Plotse hartdood

Patient experiencing a Sudden Cardiac Death


Wat is plotse hart-dood?

Plotse hartdood ( SCD ) is de medische term voor een onverwachte dood veroorzaakt door het verlies van hartfunctie. Dood treedt binnen een uur na de eerste aanvang van de symptomenop. Elk jaar, komen er 50-100 plotselinge hartdood voor per 1000 sterfgevallen in Europa en Noord-Amerika.1 In Nederland, ongeveer 10.000 mensen sterven aan een ischemische plotse hartdood, dit 26% van het totaal aantal sterfte aan hart en vaatziekte.2 Sportatleten hebben een extra verhoogd risico. Dit bedraagt 2 tot 4 maal zo hoog in vergelijk tot andere mensen.3 Het lijkt er echter op dat dit niet de oorzaak is van het sporten maar van onontdekte (mogelijk aangeboren) hartaandoeningen, die onder extreme langdurige belasting van het hart ,een hartstilstand of ventrikelfibrilleren kunnen veroorzaken.

Wat zijn de oorzaken van plotse hartdood?

De meest voorkomende oorzaak van acute hartdood bij volwassenen van middelbare leeftijd of ouder is coronaire hartziekte (CAD) . In veel gevallen gaat, ventriculaire fibrillatie vooraf aan het uiteindelijke hartfalen. Een hart aanval , andere hart ritmestoornissen , hartklepaandoeningen of aandoeningen van de hartspier (cardiomyopathie of myocarditis) kunnen SCD veroorzaken. In ongeveer 55 procent van de gevallen is de onderliggende aandoening onbekend tot nadat de tragische gebeurtenis zich heeft voorgedaan.4

What Are the Risk Factors for Sudden Cardiac Death?

Generally speaking, anyone may suffer from sudden cardiac death. People with cardiovascular diseases, middle-aged or older people, the overweight and patients suffering from diabetes are at higher risk than young and healthy people. Smoking, lack of exercise, stress and alcohol abuse also elevate the risk. While exercise in itself does not elevate the risk, intensive physical training or participating in an athletic competition may lead to sudden cardiac death if the heart is weakened by a disease, e.g., undetected myocarditis due to an infection.

How Do I Recognize Sudden Cardiac Death?

Usually, sudden cardiac death occurs without prior symptoms. Affected people collapse abruptly. They do not respond to sound or touch. Their pulse is not palpable and they stop breathing within one minute. Their pupils are enlarged and their skin may have an ashen color. Without immediate treatment to restore the heart’s rhythm, death occurs within minutes.
Sometimes, patients may experience a racing heartbeat, chest pain, shortness of breath, or feel dizzy, alerting them to a potentially dangerous heart problem. Fainting may also precede sudden cardiac death. If you experience or witness these symptoms, please seek emergency medical help immediately. Following the event, it is prudent to undergo a thorough examination from a physician, including electrocardiography (an EKG or ECG).

How to Provide Basic Life Support

In case of sudden chest pain, shortness of breath and/or fainting, an emergency medical team must be called immediately. Unconscious patients without a palpable pulse have to be reanimated by cardiac massage (also called cardiopulmonary resuscitation or CPR) because three to four minutes without oxygen can cause irreversible brain damage. Basic life support should be continued until the emergency physician arrives.
In the case of ventricular fibrillation, defibrillation (cardioversion) might be an option to halt the heart rhythm disorder and to reset the heart’s normal activity. Nowadays, there are so-called automated external defibrillators (AEDs) in many public locations and public buildings. Easy to understand step-by-step instructions assist the first aider to handle these defibrillators correctly.

How Can I Prevent Sudden Cardiac Death

One of the most important measures to prevent sudden cardiac death is to diagnose cardiovascular diseases early and treat them appropriately. Athletes, in particular, should undergo regular cardiovascular examinations in order to detect hidden cardiac health issues in time. In addition, one should pursue a healthy lifestyle and avoid risk factors like lack of exercise, obesity, smoking or alcohol abuse.

1 John et al. Cardiac Arrhythmia 3 Ventricular arrhythmias and sudden cardiac death. Lancet 2012; 380: 1520–29

3 Ferreira et al. Sudden cardiac death athletes: a systematic review Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2010, 2:19 doi:10.1186/1758-2555-2-19