Sudden death is an unexpected and sudden death in an apparently healthy person. It is most common in adults between the ages of 50 and 65 and affects men twice as often as women. Every year there are about 20 thousand sudden death episodes, and it is something uncommon in children. It only affects 1 in 100,000 of them annually. Sudden infant death is more widely known and occurs in babies under 6 months of age, with no prior known disease. The cause is unknown, but the risk is reduced if the infants sleep on their backs and the mother has not smoked during pregnancy.
The causes of sudden death are cardiovascular, arrhythmias, myocardial infarctions, and complications, ruptures of the great arterial vessels (aortic dissection), or massive thrombi in the arteries of the lung (pulmonary thromboembolism). But it is known that the most frequent cause is myocardial infarction and its arrhythmic complications.
When sudden death occurs during exercise, it is usually in people with unknown heart disease. The most frequent diseases as a cause of death in athletes are obstructions of the coronary arteries (heart attacks) in those over 40 years of age and hypertrophic cardiomyopathy in those under 35 years of age.
However, although it may seem otherwise due to its media exposure, sudden death in athletes is rare and less than that of the general population. In younger athletes, it occurs in one in 100,000 per year. In athletes over 35 or 40, sudden death occurs in 15,000 runners and one in 50,000 marathon runners specifically.
What to do when it occurs
Notifying emergencies and starting cardiopulmonary resuscitation (CPR) maneuvers as soon as possible is advisable when a person presents a loss of consciousness and stops breathing. CPR maneuvers are easy to perform if you have undergone basic training in which you learn both cardiac massage and how to use the defibrillator.
The likelihood that a cardiac arrest will lead to death depends on the cause of the cardiac arrest, and the time it takes to treat it. A cardiac arrest that is not treated with CPR maneuvers in the first minutes will be fatal. CPR maneuvers are the same for all causes of cardiac arrest. Still, the result will depend on the underlying cause: for example, if it is an arrhythmia that responds to the defibrillator, the prognosis is better than if it is a cardiac or aortic rupture.
Previous symptoms and how to take precautions
Some people have palpitations, dizziness, loss of consciousness, or chest pain before sudden death. However, in more than half of the cases, sudden cardiac arrest occurs without previous symptoms.
Therefore, symptoms of oppressive chest pain, shortness of breath, dizziness, loss of consciousness, or palpitations require medical evaluation. This is more urgent if several of these symptoms are present simultaneously, for example, chest pain and shortness of breath or palpitations with loss of consciousness. Also, people with a family history of sudden death or early cardiovascular disease are at higher risk.
Treatment should start without delay outside the hospital with CPR maneuvers and notify the Emergency Medical Service (061) that they will start or continue with advanced CPR (performed by doctors, with orotracheal intubation, administration of medication …) and then transfer to the hospital. Upon arrival, supportive treatment of vital signs is performed, and the cause of the cardiac arrest is investigated, collecting the history, previous symptoms, response to CPR, electrocardiograms, and urgent tests.
Depending on the suspected cause, different tests or treatments are performed. For example, if the cause is a myocardial infarction, an opening of the coronary artery is made that causes it, employing a stent angioplasty, a small prosthesis shaped like a spring that keeps the artery open and restores blood flow.
Once it has been possible to avoid sudden death, applying the appropriate protocols, we will speak of sudden resuscitated death. The treatment and prevention of new similar episodes in that person depending on the cause that caused it. Some patients will require a defibrillator’s implantation because the cause cannot be eliminated, and they are at risk of recurrence. The defibrillator is a device that is normally placed under the skin and protects them from new arrhythmic episodes. The sequelae depend, above all, on the damage that the brain has suffered and in which the key factor is the time it took to initiate the CPR maneuvers.