OWSD Nigeria: Slumping in Medicine ... the One Health Approach

SLUMPING IN MEDICINE, ITS BIOCHEMICAL CAUSES, PREVENTION AND MANAGEMENT: THE ONE HEALTH APPROACH.

                                                       Presented By

Dr. Winifred Chioma Udeh [B.Sc., M.B.B.S., M.Sc., M.Phil., FIMCN, CMC]

1. Introduction

“Slumping to death,” often referred to medically as sudden cardiac arrest, is a life-threatening condition where the heart abruptly stops beating. Sudden Cardiac Arrest (SCA), occurs when the heart suddenly and unexpectedly stops beating and this is a life-threatening event that can lead to death within minutes if not addressed. 

             Figure 1: Sudden Cardiac Arrest

SCA is a medical emergency caused by a complete cessation of heart function and biochemically, this occurs when the heart's electrical system malfunctions, leading to an irregular or rapid heartbeat, known as ventricular fibrillation, that prevents blood circulation. SCA can be caused by various factors, including heart diseases, electrical abnormalities, and even genetic conditions. 

The biochemical processes involved in this sudden cardiac arrest are complex, often stemming from disruptions in the heart's electrical or mechanical functions. 

Figure 2: Cardiac Conduction System

1. Cardiac Conduction System

The heart's electrical activity is crucial for its pumping function. A specialized conduction system within the heart generates and transmits electrical signals, causing the heart muscle to contract and pump blood. 

The sinoatrial (SA) node, acting as the heart's natural pacemaker, initiates these signals, which then travel through the atria, the atrioventricular (AV) node, the bundle of His, and the Purkinje fibers to stimulate the ventricles to contract. 

C. Pathway to Cardiac Conduction

1. The SA Node (Sinoatrial Node): 

• Located in the right atrium, the SA node initiates the electrical impulse, acting as the heart's natural pacemaker.
• This impulse triggers the atria to contract, pushing blood into the ventricles. 

2. The Atria:

• The electrical signal spreads across both atria, causing them to contract simultaneously.
• This contraction helps fill the ventricles with blood. 

3. The AV Node (Atrioventricular Node): 

• The signal then reaches the AV node, which delays the impulse slightly.
• This delay allows the ventricles to fully fill with blood before they contract. 

4. The Bundle of His and Purkinje Fibers: 

.      From the AV node, the signal travels down the bundle of His, which divides into the left and right bundle branches.

.      These branches further divide into Purkinje fibers, which spread the signal throughout the ventricles.

.      This rapid conduction causes the ventricles to contract forcefully, pumping blood out to the lungs and the rest of the body. 

5. Coordination and Control:

.      The heart's electrical system ensures that the atria and ventricles contract in a coordinated manner, maximizing the efficiency of blood pumping.

.      The rate of the heartbeat is also regulated by the electrical system, adjusting to the body's needs. 

D. Electrocardiogram (ECG)

The electrical activity of the heart can be recorded using an electrocardiogram and this non-invasive test provides a visual representation of the heart's electrical activity, which can help diagnose various heart conditions. Any alteration in the normal graphic representations of the ECG, could indicate a cardiac malfunction or abnormality.

Figure 3: Electrical Activity of the Heart

Figure 4: ECG and Cardiology  

E. Biochemical Causes of Sudden Cardiac Arrest

1. Disrupted Heart Electrical Signals:

The heart's electrical system, which controls the rhythm of contractions, can be disrupted by various factors like:

• Ventricular Fibrillation: A life-threatening arrhythmia where the lower heart chambers quiver uselessly instead of pumping blood, thereby disrupting the ability of the heart to pump blood efficiently according to the Mayo Clinic.
• Long QT Syndrome: A genetic condition where the heart takes longer than normal to reset after each beat, potentially leading to irregular heartbeats and sudden death, according to the American Heart Association.

1. Heart Muscle Dysfunction:

The heart muscle itself can be affected by:

• Coronary Artery Disease: A build-up of plaque in the coronary arteries can lead to heart attacks and sudden cardiac death, says the Cleveland Clinic.
• Cardiomyopathy: Conditions that weaken the heart muscle, making it less efficient at pumping blood, can also cause sudden cardiac death, according to the National Institutes of Health (NIH). 

1. Electrolyte Imbalances:

Imbalances in key electrolytes like potassium and calcium can disrupt the heart's electrical and mechanical functions, potentially leading to cardiac arrest. 

