Dr. David Chu and Associates

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News 3: NEWS 3

SUDDEN DEATH

Dear Reader,

Sudden death is not quite as widely known as cancer. Although less known, it
happens more often than all lung cancer death. When it happens the victim is often
apparently healthy and therefore it is unexpected.
The shock is understandably that much greater if the victim of sudden death is a
young athlete or a young person, someone who most people associate with perfect
health.

The keywords here are “apparently healthy”, because there is always a reason or
reasons for sudden death to occur even when the victim is an apparently healthy
individual. A machine which is perfectly tuned does not suddenly stop running (the
equivalent of sudden death).

This article will explain some of the most common reasons for sudden death and the
warning signs preceding this catastrophic event. When the processes of sudden death
are initiated, death is almost certain unless proper interventions are IMMEDIATELY
applied which are rarely the case. In other words, the chances of surviving such an
event are absolutely minimum. We will, nevertheless examine some of the life-saving
interventions together.

The best way of surviving sudden death is to prevent or minimise the risks of this
lethal event from occurring in the first place. So this article will also look at some of
the warning signs that could lead to sudden death and the precautions which a
potential victim could take to minimise the risks.

The goal of this article is to let you know that the risks for sudden death can be
greatly reduced and to show you what you need to do.

If you need more information, please contact me (see Contact).

Dr. David Chu

SUDDEN DEATH

Sudden Death is a general term that applies to any sudden and unexpected death and
it is therefore necessary to define the kinds of sudden death that this article will be
dealing with.

Sudden death in this article is construed as death which occurs suddenly,unexpectedly, AND death is preceded by a series of pathological or abnormal
physiological events and usually occurs within 1 hour or less. The kinds of sudden
death NOT considered in this article includes:

- Trauma (e.g., accident and homicides)

- Poisonings

- Acute infections

In this article, we are only concerned with sudden death related to

- Adverse cardiovascular events including aneurysm, and

- Acute allergic reaction

Sudden death related to adverse cardiovascular events

The cardiovascular system (CVS)

For those of you who are not familiar with the cardiovascular system (CVS), I will
now explain briefly and in very simple terms how the cardiovascular system
functions.

First of all, the cardiovascular system’s most important functions are to deliver
oxygen and nutrients to the body using the blood as the transporting vehicle. To
fulfill these vital functions, the CVS is made up of two distinct parts: The heart which
functions as a pump and the blood vessels which act as the conduit (the delivery
system).

Anatomically, the heart is a muscular organ with 4 chambers - 2 for the right side and
for the left side of the heart. The upper chambers are known as Atria (sing. atrium)
and lower chambers are called ventricles (sing. ventricle). The blood vessels are
made up of arteries which carries blood TO the body and veins which RETURN
blood carrying carbon dioxide and metabolic waste from the body back to the heart.
Therefore, arteries carry blood from the heart and veins returns the blood to the heart.
At the top of the right atrium, there is a group of specialized cells which are able to
spontaneously generate electrical impulses at regular interval. This cells are known as
the sino-atrial node (SA- Node). Each impulse generated spreads to the cells of the
atria (right and left) and the impulse reaches another group of cells known as the
atrioventricular node (AV-Node) which has the same excitable property like the SANode.
From the AV-Node, the impulse spreads into the cells of the ventricles. This
electrical impulse causes the heart muscles to contract and eject the blood out of the
heart chamber (ventricles).

The heart pumps by means of the contraction of the heart muscles which require a
continuous supply of oxygen and nutrients. These are being delivered to the heart
muscles by the Coronary (heart) arteries.

In a healthy heart, an electric impulse from the SA-node causes the upper heart
chambers ( the atria) to contract and push the blood into the two lower chambers (the
ventricles). As the electric impulse spreads from the AV-node to the muscles of the
ventricles, they contract and force the blood from the right ventricle to the lungs
where the blood exchange its carbon dioxide for oxygen. Whereas the blood from the
left ventricle carrying oxygen and nutrients is pumped into the arteries and
distributed to the body (including the heart or cardiac muscles) and the head (brain).
The metabolic wastes from the body which include carbon dioxide and other end
products of metabolism are passed into the veins and returned to the right atrium. At
the same time, blood with fresh oxygen from the lungs goes back into the left atrium.
The return of the blood back to the heart occurs after the contraction of the ventricles
when the heart muscles relax.

