She had gone out to dinner with her daughter. She then collapsed on the table
Immediately, Esperanza Pérez's life ended almost at the age of 62 during a vacation dinner with her daughter.
“We went to a restaurant to have dinner. I'll tell you your recount because I don't remember what happened, ”said Pérez, who was in San Francisco nine years ago and was visiting daughter Beatriz Rambarran. “We sat down and got ready to eat. She said I put my hand on my forehead and I leaned over and she asked me if I was dizzy. I just said, "Hmm hmm."
“And then, she said, I collapsed on the table. She realized that something was really seriously wrong. Someone helped her put me on the floor. She wasn't sure what was going on. She said I got really rigid. People thought I was having a fit and they knew it wasn't me. "
Pérez, now a retired medical worker in Miami, had suffered sudden cardiac arrest that kills approximately 400,000 Americans each year.
A quick response from her daughter and others in the restaurant - together with a lot of luck - helped save Pérez's life: Beatrice called to call 911; a nurse who also dined that evening gave Pérez CPR; and firefighters quickly arrived with defibrillation equipment to restore their pulse.
"They gave me these electric shocks," said the 70-year-old Pérez. "The first set didn't work. The second set didn't work. On the last set, with some medication, they made my heart beat faster and took me to the hospital."
Pérez's cardiac arrest suddenly came without warning, but now she realizes that the warning label was always there - her family history. She inherited a gene that both her mother and grandmother died of sudden cardiac death in the early 1970s and that nearly killed her older brother when he was 62 years old.
Genetic causes, family histories
"Between 35 and 70 percent of people who are prone to cardiac arrest due to a genetic cause have an identifiable gene, depending on the specific genetic disease," said Pérez 'doctor, Dr. Robert Myerburg, a Miami cardiac electrophysiologist at the University of Miami's UHealth Health System. "The reason that is valuable is that we have the opportunity to look at other family members."
Dr. Robert Myerburg
There is a 50 percent chance that any child born to a mother or father with the gene will inherit it. Generations are not skipped. If a child doesn't inherit the gene, neither will their children.
Pérez's older daughter Beatriz has tested for the gene and is not carrying it. However, the younger daughter Patricia does so and her two young sons will be tested soon after.
Testing was traditionally done by drawing blood, but today it's easier to do with an inexpensive, non-invasive saliva swab, Myerburg said.
Some genetic abnormalities, like what's called long QT syndrome, can be seen on an EKG, he said.
Long QT syndrome causes a heart rhythm that, according to the Mayo Clinic, can potentially cause fast, chaotic heartbeats. “These fast heartbeats can make you suddenly faint. Some people with this disease have seizures. In some severe cases, LQTS can cause sudden death. "
Defibrillator inserted into her chest
To help maintain a normal heart rhythm, Pérez and her younger daughter each put implantable cardioverter defibrillators in her chest.
An ICD "monitors the patient and should a heart rhythm problem such as ventricular tachycardia or ventricular fibrillation ever occur, it would automatically trigger a shock to bring the heart rhythm back to normal," said Dr. Jeffrey Goldberger, also a UHealth electrophysiologist.
Dr. Jeffrey Goldberger
According to Goldberger, sudden cardiac death is "the death of someone who is otherwise fine and who dies unexpectedly of a cardiac cause".
"We're not talking about people who are hospitalized with heart failure and then die in the hospital," he said. "You usually talk about the type of person who," Yeah, I spoke to him yesterday and everything was fine. And then I just heard, you know, five minutes later he dropped dead. "
Arrhythmias are the main problem
Most sudden cardiac deaths are caused not by long-term illnesses in which the heart muscle gradually weakens and dies, but rather by abnormal heart rhythms, Goldberger said.
And 90 percent of sudden cardiac arrests that occur outside of a hospital like Pérez's are fatal, he said.
Overall, 50 percent of sudden cardiac arrests are initial cardiac events in patients who have not previously been identified at risk or known heart disease, Myerburg said.
According to Myerburg, survival depends on where someone is suffering from cardiac arrest and whether they are asleep or at home alone.
"If we look at patients who have cardiac arrest at home, which is the majority of cardiac arrests, the survival rate is 6 percent," he said. "If you perform in public, and two conditions are met - one is that there is a spectator who knows CPR and has access to an automated external defibrillator - that combination will get you between 16 and 20 percent survival. "
Quick action is required to survive
But action must be taken within minutes, Myerburg said.
