Regulate physical activity to reduce risk of sudden death

KK Talwar

Former Director, PGIMER

DURING the recent Navratri celebrations in Gujarat, more than a dozen sudden deaths were reported. The victims ranged from adolescents to adults. While performing garba, they collapsed and died. This tragedy has again raised the question: does excessive physical exercise or exertion lead to sudden death? In recent years, famous singer KK and popular comedian Raju Srivastav collapsed during a performance and a workout, respectively. It has been observed that during vigorous exercise, there is a higher risk of sudden death. Thus, extreme exercise may result in sudden death in some individuals. Habitually sedentary people are 50 times more likely to die during vigorous exercise than those who engage in regular physical activity. Sudden death, though rare, is also observed in players during competitions or training. In most cases, sudden death is linked to heart conditions. It is important to understand the reasons for such sudden collapses so as to take preventive measures.

The medical truth is that exercise protects against heart diseases and is considered an important cardioprotective intervention. Sudden and excessive exercise may rupture an atherosclerotic plaque in the coronary arteries, which can result in heart attack and sudden death in individuals aged 30 years or above. Those who indulge in unhealthy activities such as smoking, drug abuse, excessive alcohol consumption and a sedentary lifestyle may develop plaques in the coronary arteries that do not cause significant obstruction, rendering them asymptomatic. During excessive exercise, these vulnerable plaques have a tendency to rupture and result in thrombosis and blocking of the arteries, resulting in a heart attack and even sudden death. People with an existing heart disease should avoid strenuous exercise. Individuals aged 30 or above who have a family history of heart attacks or lead an unhealthy lifestyle should undergo a preventive cardiac evaluation before initiating heavy exercise.

Coronary artery obstruction is less likely in children and adolescents. Among those who died while doing garba recently, there were two youngsters aged 12 and 17. In this age group, underlying, unknown hypertrophic cardiomyopathy or inherited arrhythmic disorders may often be the causes. Usually, such disorders run in the family, so young children/adolescents with a family history of these conditions should undergo screening and be wary of engaging in strenuous exercise. However, sometimes too much/too fast exercise, without knowing one’s fitness level, may result in dehydration that can trigger an electrolyte imbalance and potentially result in fatal ventricular arrhythmia even in a normal individual. Some forms of dance, such as breakdancing or intense aerobic dancing, can be physiologically demanding. It is, therefore, important to be aware of these serious issues while exercising and take preventive steps, such as taking breaks to avoid excessive fatigue, ensuring proper hydration and refraining from sudden, excessive exercise if you are feeling tired. Further, if one feels dizzy, nauseated or breathless during an exercise, one should immediately stop.

Recently, the Indian Council of Medical Research (ICMR) reported that sudden heart attacks and deaths may also occur in those who had previously contracted Covid-19. This risk is higher in those who had experienced severe Covid and were hospitalised for some days. There is no definite scientific proof in support of this observation. Autopsy in such cases may help identify the cause of sudden death. It is unknown whether autopsies were performed on individuals who experienced sudden death related to previous Covid infections. Indeed, in approximately 30 per cent of sudden deaths in young patients, conventional autopsy may not provide a clear explanation. Molecular autopsy, which involves DNA (deoxyribonucleic acid) sequencing, can be a valuable tool for identifying underlying channelopathy disorders in such cases.

Besides taking preventive steps, it is vital to realise the importance of early cardiopulmonary resuscitation (CPR) to save lives in case of a sudden collapse. Time is important and any minute lost in initiating CPR leads to 10 per cent decrease in the survival rate of the victim. Thus, there is an increasing recognition of the need to coordinate with the community in providing emergency medical care to optimise patient survival. The community needs to be trained to understand and perform the bystander resuscitation protocol. For effective resuscitation, immediate recognition, rapid access, rapid CPR and rapid defibrillation are all crucial. Therefore, having an automated external defibrillator available with the resuscitative team is extremely vital.

Automated external defibrillators should be installed in places where there is a large gathering, such as airports, shopping malls and big residential colonies.

The treatment time is critical while considering the chance of survival in cases of cardiac arrest. If proper resuscitation is not done in the first 4-6 minutes, there is a significant risk of brain damage or brain death. In India, most people do not know how to respond when someone suddenly collapses. The only way to have a better outcome is to have effective bystander CPR and immediate resuscitation, including defibrillation. Many of these deaths are to some extent preventable, so both preventive strategies and effective resuscitative measures are important for handling cases of sudden cardiac arrest.

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