Thus the heart squeezes the blood out from the ventricle to the body following each
electrical impulse generated by the SA-node. This contraction of the heart muscle is
felt as a pulse at the wrist. Normally in resting state, the heart beats from 60 to 72
times per minute. Depending on the activity of the body, the heart beat or heart rate
can increase to 180 beats per minute. Anything greater than this would be considered
as unhealthy or abnormal. The reason for this is that the contractions are so rapid, that
there is INSUFFICIENT time for the left ventricle to be filled with blood and as a
consequence, it will also squeeze less blood out to the body and this causes the heart
to beat even faster. The result of this is that the heart begins to pump less and less
blood out (a vicious circle) - it is heading towards a cardiac/heart failure.

To summarise, a healthy CVS requires:

1. The heart to beat regularly and to be able to adjust to the activity of the body.

2. The blood to flow continuously without any interruption, especially to vital
organs such as the heart and the brain.

3. The blood vessels to remain intact.

Now let us consider the kinds of cardiovascular abnormalities that can lead to sudden
death. The 3 most common events are:

- Arrhythmia

- Occlusion

- Aneurysm

Arrhythmia

Arrhythmia is a term which describes conditions where the heart is beating in
abnormal rhythm and is often associated with abnormal electrical activity in the
heart. There are many different kinds of cardiac arrhythmia. The 2 kinds of
arrhythmia that are relevant to sudden death are

-Ventricular tachycardia, and

-Ventricular fibrillation.

Ventricular Tachycardia (VT)

Ventricular tachycardia (VT) is a condition where th heart beats too fast (from 120 to
over 200 beats per minute). This condition originates in one of the ventricles of the
heart. This can be elicited by a decrease in blood volume (through dehydration or
bleeding), or an unexpected change in blood flow. For example that provoked by a
sudden change in position (from lying to standing) leading to a drop in blood
pressure. Other causes could be fever, hyperventilation and infection. VT can be lifethreatening
because it can degenerate into ventricular fibrillation and sudden death.

Ventricular fibrillation

Ventricular fibrillation (VF) is a condition in which there are an uncontrolled,
irregular and chaotic contractions of small groups of muscles in the ventricles.
Instead of the usual coordinated contraction which ejects blood out of the heart, the
ventricular muscle twitches randomly The absence of orderly contractions of the
ventricular muscle means that no useful contraction can be generated in VF and
hence very little or no blood flows out of the heart. This results in either very little or
no blood going to the heart muscles and the brain and in a matter of minutes the brain
cells are irreversibly damaged. Death follows within minutes. In this sense, VF is the
most dangerous kind of arrhythmia. Ventricular fibrillation is a cause of cardiac arrest
or sudden cardiac death.

Sudden cardiac arrest (SCA) is a leading cause of death in industrialized countries.
Sudden cardiac arrest is a major health problem. According to the American Heart
Association, SCA kills more than 450,000 people each year in the United States. This
is more than stroke, lung cancer, breast cancer and HIV/AIDS combined.

People with heart disease are at greater risks for dying suddenly, but there are ways to
reduce this risk. Anyone with heart disease should see a cardiologist and discuss the
risk of sudden cardiac arrest with him, especially if they have had one or more of the
risk factors mentioned below:

- Survived a SCA episode

- Have had a previous heart attack

- Have a family history of SCA or other heart disease

- Have had Heart failure

- Regular episodes of ventricular tachycardia

Treatment

You now know that ventricular fibrillation is NOT a disease; it is a condition brought
about through heart diseases. VF could be thought of as being a mechanical failure of
the heart or more specifically, it is a failure of the heart’s electrical system. The
choice of treatment is very limited - either Cardiopulmonary Resuscitation (CPR)
and/or cardiac defibrillator. The latter is more effective in restoring the heart beat
again. The major problem in the use of a defibrillator is that it is seldom available
when it is needed. When VF sets in, unless CPR is immediately applied till the
defibrillator is available, the victim has less than 5 minutes before the brain cells
begin to degenerate.