"Once you hit five minutes, the survival rate drops below 50 percent - five minutes from the onset of cardiac arrest to recovery of a pulse," he added. Very few survive more than 10 minutes without a pulse.
For people over the age of 35, the frequency of sudden death is 1 to 2 per 1,000 people per year. According to Myerburg, 1 in 100,000 for teenagers and young adults.
"If you add that to the number of people in the US population, which is 300 million, you can see that the number is getting really big," he said.
Coronary artery disease can affect people as early as their mid-30s and progressively increase until their mid-60s, Myerburg said.
Once a patient is in their 70s, "cancer is the number one cause," he said. "Coronary diseases don't go away. But if you look at the causes of death, the cancer increases a bit."
Adolescents who are not immune to sudden cardiac death
Children and adolescents are also prone to sudden cardiac death, said Dr. Kak-Chen Chan, Chief of Pediatric Congenital Cardiovascular Intervention Services at Joe DiMaggio Children's Hospital in Hollywood.
Dr. Kak-Chen Chan
Joe DiMaggio is offering free EKG screenings for families who are concerned about the risk, said Chan, a pediatric cardiologist.
When a local high school athlete suddenly dies during a game or practice session, Chan said it is usually big news. "We lose them on the field and do what they do best."
These young people are usually fine in "everyday life" but are at high risk of engaging in "really aggressive sports," he said.
Chan said the most important thing was "to counsel the family to reassure them that once you know the diagnosis and we treat them, the risk will be significantly reduced."
That often means ruling out "extreme exercise," Chan said.
“We would dictate a change in the exercise or a change and restriction of the activity. In general, competitive sport is over, ”he said. No strength or anaerobic sports like weightlifting or chinning.
"The other thing we would say is not to swim or climb alone. Best not to climb, as with long QT syndrome you will lose consciousness when attacked. If you are at a height, you will fall. If you are in the water, you will drown. "
Restricted aerobic exercise is recommended. And "they could play competitive chess," he said.
Young people at risk can be treated with ICDs and beta blockers, which slow the heartbeat.
In 2020, Joe DiMaggio treated 29 young patients with long QT syndrome, eight of whom required ICDs. The hospital also treated about 100 patients with cardiomyopathy, a heart muscle disease that is often inherited and makes it difficult for the heart to pump blood.
Beyond genetics, there are other ways to determine the risk of dying from congenital heart disease or sudden cardiac arrest.
“These factors are usually grouped into changeable risk factors and cannot be changed. There are certain things that increase your risk of heart disease that you cannot change, such as: B. Your genetics or your age, "said Dr. Alexandre Ferreira, who specializes in interventional cardiology at Jackson Health System in Miami-Dade County.
Dr. Alexandre Ferreira
"It is important for people to understand that as you age or if you have a family history of heart disease, it increases your risk of heart disease. If there is a relative - a first degree relative, either your parents or brothers or sisters - , it significantly increases your risk of heart disease, especially if your family members developed heart disease at a younger age. "
High blood pressure, high cholesterol, and smoking increase your risk
Modifiable risk factors are high blood pressure, high cholesterol and smoking. "These are things you can avoid and treat to reduce your risk of heart disease," Ferreira said.
Jackson Health System launched an online tool called "Learn Your Heart Age" this month that allows website visitors to determine risk based on basic health information such as height, weight, blood pressure, diabetes, family history, and more.
"There are special algorithms based on studies in large populations that determine the likelihood of a cardiovascular event, either a heart attack or a stroke, in the next 10 years," said Ferreira. “These algorithms are very precise. They tell you the probability of an event in 10 years. Is it 5 percent? Is it 10 percent? "
Ferreira said it was difficult for most patients to understand exactly what that meant.
"More importantly, patients understand that they are at increased risk and what steps they can take to reduce that risk," he said. “The next step is for patients to discuss with their doctors. The overall goal is for patients to become more aware of increased risk and then proactively think about what they can possibly do to reduce the risk. "
To learn more
▪ Jackson Health System's new online tool, Learn Your Heart Age, is available at https://learnyourheartage.org.
▪ Joe DiMaggio Children's Hospital offers pediatric EKG tests. For more information, please visit https://www.jdch.com/services/cardiac/services/electrocardiogram or call 954-265-3437.
▪ UHealth, the University of Miami health care system, has a website that provides information on sudden cardiac death. Visit https://news.umiamihealth.org/en/focusing-on-you-sudden-cardiac-death.
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