`Sudden` Cardiac Events Have Symptoms, Many Ignore Them

Dec. 31--It's not news to most doctors that sudden cardiac arrest isn't as unheralded as its name suggests.

The often fatal heart rhythm malfunction actually has symptoms that can occur as much as a month prior to an event.

"There's nothing 'sudden' about sudden cardiac arrest," said Dr. Gail D'Onofrio, chief of emergency medical services at Yale-New Haven Hospital. "There's always symptoms prior to that."

A new study that says more than half of patients who have sudden cardiac arrest ignore their symptoms, which can include intermittent chest pain, shortness of breath, palpitations, and flu-like symptoms, such as nausea and abdominal pain.

Cardiac facts

Here are some key facts from the study on sudden cardiac arrest, published in the Annals of Internal Medicine.

The study looked at 839 patients between 35 and 65 who had a sudden cardiac event.

Of those, 51 percent experience symptoms, predominately chest pain, prior to the cardiac arrest.

In the group that experienced symptoms, 93 percent experienced them again in the 24 hours preceding the cardiac arrest.

Only 19 percent of those who experienced symptoms called emergency medical services.

The patients who experienced symptoms and sought medical help had a survival rate of 32 percent. Those who did not seek medical treatment for symptoms had a survival rate of 6 percent.

The study -- led by a researcher from the Cedars-Sinai Heart Institute and published in the Annals of Internal Medicine -- analyzed data on 839 patients aged 35 to 65 who had sudden cardiac arrest. The patients were part of the Oregon Sudden Unexpected Death Study, a 16-hospital, multiyear assessment of cardiac death in the Portland, Ore., metro area. By interviewing patients' family members and first responders, the team found that, though 51 percent of those studied experience warning symptoms, only 19 percent of those patients called emergency services.

"I guess that is and is not surprising," said Dr. Kevin Sprague, an attending physician in Bridgeport Hospital's emergency department. "It is not surprising in that there are mild symptoms (of sudden cardiac arrest), and that's something we're aware of. But this is a good reminder that it's good to be checked out if you feel anything unusual."

Locally, doctors said this time of year is busy time for all kinds of cardiac events, due to the stress (and over-indulgent eating) of the holidays. During snowy winters, D'Onofrio said, there's also a risk of people having heart events while shoveling. So far this winter, that hasn't been a problem. But all area experts interviewed said people need to be more aware of heart symptoms and their risk for heart problems, including sudden cardiac arrest.

Risk factors

About 350,000 people in the United States die each year from sudden cardiac arrest, which accounts for roughly half of the country's cardiovascular deaths. Sudden cardiac arrest is not the same thing as a heart attack, which is usually caused by clogged arteries that reduce blood flow to the heart. Sudden cardiac arrest is when the heart suddenly stops beating, due to problems with the heart's electrical system.

D'Onofrio said most patients who go into arrest have risk factors for heart disease, such as diabetes or a smoking habit. For a long time, it was believed that the problem was completely without warning, said Robert Winslow, director of electrophysiology at Danbury Hospital. "Sudden cardiac arrest, we had always been taught, was death with one hour of the onset of symptoms," he said.

Now most doctors know that there are symptoms, but not all patients are aware of them, mistaking them for another condition, such as indigestion. If nothing else, studies like this one illustrate the point that anyone who has symptoms that could be cardiac-related should get them checked out right away, said Dr. Edward Tuohy, president of the Connecticut chapter of the American College of Cardiology.

"A lot of these people can be triaged and prevented from going into cardiac arrest," said Tuohy, an interventional cardiologist with Bridgeport Hospital.

Bridgeport Hospital chief of cardiology Stuart Zarich agreed. Thought not all symptoms will result in a cardiac event, he said people can't be too careful, and advised patients to regard cardiac symptoms as the reverse of the American legal system.

"When it comes to the heart, it's guilty until proven innocent," Zarich said.

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