Senior cardiologist Dr B Hygriv Rao on causes & prevention of sudden cardiac arrests

Hyderabad: With the growing incidence of sudden cardiac arrest, cardiologists advise increased awareness and response training. NewsMeter spoke to Dr. B. Hygriv Rao, a senior cardiologist and director of pacing and electrophysiology at KIMS Hospitals, to understand the reasons for sudden cardiac arrests and what we can do, as a community, to better the situation.

About Dr. Hygriv Rao

Dr. B. Hygriv Rao completed his MBBS from Osmania Medical College and MD in general medicine from Gandhi Hospital. He later pursued a Fellowship at Electrophysiology Research Foundation, New Jersey, USA. He is the editor of the electrophysiology section of the Indian Heart Journal.

What is a cardiac arrest?

A cardiac arrest is generally caused due to an abnormal heart rhythm, which occurs when our heart's electrical system is not functioning properly. An acute heart attack can also sometimes trigger an electrical disturbance resulting in a sudden cardiac arrest.

Symptoms and steps to take

Speaking about the symptoms of cardiac arrest, Dr. Rao says, "The first thing is that many people confuse acidity with a cardiac arrest and vice versa. This is because only a few people know that the stomach and the heart are very close. The stomach is not located in the abdomen but in the chest. Shockingly, even doctors sometimes get confused."

When asked if there are any differences in symptoms between men and women, the doctor says, "Women mostly experience atypical symptoms like back pain or pain that is described as burning, stabbing, or pain characteristic of indigestion. Men generally experience pain in the chest, arm, or jaw."

False positives are common and there is only one way to be sure of the symptoms. "In case of any discomfort from naval to the jaw, it is better to go to the hospital because no one can decide by sitting at home. Even the doctors can't tell. Approach the emergency room and take an ECG (electrocardiogram). In these cases, one has to be proactive."

What happens once the person reaches the hospital? "There is a clear protocol. An ECG is taken as soon as they arrive, and after half an hour, if both the tests are normal, they go for a lipoprotein blood test after six hours. It is generally not a cardiac arrest if this is also normal," adds Dr. Rao.

Increased risk among Indians

There has been a significant increase in cardiac arrest cases in India, particularly in the younger age groups. As per estimates, more than 7 lakh sudden cardiac deaths are reported annually in India.

According to a 2012 study by Dr. Rao called "Global burden of Sudden Cardiac Death and insights from India," overall mortality owing to sudden cardiac deaths (SCD) in India was 10.3% with persons under the age of 50 accounting for 21% of the deaths.

When asked if there has been any improvement since then, he says, "The mean age hasn't changed in the last 10 years. We did a countrywide study in 2021-2022 also and found that the mean age is 10 years less compared to other parts of the world. It is 50-55 years, although many parameters have improved."

About the effect of ethnicity or genes on the risk factors, he says, "The only way to know that precisely is through data, but we don't have systematic genetic studies. We can only speculate and analyse."

When asked how a person can decide if he is more at risk than the average person, he says, "If the person's father had cardiac issues before he turned 50 years or the mother before she turned 60 years, they come under the risk category. Keeping a close check on cholesterol, blood pressure, and diabetes is advisable for them."

A sedentary lifestyle is one reason that directly impacts cardiac health. "Unrecognised diabetes is another silent killer," he warns.

Awareness and prevention

According to the World Health Organisation (WHO), 86% of cardiovascular disease deaths could have been prevented or avoided through prevention and treatment.

When asked about the impact of awareness on early detection, Dr. Rao says, "We need data before we can say anything. Like how through data we could determine that the mean age hasn't changed, for this also we need data."

But based on clinical observations he says, "Especially in the last five years, people are certainly more aware. So, people are getting evaluated more."

The doctor says awareness created by organisations or at the individual level is not enough. "There needs to be a national-level effort, and even corporate hospitals can and should invest more in creating awareness."

He adds, "All these parameters that cause a heart attack should be made public."

Impact of Covid

Cardiac arrest has been reported more in young people. This, Dr. Rao says, is due to clotting in the blood vessel, particularly in the lungs. "Covid did raise the chance of cardiac arrest," he adds.

CPR (Cardiopulmonary resuscitation)

CPR is one such tool or technique that can save many lives. Dr. Rao says it is not enough to highlight the importance of CPR only during events or awareness months but regular training sessions should be conducted. "The government, hospitals, and workplaces should conduct regular training, especially for those who interact the most with people, like the police and staff at malls. They have to be trained," he says.

He says corporate hospitals can start by training their non-medical staff in CPR.

Post-recovery care

Dr. Rao explains the care and precautions to be taken post-recovery. "After the treatment, there will be a complete profiling to determine the risk factors and family history. But there is also a device that can be used called an implantable cardioverter-defibrillator. It is put under the skin. It detects cardiac arrest and gives shock treatment in case of one," he says.

Besides regular exercise and a healthy lifestyle, he says excellent control of diabetes, not just identifying but predicting and taking care, is essential. "Tests like A1C should be taken, which measures your blood sugar of the past 2-3 months," he explains.