Basically, there is only one reasonable “treatment” and that is prevention.

Prevention

The most effective prevention is to maintain a healthy heart. BUT in some cases, this
is NOT possible because the problem is congenital (birth defect). In this case, a
thorough check up by a cardiologist is recommended before undertaking to engage in
acute or very strenuous physical activities. This is particularly true for young people.
But many cardiac or heart diseases can also lead the heart to develop VF. Everyone
with some form of CHD (coronary heart disease) should be monitored frequently and
it may necessitate taking drugs (in some cases life long).

You can appreciate that arrhymias, like most diseases, reflect the state of the cells. In
this case, it is the cardiac cells. Instability of the cellular processes has great effect on
the activities of these cardiac cells. Likewise, a decrease in blood flow to these cells
increases the instability of these cells. Many herbs are able to stabilize the cardiac
cells and promote blood flow. It is therefore, not surprising that these herbs exert
positive influence on the heart by reducing the risks to arrhythmia.
Preventive measures also include optimizing life-style and reducing stress.

Occlusion

Occlusion here means the delivery of blood to tissues is blocked or occluded and thus
preventing tissues distal to the occlusion from receiving arterial blood containing
oxygen and nutrients. If vital organs such as the heart and the brain are prevented
receiving their regular supply of blood for just a few minutes, the cells in these
organs will be irreversibly damage and could subsequently lead to death. This is often
the case with a heart attack where one of the coronary (heart) arteries is blocked by
an emboli (blood clot).

In sudden death, there are 2 different kinds of occlusion:

1. Thromboemboli (blood clots)

2. Severe arterial constriction

Thromboemboli or emboli means a blood clot from a distant part of the body is
broken off (by a physical blow for example) and carried by the blood stream until it
gets stuck in a blood vessel whose diameter is smaller that that of the clot. Especially
relevant to sudden death are the large emboli because they block a relatively large
artery which supplies a relatively large area of tissues. Once the clot is lodged in the
vessel, ALL tissues supplied by this blocked artery will have their blood supply
completely or dramatically cut off. This means that oxygen and nutrients are no
longer available to these tissues. Highly sensitive tissues like the brain cells or the
heart muscles will rapidly deteriorate and death ensues within minutes.

Blood clot blocking an artery of the heart muscles results in a heart attack
(myocardial infarction). If a relatively large coronary artery is involved, the muscle
cells distal to the clot will die and these muscles can no longer contribute to the
pumping action of he heart. This means that the amount of blood pumped out is likely
not adequate to supply the needs of the body. The fall in blood volume leads to a fall
in blood pressure. The heart recognizes these shortfalls immediately and it increases
the pumping rate (heart beat). If the shortfall is significant, the heart continues to
increase the heart rate to compensate the fall in blood volume. As the rate increases
beyond 180 beats per minutes, another problem crops up - there is not enough time
for the blood to fill the heart even if there is no loss in blood volume. As the heart rate
continues to increase, suddenly, fibrillation sets in and the heart stops beating as an organ and. At this point, the heart effectively ceases to beat and very little or no bloodis pumped from the heart. The brain cells are irreversibly damaged within 4 - 5 minutes and the victim dies.

Sudden death as described above is a feared sequel to heart attack.

Another form of occlusion which very often leads to sudden death is pulmonary
(lung) emboli. In this case, the thrombus is generated in a part of deep veins and it is
generally known as deep vein thrombosis (DVT). Frequently, a piece of the clot is
broken off at the site of its formation, carried away in the blood stream and then gets
lodged (stuck) in the pulmonary artery. A part of the lung cells (alveoli) supplied by
this blocked artery can no longer function and the heart increases the heart rate to
pump more blood out to compensate for the decrease in oxygenated blood. Added to
this, there is a fall in the blood volume and a fall in blood pressure and the vicious
circle leading to VF is initiated and the victim dies.

