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There is No Coming Back from Sudden Cardiac Death

February 18, 2009 12:00 PM with Dr. Jose Nazari

An ounce of prevention may well save your life. Dr. Jose Nazari, Cardiac Electrophysiologist discusses the risks of Sudden Cardiac Death and how you can prevent it.

Kristin Philbin (Moderator) - 11:52 AM:
Welcome! Todays chat: THERE IS NO COMING BACK FROM SUDDEN CARDIAC DEATH will be beginning shortly. Please start submitting your questions and Dr. Jose Nazari will begin answering them shortly. While you are waiting for the chat to begin, feel free to visit the Cardiac Electrophysiology Department to obtain more information about sudden cardiac death and how you can prevent it.

Dr. Jose Nazari (NorthShore) - 12:09 PM:
Hello and welcome to the webcast. Happy to be here.

  Farrah (Lake Forest, IL) - 12:10 PM:
Does sleep apnea put you at an increased risk for Sudden Cardiac Death?
Dr. Jose Nazari (NorthShore)
Sleep apnea is a recognized cause of sudden death, albeit not a common one. It is thought that it does so by causing very severe slowing of the heart, for which pacemakers are occasionally implanted.

  Suzanne (Chicago, IL) - 12:11 PM:
Who is most at risk for sudden cardiac death and how can it be prevented?
Dr. Jose Nazari (NorthShore)
Most sudden cardiac arrests occur in people who have segnificant heart disease. The most common is a previous heart attack. The only known preventive approach to sudden cardiac arrest once you have developed the risk of it (eg had a severe heart attack) is implantation of a defibrillator. Of course, prevention of heart attacks (reasonable diet, avoidance of smoking, exercise) all contribute best to keeping your heart healthy.

  Jim (Buffalo Grove, IL) - 12:14 PM:
I had a heart murmur as a young child which I know is fairly common in children. My mother began having serious heart problems when she was 45. She's had two open heart valve replacement surgeries and a myriad of other heart-related problems over the past 33 years. I'm a little concerned - now that I'm in my early 40s - that I may experience similar health problems. What should I be doing from both a personal and clinical perspective at age 41 to minimize potential heart problems down the road?
Dr. Jose Nazari (NorthShore)
You need to discuss this with a doctor who takes a formal history and examines you. Most likely, he will get an echocardiogram (painless, easy, noninvasive) to assess the structure of your heart

  Shelly (Glenview, IL) - 12:15 PM:
What medications can be prescribed to prevent sudden cardiac death?
Dr. Jose Nazari (NorthShore)
Medications that optimize heart function in patients with previous heart damage (prior heart attack, congestive heart failure) all improve the chances of overall heart health. They include but are not limited to beta blockers (metoprolol and many others), ACE inhibitors and blockers (enalapril, benazepril and others).

  Rachel (Winnetka, IL) - 12:17 PM:
Hello Dr. Nazari, I am wondering why women are not diagnosed with heart problems as quickly as men are? Women are often told that they are experiencing anxiety or stress and can find out later that it was a heart attack.
Dr. Jose Nazari (NorthShore)
Unfortunately that is complex. It involves perceptions and misperceptions on the part of patients and their doctors. Heart attacks were studied more in men, so we understand them better in men. We cannot try to apply the same criteria to women, who present differently. Most currently trained doctors are far better sensitized to the different manifestations of similar diseases in different genders and we are making headway...with lots of room for improvement.

  Margot (Northbrook, IL) - 12:19 PM:
How common is it for the wires of a pacemaker to come loose from the site of implantation? Is a large-breasted woman more likely to have this happen than a man?
Dr. Jose Nazari (NorthShore)
It is uncommon, but it can happen to anybody. Large breasted women can have te weight of the breasts pull down the full thickness of the skin over the clavicle down towards the belly by several inches, "dragging" the pacer and its wires with it. It is particularly common in them and sometimes VERY hard to overcome with the usual surgical tricks.

  Shelly (Glenview, IL) - 12:21 PM:
What symptoms occur that alert a person to seek medical help?
Dr. Jose Nazari (NorthShore)
The first symptom of a cardiac arrest is simply dying. Few people survive to talk about it. The symptoms of heart disease are ubiquitous: chest pain and shortness of breath always require a visit to your doctor. Passing out is most often NOT a predictor of sudden death. However, in people with heart disease or a family history of unexpected sudden death, passing out is ominous

  Izabella - 12:24 PM:
I have hypothyroid, I gain weight very fast, since june 2008 I gained around 30 pounds. My mother had serious heart problems, two mitral valve replacements. Is it sign that I might have heart problem? My physician says it's o.k.
Dr. Jose Nazari (NorthShore)
I would follow your doctor's advice.

