A new study counters the
commonly held belief that when most middle-aged men suffer cardiac arrest, it
typically comes completely out of the blue.
Researchers found that the
majority of victims have symptoms in the days and weeks before the emergency.
Most had chest pains
between four weeks and one hour before a sudden cardiac arrest when the heart
stops abruptly, the study found. Others had noted shortness of breath, while a
small percentage experienced dizziness, fainting or heart palpitations.
The study authors said that
although middle-aged people are considered to be in the prime of life, they are
not immune to cardiac emergencies.
Electrical system failure
"At least a third of
cardiac arrests in men are happening in middle age," said study lead
author Dr Sumeet Chugh, a cardiologist at Cedars-Sinai Medical Centre in Los
The recent death of The
Sopranos star James Gandolfini at the age 51 highlighted the fact that
sudden cardiac arrest can affect relatively young people.
The study was scheduled for
presentation Tuesday at the annual meeting of the American Heart Association,
Sudden cardiac arrest
occurs when the heart suddenly starts beating either very quickly and
erratically, or extremely slowly, due to a failure of its electrical system,
said Dr Gregg Fonarow, a cardiologist at the University of California, Los
Angeles. "That's different than a heart attack, where there is a blockage
that injures the muscle," he said.
About 360 000
out-of-hospital cardiac arrests are reported each year in the United States,
according to the American Heart Association. Less than 10% of those who have a
cardiac arrest outside the hospital survive.
For the study, the
scientists focused on the population of Portland, Oregon., assessing every man
between the ages of 35 and 65 who had a sudden cardiac arrest within a period
of almost 12 years. Of the more than 800 total cases, 31% of the medical
records did not have enough information to identify whether symptoms were
present before the attack.
The researchers also
reviewed the accounts of family members, witnesses, emergency medical personnel
and medical records from the time period around the cardiac arrest.
In the remaining cases, 53%
had symptoms that ranged from episodes of chest pain to feeling like they had
Although the data helps point
to the importance of recognising symptoms and seeking help, Chugh said, there
are still more questions than answers. For many people with early symptoms of
potential heart problems, doctors' exams may not show anything definitive.
"We're trying to
improve the scope of a complete [cardiac] work-up, but there are big gaps in
what we know," Chugh said. "What happens in the hour before cardiac
arrest? What about in the 24 hours before, the week before or the month
Part of the challenge is
that a variety of problems may trigger sudden cardiac arrest. Depending on genetic,
anatomical and other factors, people may respond differently.
"We are teasing out a
million different variables at this point," Chugh said. "The nature
of heart disease isn't so different from cancer. There's a genetic component... and then there are clinical factors and some lifestyle factors."
The study results do not
apply to women, and more research is needed, Chugh said. "Women are
different in so many ways," he said.
The research supports
current recommendations for anyone having these kinds of symptoms, especially
chest pain, shortness of breath and dizziness to seek medical attention, UCLA's
Fonarow said. "Many people don't follow these recommendations and they
delay," he said. "Their health may really be at stake."
Chugh agreed. "We have
not educated men in middle age very much, and we need to do that," he
Learn more about sudden
cardiac arrest from the US
National Heart, Lung, and Blood Institute.