Sudden cardiac death without warning

Sudden cardiac death usually overtakes people completely unexpectedly

10/18/2012

Sudden cardiac death causes more than 100,000 deaths annually in Germany. The victims succumb suddenly to a cardiological event. Possible causes include heart muscle inflammation, cardiac arrhythmia and structural heart disease. The underlying diseases often go undetected in the run-up to sudden cardiac death.

While in the elderly, sudden cardiac death is usually the result of a heart attack with massive cardiac arrhythmia, younger patients often have cardiac arrest infections as the cause of sudden cardiac death. The infection causes myocarditis, which can lead to cardiac arrhythmia, ventricular fibrillation, and eventually death. Since the heart muscle inflammation often goes unnoticed for a long time, it is particularly dangerous for those affected, as well as the tragic death of the model Jennifer Scherman, known from the Vox casting show „The perfect model“, tragically illustrated. Scherman suffered myocarditis as a result of a delayed influenza infection and died of sudden cardiac death at the age of only 20 years.

Heart muscle inflammation as a cause of sudden cardiac death
Although heart muscle inflammation is relatively rare overall, the risk is by no means to be underestimated. Because the myocarditis is often diagnosed only very late. In about 20 percent of the cases, the diagnosis is determined only after autopsy of the deceased. The diagnosis of heart muscle inflammation is relatively difficult, not least because of the non-specific symptoms. Clear leading symptoms are unknown. General malaise, fatigue, fever and respiratory distress are more common in the course of the disease but are also associated with many other diseases. A small proportion of patients experience breast puncture, heart pain, heart stuttering or palpitations, providing at least reasonably reliable evidence of heart discomfort.

Unspecific symptoms of myocarditis
The Deputy Director of the Department of Cardiology and Pulmonology at the Berlin Charité, Carsten Tschöpe, also confirmed „World Online“, that the „virus-related myocarditis not easy to diagnose“ is. Therefore, special attention should be given to the relatively nonspecific symptoms. This „are warnings that need urgent clarification“, emphasized the expert. Tschöpe called cardiac ultrasound and electrocardiogram the most important examination methods for the diagnosis of myocarditis. Hereby the disturbances of the heart function can be proven relatively clearly. However, myocarditis causes no disturbed heart function, it is reliably detected neither by ultrasound nor by an electrocardiogram. Here only a biopsy (tissue sampling) of the heart muscle can make a clear diagnosis possible. However, this is relatively expensive and always brings with it an injury to the heart.

Myocarditis mostly triggered by viruses
Possible indications of myocarditis also provide the treating physicians with the history of the disease. If the current rather unspecific symptoms were preceded by an infectious disease, it is suspected that the infection may have spread to the heart. In case of unspecific signs of myocarditis, the treating physicians should definitely take their time and ask patients about recent infectious diseases. In general, viral, bacterial or parasitic infections may also affect the heart and cause myocarditis here. In this country, however, mostly viral infections are the cause of myocarditis. Enteroviruses, in particular the so-called coxsackie viruses, are regarded as the most frequent trigger. Myocarditis caused by bacteria or parasites is extremely rare in Germany.

Sport as a cause of myocarditis?
The enteroviruses usually cause only a flu infection with typical symptoms such as fever, headache and body aches. If those concerned are not sufficiently cared for and are possibly still physically active, the risk of spreading the infection to the heart muscle increases. Sport during a flu infection is, according to the experts as a significant risk factor for the occurrence of myocarditis. The heart muscle inflammation heals in most patients on their own again, but a fifth of those affected shows a much more severe course. „In these cases, the immune system can no longer stop the inflammatory reaction of the heart“, explained the expert from the Berlin Charité.

Heart muscle inflammations with fatal consequences
In the course of myocarditis that will „Heart then in the course of more and more damaged“ and ultimately threatened the sudden cardiac death, so Tschöpe opposite „World Online“. According to the expert from the Berlin Charité, the affected patients usually come to the doctor only after the original symptoms of the flu have subsided with a long existing heart muscle inflammation. The damage to the organ is therefore often too advanced to eliminate it. Succeed here „Unfortunately, not always, the normal heart function completely restore“, Tschöpe explained. However, permanent damage to the heart is still a rather harmless consequence of myocarditis compared to the dramatic consequence of sudden cardiac death. Because too much of the heart muscle is damaged by the inflammation, the heart can no longer apply the required pumping power, severe cardiac arrhythmia, ventricular fibrillation and at worst a complete failure of the organ are the result. Patients must be admitted to a hospital immediately as a cardiac emergency to avoid a fatal outcome as far as possible. (Fp)

Also read:
Sudden cardiac death depending on the time of day
Stress & anger worsens heart attack prognosis
Often no heart attack diagnosis by ECG
Heart attack worse in the morning than in the evening

Image: Michael Bührke