Sudden death from abnormal heart rhythm: Am I at risk?

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1 DISCLAIMER: The views and opinions expressed in this presentation are those of the author. The slides in this presentation are prepared as talking points. It is possible that key substantive elements were delivered orally during presentation and are not present on the slides. The presentation is designed to provide the public with general information. The information in this presentation is not to be distributed, changed or altered in any way without expressed, written permission from the National University Heart Centre, Singapore. 1 Sudden death from abnormal heart rhythm: Am I at risk? NUHCS The HEART Truth 2015 Dr Pipin Kojodjojo ( 许丕评医生 ) Consultant in Cardiology (Cardiac Electrophysiology) Assistant Professor in Medicine National University Hospital Singapore 2 1

2 The heart functions as a pump to circulate blood around the body Regular beating of the heart is sustained by an remarkable built-in electrical system Normal Electrical Functioning of the Heart Our hearts beat 100,000 times per day Normal heart rate 50 to 80 beats per minute Starts from 6 weeks in womb until death Over our lifetime, the heart will beat 3 billion times (3,000,000,000+) 3 Arrhythmias - Terminology Problems with the electrical system of the heart = Arrhythmias Two broad groups of Arrhythmias: 1. Heart beat too slow / too few Bradycardia 2. Heart beat too fast / too many - Tachycardia 4 2

3 Causes of Sudden Death Tachycardia 83% Bradycardia 17% 5 Bradycardia Usual heart rate ranges from 50 to 80 beats per minute at rest Due to heart rate too slow or missing heart beats, patients experience symptoms such as: Tiredness Breathlessness on exertion Giddiness, loss of consciousness and sudden death 6 3

4 Causes of Heart Block Ageing (by far most common) All forms of heart diseases e.g. heart attacks, heart failure Heart Surgery Congenital (born with heart block) Infections unlikely in Singapore 7 Pacemakers : Only Treatment for Bradycardia Battery (30g) and 2 wires More than 1 million implanted worldwide yearly More than 9 million people carry a pacemaker today Done under local anaesthesia Takes minutes Battery lasts > 10 years No restrictions on travel, driving, work 8 4

5 Tachycardia Rapid heart beat (in excess of 100 beats/min) Tachycardia can originate from the Top chambers of the heart (supraventricular tachycardia / SVT) Bottom or pumping chambers of the heart (ventricular tachycardia / VT) 9 Life-threatening Ventricular Tachycardias Rapid beating of the pumping chambers (usually more than 200 beats per minute) Starts suddenly Symptoms include palpitations, dizziness, sudden death 10 5

6 Ventricular Tachycardia: Q&A What causes it? Most commonly occurs in patients with weak hearts (heart failure) After a heart attack (myocardial infarction) Any condition that results in scarring of the heart (surgery, infections) Less common hereditary conditions (younger patients, usually with a family of sudden death) Some patients may not know that they have underlying heart disease If I don t feel any symptoms, am I safe? No relationship between symptoms and seriousness of the condition is poor. In a few patients, sudden death can be the first symptom Can it be picked up if I went for check-up with ECG? Not always tachycardias come and go. A normal ECG does not rule out tachycardia 11 ECG During Episode of Sudden Death VT often degenerates into asystole (no electrical activity within the heart) in less than 10 minutes The only successful treatment is to defibrillate (controlled electrical shock) the patient Early defibrillation is key to good outcomes 6:07 AM 6:11 AM 12 6

7 Availability of Automated Defibrillators in Public Places (MRT / shopping malls) But being able to deliver defibrillation to a patient in need within 10 minutes is very difficult! 13 More sophisticated devices, derived from pacemakers are used to treat VT and prevent sudden death Implantable defibrillators (ICD) to prevent sudden death Cardiac Resynchronisation Therapy (CRT) to improve function of failing hearts 14 7

8 How can you protect yourselves from sudden death? Healthy living and lifestyle Be vigilant. If you experience symptoms, seek medical advice and have the appropriate tests Regular check-up for certain at-risk groups (above 60 years old, diabetes, hypertension, strenuous sports) Unexpected diagnosis / death in the family Learn CPR (Singapore Heart Foundation) 15 Advances in telemedicine Injectable cardiac monitor Injected under skin using local anaesthesia in 2 minutes Continuous recording of heart rhythm for 3 years Able to identify abnormal heart rhythms (bradycardia / tachycardia) Automatically initiate transmission and alert physician to take action 16 8

9 State of Art Telemedicine Injectable cardiac monitor Wireless technology allows for continuous remote monitoring of patients around the world We currently employ this technology to monitor patients living in Singapore, Indonesia, Malaysia, Burma, US and Europe 17 Summary Our heart beats according to electrical pulses travelling through a built-in electrical system Sudden death is caused by the heart beating too slow (bradycardia) or too fast (ventricular tachycardia) Implantable cardiac devices such as pacemakers / ICDs / ablation can effectively prevent sudden death Do not disregard symptoms and seek medical advice NUHCS will make use of continuous advances in technology and medical research to minimize risk of sudden death Healthy living 18 9