion.

Any heart rate of less than 60 or more than 100 per minute should also warrant, a further evaluation, especially if it is associated with wide QRS duration, as mentioned above. The heart rhythm should be regular and any irregularity should be evaluated.

Missing beats is a common occurrence but if a person misses his beat on exercise, it may be a sign of underlying heart blockages. In children, one should also look for QT prolongation in the ECG and if it is prolonged, it is a matter of concern.

Sudden Cardiac Death

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It is easy to anticipate and identify people at risk of sudden cardiac death. The following people are at risk of sudden cardiac death:

  • People who have survived a past cardiac arrest.
  • Heart patient with pumping action of the heart less than 30%
  • ECG showing wide QRS conduction of more than 120 msec.
  • Inability to climb two flights of stairs without symptoms.
  • Inability to walk 2 kms on level ground without symptoms.
  • Inability to do exercise in the bed with the partner without symptoms.
  • Patient with uncontrolled blood pressure, diabetes, smoking and people who drink more than 5 pegs of alcohol in one hour or 6 pegs of alcohol in one day.
  • People who have uncontrolled snoring.

A campaign should be started all over the country and awareness should be created to the general public about the following messages:

  • Sudden cardiac death is preventable – Learn chest compression CPR
  • Revival from cardiac arrest is possible in the first 10 minutes. Earlier the better.
  • Sudden cardiac death is common in the first hour of acute heart attack.
  • Most heart attacks occur in the early hours of the day.
  • Chewing a tablet of water-soluble aspirin at the onset of the heart attack reduces the chance of death by 22%.
  • Heart attack can be reversed within three hours of chest pain with clot-dissolving drug or by angioplasty.
  • All heart patients should know their ejection fraction; if less than 30%, they need further evaluation.
  • Sudden cardiac death is preventable – quit smoking today.
  • Sudden cardiac death is preventable – keep your blood pressure under control.
  • Sudden cardiac death – keep your diabetes under control.
  • A 5 mm reduction of blood pressure can reduce chances of heart attack
  • All group residential colonies should keep an automatic external defibrillator to tackle a cardiac arrest.
  • If you are a heart patient with less than 30% ejection fraction, talk to your doctor about an automatic Implantable Cardioverter Defibrillator (AICD) – an internal electric shock device.
  • All heart patients should know their QRS duration on ECG (should be < 120 ms).
  • Heart patients with QRS duration of more than 120 ms on ECG need further evaluation.
  • To reduce sudden cardiac death, all post heart attack patients should be on beta blockers, if not contraindicated.
  • To reduce sudden cardiac death, all post heart attack patients should be given cholesterol-lowering drugs.
  • To reduce sudden cardiac death, all post heart attack patients should be on lifelong aspirin.

 

Stress Management Programs For Heart Patients A Must

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Drugs such as beta-blockers and psychosocial interventions can reduce the physiologic response to some forms of stress.

In patients with known coronary disease, the cardioprotective effect of beta blockers with regard to heart attack and sudden cardiac death are partly due to a diminution of catecholamine and hemodynamic-induced endothelial damage and a rising of the threshold for ventricular fibrillation.

In patients at risk for cardiovascular events who are under increased psychosocial stress, a stress management program can be considered as part of an overall preventive strategy. In premature heart attack, the mean age is 53-54 yrs.

In general, the goal of a stress management program is to reduce the impact in the individual of stressful environmental events and to better regulate the stress response.

Interventions may be considered at several levels:

  • Removal or alteration of the stressor
  • Change in perception of the stressful event
  • Reduction in the physiologic sequelae of stress
  • Use of alternative coping strategies

Stress management techniques typically include components of muscular relaxation, a quiet environment, passive attitude and deep breathing with the repetition of a word or phrase.

The physiologic changes produced include a decrease in oxygen consumption, reduced heart rate and respiratory rate and passive attitude and muscular relaxation. Such changes are consistent with a decrease in sympathetic nervous system activity.

Other measures, such as relaxation techniques and biofeedback, can produce a small reduction in blood pressure of 5 to 10 mmHg.

Behavior modification programs are also an important adjunct to smoking cessation and have been associated with a reduction in cigarette consumption. Improvements in compliance with medication regimens may be an additional benefit from stress reduction program.