Is COVID-19 raising the risk of sudden cardiac arrest among women?

 

The COVID-19 curve is rising exponentially. The times are more alarming for people with pre-existing heart conditions as studies suggest that the novel virus is putting them at an added risk. COVID-19 patients suffering from cardiac arrest are more likely to die than those are not tested positive for COVID-19 as per studies. Additionally, the study emphasized how the risk for women is nine times more than men. Over the years, technology advancements have helped us fight the heart disease burden to a large extent. However, the Covid-19 pandemic has brought forward an urgent need to raise awareness on fears like sudden cardiac arrest, especially for women who are more likely to be affected.

Sudden Cardiac arrest is the outcome of an atypical heart rhythm, due to the irregular functioning of the heart’s electrical system. Our heart has an electrical system that wheels the rhythm and rate of each heartbeat. Sometimes, when the heart’s electrical system is not functioning appropriately, it can lead to irregular heartbeats. This means either the heart beats too fast, or in irregular rhythms, and in some cases, the heart stops pumping blood to the body— leading to SCA. Often, SCA is confused with or for a heart attack. It is vital to know that both are not the same. While a heart attack happens when the supply of oxygen-rich blood is blocked to an artery, the heart usually doesn’t suddenly stop beating as in SCA. Hence, SCA can also happen after recovery from a heart attack.

Symptoms of a sudden cardiac arrest include— loss of breath, shortness of breath, collapse in some cases, loss of consciousness, chest discomfort or fast heartbeat, palpitations, to name a few. In case you are in a situation where someone is suffering from a sudden cardiac arrest, and immediate medical help is yet to come, try to push the patient’s chest, hard and fast. Try to keep this between 100 to 120 compressions per 60 seconds. The chest should completely rise between the compressions. Cardiopulmonary resuscitation (CPR), or just giving compressions to the chest have improved patient outcomes over the years. There is a need to identify those patients who are predisposed to have sudden cardiac death.

Preliminary investigations like ECG (echocardiogram) TMT and HOLTER (24hrs ECG) go a long way in identifying people who are predisposed for such a catastrophe. In the setting of COVID, increased predisposition to heart attacks, arrhythmias and sudden cardiac deaths are noted . People recovering from COVID need to be on certain preventive medications and do need stratification by way of investigations.

With the help of professional medical care, the experts administer a shock externally to correct the rhythm of the heartbeat. In some cases, doctors may ask some questions to understand the symptoms and recommend an echocardiogram test (ECG) to understand the impact of SCA on the heart muscle. For further examination, sometimes a test called ejection fraction is recommended to understand the functioning of the heart, more closely observe the percentage of blood being pumped out of the heart’s chambers with each heartbeat. For instance, weak ejection fraction, or reduced fraction indicates damage to the heart muscle or a valve. In these cases, a cardioversion defibrillator (ICD) is implanted to bring the heart beats back to normal. ICDs are implantable devices which are used in people with ejection fraction less than 35 %. They administer a shock internally to correct the rhythm by delivering pulses or shocks to revive a traditional cardiac rhythm. These technologies run on batteries that’s sealed inside the device.

Until a few years ago, these devices were transvenous, the wires were inserted in a patient’s veins. Owing to technological advances, we now have more sophisticated systems like the S-ICD, a subcutaneous implantable defibrillator which has been successful in providing protection from sudden cardiac arrest (SCA). It also leaves the vasculature untouched. Although it works like the transvenous ICDs, using a pulse generator, what makes it different is the wires from the device are inserted under your skin, instead of your veins. This makes it easy to replace or remove when the need arises. From detecting a fast to abnormal heart rhythm to delivering energy to the heart to function perfectly, the device sends an energy shock to restore the functioning of your heart. In case of sudden cardiac arrests, S-ICD technology has come as a lifesaver.

Even as technology plays its role, it is imperative to make lifestyle changes to lower the risk of sudden cardiac arrest. For example, simple steps like walking or exercising at least 30 minutes a day, quit smoking, eating a diet rich in fiber, like whole grains, vegetables, fruits, etc. and watching the calorie intake, can prevent SCA. Consult your doctor for managing your bodyweight and lifestyle better. Get a plan that suits your body type and heart condition. Having said that, with simple lifestyle management, timely intervention and raising our awareness levels about the technologies that exist today, we can save many lives lost due to sudden cardiac arrest.

 

Authored by Dr. Abhijit Vilas Kulkarni – MD DM
Consultant Cardiologist & Electrophysiologist, Apollo Group of hospital, Bangalore