The world is battling cardiovascular disease (CVD) burden for decades that account for almost 31 percent of deaths. More alarmingly, 75 percent CVD deaths occur in low- and middle-income countries, including India, where high blood pressure remains the most critical risk factor for cardiac ailments.
Now, coronavirus and its after-effects have added to the woes of patients across India. Several patients report heart damage months after they have recovered from COVID-19.
The inflammation triggered in the body by COVID-19 may weaken the heart muscle, and lead to clot formation in blood vessels and abnormalities in heart rhythm. Additionally, for people with pre-existing heart diseases, the virus can result in the rise of different heart ailments.
This is worrisome for a country like India that where total deaths due to non-communicable diseases attributed to CVDs are huge. Among cardiac problems, sudden cardiac arrest contributed to about 10 percent of overall mortality in the country.
Sudden cardiac arrest can affect a seemingly healthy person of any gender or age at any time without warning. Survival is subject to the amount of time between the onset of the sudden cardiac arrest and treatment available. The chances of survival are reduced by seven to 10 percent with every minute of delay in care.
Understanding cardiac arrest
When the heart’s electrical system does not work efficiently, an abnormal heart rhythm also known as arrhythmia develops which is usually the cause of sudden cardiac arrest.
Even though these arrhythmias are brief and harmless, at times, some can lead to sudden cardiac arrest. Erratic and rapid electrical impulses cause the ventricles to quiver instead of pumping blood. Therefore, reduced blood to the brain causes unconsciousness when sudden cardiac arrest occurs.
It is imperative to understand that a life-threatening arrhythmia usually develops in a person with a pre-existing heart condition. These conditions include heart attack, coronary artery disease (CAD), valvular heart disease, enlarged heart known as cardiomyopathy, congenital heart defect, and electrical problems in the heart.
Warning signs and symptoms of sudden cardiac arrest include unexplained fainting or dizziness, fatigue, heart palpitations, rapid or irregular heartbeats, shortness of breath and wheezing.
Managing cardiac arrest with palliative care
If you notice someone around you with sudden cardiac arrest, you should push the person’s chest at a rate of 100 to 120 compressions a minute, until professional cardiac care is available and ensure that you permit the chest to completely rise between compressions.
When a person with sudden cardiac arrest is under medical supervision, the doctor administers a shock externally to correct the rhythm of the heartbeat. Subject to symptoms, a physical examination is conducted to check for problems like irregular heart sounds, heart enlargement, water retention and swelling or tenderness of the liver.
This is followed by blood tests, x-rays, an electrocardiogram, ECG test and the doctor will evaluate the patient’s condition by asking questions regarding the cardiac attack.
Another test called Echocardiography reveals the Ejection Fraction. Ejection Fraction is carried to check the general functioning of the heart and the percentage of blood that is pumped out of the chambers of the heart with each heartbeat.
A reduced ejection fraction indicates weakness of the heart muscle, heart attack in the past that damaged the heart muscle, heart valve problem and uncontrolled high blood pressure.
Saving lives with technologies: Zooming in on implantable cardioverter defibrillator
After diagnosis, the doctor recommends treatment options such as medications, implantable devices, and surgeries. As medical science has evolved remarkably in the last two decades, we now have minimally invasive techniques of managing patients with sudden cardiac arrest.
For instance, an in-built implantable cardioverter-defibrillator (ICD) is used for people with an ejection fraction less than 35 percent to detect abnormal heartbeats and restore normal ones.
Over the years, ICD has helped in reducing hospital stays, saved millions of lives, and given patients a better quality of life. ICD is a pager-sized device placed in the patient’s chest to reduce the risk of dying when the lower chambers of the heart stop beating effectively.
Like any other device, ICD runs on batteries that deplete with time. It is unsafe to change it repeatedly as the battery is sealed inside the device. Therefore, the entire device had to be replaced after every three to seven years that increased the risk of infection and treatment cost.
As healthcare breakthroughs have made significant stride in India, the devices used now run on batteries that last for at least 13 to 16 years. This eliminates the need of repeating the implant.
Today, when innovations have redefined cardiac care in India, it is unfortunate that the success rates of immediate treatment through cardiopulmonary resuscitation (CPR) remains abysmally low at one percent.
This is due to lack of awareness and the delay in response time due to longer congestion on the roads. Therefore, there is a dire need of spreading awareness about palliative care available for sudden cardiac arrest and lifestyle changes that can go a long way in giving people a better quality of life.
—Dr Ashish Chauhan is a Senior Consultant, Interventional Cardiology at Sarvodaya Hospital, Faridabad. Views expressed are personal.