  Farrah (Lake Forest, IL) - 12:25 PM:
What if you haven't had a heart attack but there is family history of heart disease and heart failure? How do you know if you have significant heart disease, especially if you are like my brother, who is in his 30's with high blood pressure?
Dr. Jose Nazari (NorthShore)
It is best to keep yourself at optimum weight, exercise regularly, not smoke, keep your cholesterol and blood pressure under excellent control under medical guidance. Occasionally checking an electrocardiogram and echocardiogram is often done in patients with a strong family history.

  Erica (Dallas, TX) - 12:26 PM:
My grandmother & father have enlarged hearts. I have never had a problem with mine, but now that I am close to 40, I would like to know if there is anything I should do now to make sure my heart is okay as I age.
Dr. Jose Nazari (NorthShore)
A visit to your internist should be all that is needed to start. He/She will probably get an electrocardiogram and a chest X Ray. Not much else is required.

  Jack Whitney (Highland Park, IL) - 12:28 PM:
How timely and to whom should adolescents with near syncope and syncopal episodes with prolonged QTc on 12 lead EKG be referred?
Dr. Jose Nazari (NorthShore)
They should see a doctor IMMEDIATELY. The best doctor to see is probably an electrophysiologist. Geneticisists and cardiologists also can address this initially.

  Suzanne - 12:29 PM:
When a person is in the most serious stage of congestive heart failure, has signed a do not rescusitate order and is in hospice, how is the patient protected from dangerous and painful shock?
Dr. Jose Nazari (NorthShore)
Any patient with an implanted defibrillator can have the shocking functions turned off, to allow a dignified death without shocks.

  Jerry (Glenview, IL) - 12:30 PM:
What should a person who has a stent be looking out for in order to prevent sudden cardiac death?
Dr. Jose Nazari (NorthShore)
Check with your cardiologist. Patients with heart disease of ANY kind should be aware of their "ejection fraction". This measurement of the heart's efficiency is the most valuable predictor of sudden death. Ejection fraction's under 35% are generally considered bad and warrant assessment of the risk of sudden cardiac arrest.

  William (Lincolnwood, IL) - 12:32 PM:
You said earlier that the first symptom of cardiac arrrest is dying. But could there potentially be instances where cardiac arrest can be reversed? And if so, how?
Dr. Jose Nazari (NorthShore)
The only reversal of cardiac arrest is resuscitation using a defibrillator (external defibrillators, AED's). The wider availablity of AED's has markedly improved the chances of surviving a cardiac arrest in places where they are available (eg airplanes and airports)

  David (Chicago, IL) - 12:33 PM:
How is sudden cardiac arrest different from a heart attack?
Dr. Jose Nazari (NorthShore)
A heart attack is the obstruction of an artery leading to damage to the heart. Most are NOT immediately lethal. Some don't even cause symptoms (though they are still bad). A cardiac arrest is the sudden loss of any cardiac pumping function and leads to death within minutes if not reversed.

  David (Chicago, IL) - 12:35 PM:
What are the symptoms of sudden cardiac arrest?
Dr. Jose Nazari (NorthShore)
Simply dying. Please see the answers above.

  David (Chicago, IL) - 12:36 PM:
What tests can I take to find out if I am at risk for sudden cardiac arrest?
Dr. Jose Nazari (NorthShore)
A visit to your cardiologist is a good start. You need a medical history and physical exam to start with. They will determine if you need any tests.

  David (Chicago, IL) - 12:37 PM:
Which cardiac conditions are considered to be at-risk for SCD?
Dr. Jose Nazari (NorthShore)
The most common one is a prior heart attack (most commonly long before the cardiac arrest occurs). Many other conditions that damage the heart can do it. There are congenital abnormalities of the heart that may have cardiac arrest as the only clinical manifestation (for example long QT syndrome)

  Cameron (Matteson, IL) - 12:38 PM:
Can uncontrolled arrhythmias lead to SCD?
Dr. Jose Nazari (NorthShore)
Uncontrolled arrhythmias are the sine qua non of sudden death. But only ventricular arrhythmias (not atrial fibrillation, for example).

