Sudden Cardiac Death (SCD) or sudden cardiac death is again a hot topic of discussion among the public. SCD is defined as the sudden death of a person who is not known to have a cardiac risk and is not caused by trauma. Recently, there have been several incidents of SCD affecting healthy young people, without a history of heart disease. This is quite a cause for concern in the community because cardiac arrest usually occurs in the elderly population with risk factors for heart disease.
The incidence of SCD in people aged less than 35 years or called SCD in the young population, ranges from <1 to 10 deaths/100,000 population per year. This figure is far below the incidence of SCD in populations >35 years. However, what is of concern is the loss of productive age figures in the incidence of SCD in the young population.
The incidence of SCD in the young population is associated with heart disease, both genetically inherited and acquired throughout life. The most common forms of cardiovascular disorders that cause SCD are congenital disorders, namely: hypertrophic cardiomyopathy, heart rhythm disorders (Brugada syndrome, long QT syndrome), and coronary artery disorders. Hypertrophic cardiomyopathy is a congenital disorder in which the wall of the heart muscle thickens, disrupting the electrical conduction and rhythm of the heart. This disease is the leading cause of sudden death under the age of 30 years and also the most frequent cause of death in cases of SCD among athletes. Coronary abnormalities that can cause SCD are congenital conditions in the form of abnormal coronary artery connections so that blood flow to the heart muscle is reduced during moderate-severe activity, and leads to death. Abnormal heart rhythms such as long QT syndrome and Brugada syndrome are congenital disorders that cause the heart rhythm to become fast and irregular so that sufferers often experience fainting. Apart from these three causes, commotio cordis which is a condition caused by blunt trauma to the chest is also a cause of SCD. Blunt trauma can cause heart rhythm disturbances that are lethal. Commotio cordis is usually found in cases of SCD in cricket, football, hockey and martial arts athletes.
SCD at a young age is often found in athletes or someone who has just done sports or strenuous activities. A study in America showed that the incidence of SCD in athletes increased 2-3 times compared to the general population. This raises the question whether strenuous physical activity and strenuous exercise can increase the risk of SCD in the young population. In fact, the incidence of SCD in athletes is not only caused by cardiovascular problems, but also by non-cardiovascular problems such as heat stroke and trauma. Unfortunately there is no data regarding the percentage comparison between these two groups of causes. What is interesting about SCD in athletes with cardiac disorders is that it occurs at rest, even during sleep. So it is still being investigated whether strenuous activity and exercise increase the risk of SCD in this group.
Some of the heart defects that cause SCD can produce symptoms. Symptoms to watch for include palpitations, repeated fainting, seizures, or chest pain. So if there are these signs, it is highly recommended to carry out a medical examination. A person's risk of SCD increases if there is a family history of SCD under the age of 50.
By knowing the causes and risk factors, early detection of SCD in the young population can be carried out in a more targeted manner. Unfortunately, early detection programs for both the general population and special populations such as athletes still do not exist. So that early detection is carried out on the awareness of each individual with cardiac examinations such as EKG, treadmill tests , Holter monitors, echocardiography and so on, the selection of which is adjusted to the patient's condition. As for groups that have high risk factors, namely the nuclear family of patients who experience sudden cardiac death under the age of 50, it is highly recommended to undergo a medical examination.
When you know the causes and risk factors, the next question that arises is whether SCD can be prevented? The answer is yes. Several therapies and lifestyle modifications can reduce the risk of developing SCD, depending on the inherited disorder and a person's condition. The therapy given depends on the type of disorder that occurs. Therapy can be in the form of medical therapy with drugs or even through surgery and the use of a pacemaker implanted in the body. Lifestyle modifications that can be made can be in the form of exercise modifications and also food.
With this, sudden cardiac death (SDC) in the age group under 35 years can be prevented. Special attention needs to be paid to at-risk or symptomatic groups by conducting early examinations. So that the risk of SDC events can be detected as early as possible and given appropriate therapy to reduce the possibility of SDC occurrence.
Article written by dr. Dede Moeswir Sp.PD-KKV, FINASIM, FAPSC, FSCAI (Internal Medicine Specialist – Cardiovascular Consultant at EMC Pulomas Hospital).
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