The sudden death of the Lebanese Anchor, Najwa Qassem, and many others incidences created interest in knowing what happened and why it happened. Why, from time to time, do we hear about cases where people who would look so healthy, just fell down?
Several public figure such as late star Haitham Ahmed Zaki and the soccer player Mohamed Abdel Wahab, many other youth met their death due to what is always explained as: a sharp drop in blood circulation.
I went to one of the iconic figures in this speciality.. Dr. Sherif Mokhtar.. Professor of Cardiology and Board Chairman at the Egyptian College of Critical Care Physician and founder of “Save a Life” initiative, which he launched three years ago to help save the victims of sudden death.
Here is an excerpt of an interview with Dr. Mokhtar.
Causes of sudden cardiac arrest:
*What does Cardiac arrest mean and does it strike a healthy person or a person with heart disease?
Cardiac arrest or sudden death is defined as the occurrence of an unexpected death within an hour after symptoms or even without symptoms and in more than two-thirds of cases; people get surprised by the death of a person without being able to exactly define when it happened.
Rarely, does cardiac arrest happen in healthy hearts, and what is called a healthy heart might not be as healthy as thought, and this is due to deficiencies in modern diagnostic methods, which whenever the accuracy increases and the level rises, the cardiopathy is shown upon physical examination or electrically.
Among the scientific facts that research has shown is that cardiac arrest is more common in males than females (2-3 times) and is more common in people who already have heart disease (6-8 times). In adults, coronary artery clots is the most common (60 - 80%). Sudden death rate increases with age, but it may occur in people who do not have apparent diseases (cardiac dysfunction) at relatively young ages as a result of genetic predisposition (such as genetic heart enlargement). Unfortunately, we do not have similar statistics in Egypt.
*Does genetics have a role in sudden cardiac arrest?
There is no doubt that the family history, especially of young cases, plays a role in identifying potential victims. A study was conducted in the United States on more than 1,400 athletes who died from cardiac arrest in their youth. It turns out that genetic heart enlargement (cardiac hypertrophy) tops the list of causes.
As for the electrophysiological disorders of the heart, this can only be discovered by conducting electrocardiograms first. Further electrophysiological studies may be required, and a genetic examination may be needed to determine the genes or genetic mutations that may cause sudden death.
*What about the sudden death of athletes, who are supposedly in their utmost health conditions, or people like the late star Haitham Zaki, for example?
Sudden death may occur as a result of violent sports activity (such as a punch in the chest or rib cage during a boxing match, hockey racket or baseball) or causes outside the heart, such as a pulmonary artery clot, and it is worth noting that some drugs that provoke the involuntary nervous system may precipitate death, especially medicines containing decongestants (if used excessively) in cases of colds or anti-depressants.
*Is there a way to save lives from this phenomena?
Usually 80% of stroke occur before transportation by ambulance. Among this percentage, 50% of those die after reaching hospital. The destruction of cerebral cortical cells (responsible for awareness and cognitive abilities) occurs within 6-8 minutes of cardiac arrest, hence the importance of rapid intervention with immediate chest compressions to effectively pump the heart as well as mechanical or artificial breathing methods.
In the case of non-immediate intervention, the chances of returning to healthy life decreases at a rate of 7% with each passing minute. However, if the immediate recovery process succeeds, the rate of rescuing victims may increase to 30%, especially with the use of an external shock device.
*I heard about “Save a Life” initiative.. that you founded in 2014 to save the victims of sudden death; can you give us a brief information about the initiative?
The Egyptian College of Critical Care Physicians is an organization that includes all medical professions in this field and was approved by a decision of the Council of the Egyptian Medical Syndicate in 2011); it decided to undertake a project that aims to address this problem, which has almost no statistics but American ones talking about an incidence rate of 1 in every thousand people and one in every 50,000 athletes. The incidence rate is 1 to every 2000 people under the age of 18 years (7 million worldwide).
The problem is statistics in Egypt
In a large country like Egypt (one million square kilometers, more than 100 million people and 28 governorates), the greatest difficulty with this problem lies in the following:
First: The lack of accurate statistics on the magnitude of the problem and the numbers of patients at risk of cardiac arrest, especially with lack of accuracy in clinical examination reports when issuing a death certificate and only mentioning the typical phrase "sudden drop in blood circulation."
Second: The difficulty of carrying out resuscitation process by those surrounding the patient, due to the insufficiency of training programs that are currently limited to physicians, while it must extend to include all physicians at senior grades and medically assisted professions or paramedics (nursing, technicians and assistants), and they must extend to also include selected groups of people whom have the basic skills to perform resuscitation.
Third: Inefficiency and inadequacy of awareness programs that should aim at urging family members of those who are likely to be affected to undergo thoroughly check up with modern diagnostic methods.
*What are the objectives of the project to face of these difficulties?
The project aims to:
-- Investigative search for potential victims and their first and second degree relatives and putting them up to clinical examination, electrical planning and laboratory analysis with a view to preventive or definitive treatment for those who are proven to be at risk.
-- This can be done via: (1)The statistical survey of the governorates to determine the size of the problem, nationally, by selecting a representative sample for the Egyptian people. (2) Examining the families of victims of cardiac arrest by studying history. (3) Carry out advanced diagnostic studies that potential victims may need, such as electrophysiological studies, cardiac catheters and MRIs. (4) The immediate intervention phase for survivors of cardiac arrest or relatives who are at risk of stroke, including implantation of pacemakers and Implantable cardioverter defibrillator (ICD), electrophysiologic ablation to ectopic foci, and diagnostic coronary angiography, stenting and Percutaneous Coronary Intervention (PCI).
-- The project also aims to train on Basic Life Support and Advanced Cardiac Life Support for physicians with Egyptian programs accredited by the Egyptian College of Critical Care Physicians in association with Egyptian Medical Syndicate and the Egyptian Association of Continuing Medical Education.
This includes other organisations the nursing and associated medical professions (lab and catheter technicians, radiologists and paramedics) and for citizens who are psychologically and physically qualified to participate and carry out basic resuscitation if the heart stops in community places from schools, educational institutes, universities, factories, companies, major institutions, and sport clubs ... etc.
With the beginning of the year 2014, the project started with an exploratory study, which included 8786 inpiduals by filling out the questionnaire forms by faculty members at Cairo University, the Shooting 'Al Sed' Club, the Al-Ahly Club, and five medical convoys toured neighbourhoods in Cairo. This study was completed in 2016 and published in the Journal of the Egyptian College for Critical Care Physicians .
Read about :here
Contributed by Yassmin El Sayed
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