Severe arterial constriction. Muscular walls of the artery constrict so severely that no
blood flows through the constricted area. The effects are the same as arterial emboli.
This kind of constriction occurs more frequently in the extremities (fingers and toes),
but is only life-threatening when it happens in the heart (coronary arteries).

Aneurysm

Aneurysm means a localized balloon-like bulge in the wall of an artery, vein, or heart
due to a weakened wall caused by injury, disease, or abnormality present at birth. It
occurs most frequently in arteries (blood vessels carrying oxygenated blood from the
heart in the brain) and the aorta, the blood vessel that originates from the left
ventricle of the heart.

An aneurysm seldom results in clinical symptoms if it remains intact and therefore, it
is seldom detected prior to rupture. Detection of an aneurysm is generally accidental,
discovered during clarification of clinical complaints such as headaches. As the size
of the aneuristic bulge increases, the risk of it rupturing increases correspondingly.
Hemorrhaging and the resulting blood clots are the two greatest risks of sudden death
following the rupture of an aneurysm except those in the periphery. Death results
from the loss of blood volume which leads to a decrease in blood pressure and
ultimately to ventricular fibrillation. OR death comes from a clot(s) occluding a
major blood vessel as describe above.

Prevention

The formation of certain kinds of aneurysm cannot be prevented - birth defects and
those due to the geometry of the blood vessels. Risk factors for an aneurysm are
diabetes, high blood pressure (hypertension), over-weight, tobacco and alcohol
consumption and copper deficiency.

Treatment

Except for surgical intervention, there is no other treatment alternative in modern
medicine. The problem here is that about one-third of the patients develop aneurysm
again within one year after surgery. Often, the new aneurysm appears at different
parts of the circulation system. In view of the high risks of recurrence following
surgery, herbal supplements (see above) could well be a worthy alternative.
It must be realized that eventually all aneurysms will rupture unless treated.
Acute allergic reaction

The most severe form of Allergic reaction is known as anaphylaxis or anaphylactic
shock. It is a life-threatening and whole-body allergic reaction. Different parts of the
body release histamine and other substances which constrict the airways (bronchi)
making breathing difficult. These substances dilate the blood vessels which result in a
fall in blood pressure and the subsequent predictable effects on the heart. In addition,
these substances promote the leakage of fluids from the blood vessels into the
surrounding tissues. In this manner, fluid finds its way into the alveoli (air sacs in the
lungs where oxygen is being picked up by the red blood cells) making the exchange
of gases impossible and therefore the victim “drowns”.

Anaphylactic shock kills in at least 3 ways: constriction of the airways severely
reducing the amount of air to the lungs, pulmonary edema (fluid in the alveoli) and
ventricular fibrillation as a result of a fall in blood pressure. It is therefore, not
surprising that death can occurs within minutes following the start of the allergic
response.

Anaphylactic shock can be elicited by any allergen such as insect bites or stings, food
(peanut , shellfish), pollens, etc. Some of the common symptoms are: wheezing,
abdominal pain, cramps, vomiting and diarrhea, hives (itching) and anxiety.

Treatment

Treatment consists primarily of the injection of epinephrine (adrenaline) which
immediately stops the progression of the constriction of the airways. This is usually
followed by a bronchodilator which further opens the airways. For the accumulation
of fluids in the tissues and lungs, cortisone is generally used. Other drugs such as
antihistamines also belong to the standard therapeutic regime.

Prevention.

Avoiding contact with the allergen is still the most effective preventive measure.

Summary

The kinds of sudden death discussed in this article are silent killers. My message is
clear: the risks of being a victim to sudden death can be reduced dramatically. If you
want to live, it is worth it to take the extra step to consult your doctor.