  David (Chicago, IL) - 12:39 PM:
Are there any forms of genetic testing that a cardiologist can preform to see if I am at risk? What kinds?
Dr. Jose Nazari (NorthShore)
Genetic testing is done in specialized genetics laboratories such as Evanston Hospital's genetics institute. Patients are carefully selected for these tests based on family and personal history. It is expensive, generally paid out of pocket, time consuming and of no utility as a "screening test"

  David (Chicago, IL) - 12:41 PM:
Can you tell me a bit more about long QT syndrome?
Dr. Jose Nazari (NorthShore)
It is a congenital abnormality of the ability of the heart to conduct electricity properly. Long QT refers to its manifestation on an electrocardiogram. It can cause recurrent bouts of passing out and ultimately suddden death. It is not common.

  Izabella - 12:43 PM:
What makes a heart beat? I know it is electric shock in certain cells, but what actually makes this electric shot.
Dr. Jose Nazari (NorthShore)
It is a complex and very well orchestrated exchange of sodium, potassium, calcium and magnesium between the inside and the outside walls of the heart cells. It is an incredible phenomenon almost unique to heart cells.

  David (Chicago, IL) - 12:44 PM:
Instead of genetics testing kind of tests are typically preformed for seeing if you're at risk for SCD?
Dr. Jose Nazari (NorthShore)
a medical history and physical exam are the most important. An electrocardiogram, chest X ray and echocardiogram are often performed too.

  Janette (Skokie, IL) - 12:45 PM:
What do I do if I witness sudden cardiac arrest?
Dr. Jose Nazari (NorthShore)
First and foremost. GET HELP IMMEDIATELY. Then start CPR (if needed, take a class, they are widely available).

  Becky Ofsaiof (Northbrook, IL) - 12:46 PM:
What research are you doing at the time?
Dr. Jose Nazari (NorthShore)
No current research projects on sudden cardiac death. We are studying different defibrillator leads and defibrillators.

  David (Chicago, IL) - 12:47 PM:
Who is at risk for Long QT?
Dr. Jose Nazari (NorthShore)
Patients with a family history of unexplained sudden cardiac death.

  Janette (Skokie, IL) - 12:47 PM:
Is SCD more common among athletes? Why is this so?
Dr. Jose Nazari (NorthShore)
Sudden death is more common during strenous activity beyond the usual levels. Athletes by nature engage more often in this form of activity. Also by nature they are healthier than most and therefore at less risk overall.

  David (Chicago, IL) - 12:48 PM:
Are specific age groups at risk for SCD?
Dr. Jose Nazari (NorthShore)
The prime group affected is men over 50. It can affect anyone, though.

  Becky (Northbrook IL) - 12:49 PM:
What defibrillator seems the most promising now?
Dr. Jose Nazari (NorthShore)
They are all very good. We all develop particular likes for certain brands and models but the differences are often personal or related to specific disease issues.

Kristin Philbin (Moderator) - 12:49 PM:
Thank you everyone for your great participation, the chat will be ending in 10 minutes. Please submit any final questions you have.

  Janette (Skokie, IL) - 12:50 PM:
Is there anything athletes or athletic coaches can do to monitor whether they are pushing athletes/themselves too hard?
Dr. Jose Nazari (NorthShore)
There are guidelines being explored for possibly testing all prospective athletes with a medical history and possibly an EKG

  David (Chicago, IL) - 12:53 PM:
Are there definitive treatments for sudden cardiac arrest?
Dr. Jose Nazari (NorthShore)
A defibrillator.

  Kevin (Mount Prospect) - 12:53 PM:
I have a friend who has heart arrythmias. He's undergone something called a cardioversion to apparently "shock" his heart back into rhythem. Is cardioversion the same thing as defibrilation?
Dr. Jose Nazari (NorthShore)
There are minor technicalities that are diffent between them. A cardioversion is usually planned and a defibrillation emergent.

  David (Chicago, IL) - 12:55 PM:
Other than Long QT, are there any other heart conditions associated with SCD?
Dr. Jose Nazari (NorthShore)
Heart attacks and congestive heart failure are the most common.

  Janette (Skokie, IL) - 12:56 PM:
What causes sudden cardiac arrest?
Dr. Jose Nazari (NorthShore)
The sudden loss of organized electrical activity in the heart (known as ventricular fibrillation and ventricular tachycardia.)

Dr. Jose Nazari (NorthShore) - 12:58 PM:
Thanks for participating. For more information, feel free to contact (847) 570-2640, the electrophysiology department of NorthShore University Health System.

Kristin Philbin (Moderator) - 12:58 PM:
Thank you again to everyone for joining us today. If you have any more questions, please visit the Cardiac Electrophysiology Department for additional information and resources.

This chat has ended.

Thank you very much for your participation.