As a 42-year-old doctor and avid trekker from Sassoon General Hospital in Pune died due to breathing difficulties and a suspected cardiac arrest while trekking in Himachal Pradesh, there seems to be more questions about heart health than answers. However, there are conditions which can cause sudden deaths.
Dr Nitin Abhivant, Head of the Psychiatry Department at the government-run hospital, was on an expedition with his friends from Mumbai. “The group began the trek on Monday morning, but within half an hour, he started experiencing severe breathlessness. His doctor friends attempted to revive him and rushed him to the base camp but he could not be saved,” a hospital official said. This is thought to be a sudden cardiac arrest, when the heart’s electrical impulses go haywire and stop suddenly, or pulmonary embolism, when a blood clot sneaks up to the lungs and obstructs blood flow.
Can a fit person get a sudden cardiac arrest?
Since he was fit through the years and a doctor at that, most probably, he didn’t do an immediate heart test to understand what condition it was in and whether it could adapt to unaccustomed physical activity or stress of any kind.
“A person could be trekking with a 50-60% arterial blockage, which might remain symptomless until a moment of extreme exertion. During high physical stress like trekking or running, blood pressure and heart rate rise significantly. If there are cholesterol plaques in the arteries, they can rupture. The body tries to repair this rupture using platelets, but in the process, a clot might form, blocking the artery entirely and triggering a heart attack. A heart attack can also alter the heart’s electrical activity, triggering cardiac arrest,” says Dr Kaushal Chhatrapati, interventional cardiologist at Saifee Hospital, Mumbai.
That’s why besides extended lipid profile and blood tests, he recommends a 2D Echo (which assesses the structure and function of the heart) and calcium scoring (an imaging test of calcium deposits and plaque) to every adult over 40 years before undertaking any adventure activity.
“At high altitudes, oxygen thins out. When the body and lungs cannot adapt to this reduced availability, this results in pulmonary edema. Fluid accumulates in the lungs, blood vessels in the lungs squeeze together, causing fluid to leak into air sacs, Consequently, blood oxygen saturation (SpO₂) levels fall. Low oxygen levels can strain the heart and potentially trigger arrhythmias (irregular heartbeats) and stop the heart,” says Dr Rajiv Bhagwat, senior consultant cardiologist at Breach Candy Hospital, Mumbai.
What about family history?
Family history could be the reason for a sudden onset of a heart issue. Dr Bhagwat feels family history should be taken very seriously as a risk factor because such patients have elevated levels of lipoprotein (A), a stubborn kind of cholesterol that clings easily to heart vessels, leading to aggressive build-up of plaque. It is also the reason for recurrent heart attacks.
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“Lp(a) causes embolism, which leads to a sudden drop in oxygen levels, a rise in blood pressure and ultimately, cardiac arrest,” says Dr Balbir Singh, Chairman, Cardiac Sciences, Max Healthcare.
Some people have a rare genetic disorder called hypertrophic cardiomyopathy, which thickens the heart muscle gradually, preventing the heart from pumping the required amount of oxygenated blood with each heartbeat. “Such people may only feel symptoms with exercise or exertion, which in turn trigger sudden cardiac arrest,” says Dr Singh.
The role of stress and other factors
Stress impacts the heart’s electrical properties directly. Viral infections can cause myocarditis, leading to scarred heart tissue over time that interferes with heart rhythm. “Asymptomatic or silent viral infection, apparently trivial, can have myocardial or heart muscle involvement, triggering cardiac arrest,” he adds.
© The Indian Express Pvt Ltd