1. Genetic Conditions:

Some genetic conditions, like Brugada syndrome, Arrhythmogenic cardiomyopathy, Catecholaminergic polymorphic ventricular tacchycardia (CPVT) and Long QT syndrome, can increase the risk of sudden cardiac death. 

1. Other Medical Conditions:

Some other medical conditions can lead to sudden cardiac arrest by disrupting the heart's function, with subsequent death if not promptly treated. These other conditions include;

*Pulmonary embolism (a blood clot that blocks and stops blood flow to an artery in the lung)

*Aortic dissection (blood leak through a tear in the body's main artery called the aorta)

*Hypertension (High blood pressure),

*Hypoglycaemia (Low blood sugar) and

*Severe infections like sepsis.

1. Physical Causes of SCA

Many physical reasons why someone may just slump and die  could be due to lack of exercise, not eating the right foods, smoking, alcohol and drug abuse, stress, as well as other reasons. 

F. Signs and Symptoms of Sudden Cardiac Arrest

These include all the symptoms illustrated in the diagrams below, which include shortness of breath, abnormal pulse or breathing, chest pain and discomfort, fatigue and weakness, nausea and vomiting, abnormal heart rhythms, dizziness or light-headedness and loss of consciousness.

Figure 5: Symptoms of Sudden Cardiac Arrest

However, these symptoms overlap with those of a heart attack and the difference include those illustrated in the diagram below;

Figure 6: Symptoms of Cardiac Arrest and Heart Attack

G. Consequences of Sudden Cardiac Arrest

Without intervention, SCA can lead to loss of consciousness, brain damage, and death. 

H. Importance of Early Intervention

Prompt medical attention, including cardiopulmonary resuscitation (CPR) and defibrillation, is crucial for survival in cases of SCA. These interventions help to restart the heart, thereby enabling restoration of blood supply to the brain, preventing brain damage and ultimately saving the patient’s life.

I. Prevention strategies against SCA

To prevent a heart attack, it's crucial to manage risk factors through lifestyle changes and medical interventions. Key strategies include avoiding smoking, maintaining a healthy weight, exercising regularly, eating a balanced diet, managing stress, and controlling blood pressure, cholesterol, and diabetes. Regular checkups and taking prescribed medications as directed are also important.

1. Lifestyle Modifications:

• Quit smoking:

Smoking is a major risk factor for heart disease and should be avoided or quit. 

• Maintain a healthy weight:

Obesity increases the risk of heart disease, so maintaining a healthy weight is crucial. 

• Regular exercise:

Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous activity per week. 

• Balanced diet:

Focus on fruits, vegetables, whole grains, and lean protein, while limiting saturated and trans-fats, processed foods, and added sugar. 

• Manage stress:

Find healthy ways to cope with stress, such as exercise, meditation, or spending time on hobbies. 

• Get enough sleep:

Aim for 7-9 hours of sleep per night to support overall health, including heart health. 

2. Medical Management:

• Control high blood pressure:

High blood pressure can damage arteries and increase the risk of a heart attack. 

• Manage cholesterol levels:

Aim for low LDL (bad) cholesterol and high HDL (good) cholesterol levels. 

• Control diabetes:

Diabetes can increase the risk of heart disease, so it's important to manage blood sugar levels. 

• Take prescribed medications:

Follow your doctor's instructions on when and how to take medications, such as statins for cholesterol or blood pressure medications. 

• Regular checkups:

Get regular check-ups with your doctor to monitor your risk factors and make sure your medications are working effectively. 

3. Specific Dietary Considerations:

• Limit saturated and trans fats: These fats can raise cholesterol levels and increase the risk of heart disease.
• Limit salt and sugar: These can contribute to high blood pressure and weight gain.
• Consider the DASH diet or Mediterranean diet: These diets are known to be heart-healthy and can help lower blood pressure and cholesterol. 

By making these lifestyle changes and seeking appropriate medical care, individuals can significantly reduce their risk of heart attack. 

                  SUMMARY

In              Slumping to death (sudden cardiac arrest) is often triggered by a combination of factors that disrupt the heart's ability to                  pump  blood effectively, either due to electrical problems, heart muscle damage, electrolyte imbalances, genetic predisposition or other medical conditions and prompt medical attention, including cardiopulmonary resuscitation (CPR) and defibrillation, is crucial for survival of the patients of SCA.

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