UC HEALTH LINE: Heart Attack Can Strike Those Who Least Expect It

Sudden heart attack can strike anybody—not just the aging, or people we consider to be “out of condition.”

It can fell young adults, and children, and even those who make heroic efforts to keep fit … athletes seemingly in the prime of life.

As we head into spring, with all its outdoor family activities and strenuous organized sports, it’s time to consider the unsuspected risks that many of us face from sudden heart attack.

Depending on your medical and family history, says Mehran Attari, MD, it might be wise to consider screening.

“Sudden death doesn’t just occur when people with heart disease exercise, it can happen during minimal activity—even while you’re sleeping,” says Dr. Attari, an assistant professor of medicine at the University of Cincinnati Academic Health Center and an electrophysiologist with the UC Heart & Vascular Center.

The moderate to intense activity required by most team sports, including hockey, basketball and football, may place an additional strain on the heart, he points out. He cites the sudden deaths of

28-year-old Atlanta Hawk center Jason Collier, in October 2005, and 23-year-old Loyola Marymount University basketball player Hank Gathers in March 1990, and the indefinite sidelining of Detroit Red Wings defenseman Jiri Fischer, 25, who collapsed on the bench during a November 2005 game.

Sudden cardiac death victims don’t even have to be as “old” as their 20s, Dr. Attari says. In fact, about 100 sudden deaths occur each year in high school and college athletes,

Most of these deaths, says Dr. Attari, are associated with such problems as an enlarged or inflamed heart, abnormal coronary arteries and heart valves, or irregular heart beat caused by disturbances in the heart’s natural electrical pulse mechanism.

Many people who have died from sudden heart attack had earlier experienced a very fast, abnormal heart rhythm (atrial fibrillation) that caused them to faint, he says. Without a strong, steady heart beat, blood is not pumped out from the heart efficiently, the brain quickly becomes deprived of oxygen, and a sudden loss of consciousness or sudden death occurs.

Most heart conditions cannot be identified during a routine physical examination, Dr. Attari says. That’s why it’s really important to know your family history and watch for signs and symptoms.

“If anyone in your family has suffered a sudden or unexplained death, or if any of your relatives under the age of 50 suffer from heart disease—talk with your doctor,” he advises.

A thorough evaluation, including an electrocardiogram and other imaging studies, needs to be done if you or an athlete you know has a history of heart murmur, high blood pressure, fatigue, fainting and near fainting, excessive shortness of breath during exertion, chest pain or irregular, fast or slow heart beat.

A physician may perform other tests, such as an echocardiogram, heart ultrasound, ambulatory heart monitor, treadmill exercise and CT and MRI scans.

“However,” Dr. Attari insists, “nothing can replace vigilance about any abnormal symptom.”

When starting an exercise program, especially of moderate to high intensity, Dr. Attari says, assess your risk by completing an American Heart Association fitness-facility screening questionnaire. And it’s always wise to consult a physician before starting an exercise program if you have experienced fainting or shortness of breath, have a family history of heart or vascular disease, have heart disease risk factors such as high cholesterol, high blood pressure, diabetes or obesity, or are a smoker.

Even people without these risk factors should enter an athletic/exercise program gradually, he says.

Dr. Attari offers a final word of advice: Become familiar with cardiopulmonary resuscitation and use of the automatic external defibrillator, both of which can significantly increase a sudden death victim’s chances of survival when applied promptly.

UC Health Line contains timely health information and is distributed every Tuesday by the UC Academic Health Center public relations and communications department.