Prevention is better than ... death

St Anthony's Hospital, Cheam, Surrey

The recent sudden death of Boyzone band member Stephen Gately was a sombre reminder of the existence of undiagnosed clinical conditions with catastrophic potential. At the time of writing, the reasons for Stephen Gately�s death have not been confirmed but at least 8 young people die every week in the UK from an undiagnosed heart condition. The cause of death is sudden cardiac arrest and it is preventable.

Sudden Cardiac Arrest can happen to anyone, at any time. The first presentation of an underlying heart condition is often sudden death. One of the main factors which can contribute to the premature and sudden death of young adults, between 14 and 35, is extreme physical exercise. In older people, sudden unaccustomed exertion or high stress levels can also precipitate a crisis.

An underlying and undiagnosed heart condition can affect the performance of the individual�s heart and, under exertion, can and does cause a cardiac arrest caused by ventricular fibrillation.

What is Ventricular Fibrillation?

Ventricular Fibrillation, or �VF�, is caused when the heart�s electrical channels, which control the contraction of the heart muscle, are disrupted. As a result, the heart goes into a chaotic rhythm which is uncoordinated and stops the heart from beating. The only way to reverse Ventricular Fibrillation is by using a defibrillator to administer an electrical �shock�. Although this is an often effective method of treating a VF cardiac arrest, it is by no means guaranteed and, for each minute the individual�s heart is in Ventricular Fibrillation, their chance of survival drops by 10%.

How is it preventable?

A simple, non-invasive cardiac screening test can detect any underlying heart conditions within a matter of minutes. Whether the individual is displaying symptoms of a heart condition or not, advances in technology make diagnosing a heart condition easier than it ever has been.

What tests are carried out?

One of the simplest tests is a resting Electrocardiogram, or �ECG�. This is a simple and painless test which involves the individual simply lying back and having some electrodes stuck on their chest. The reading from the machine is almost instantaneous and once the results have been analysed by a Cardiologist, the findings can be reported.

An Echocardiogram or �Echo� is another painless and non-invasive technique which uses ultrasound to look at the heart from a different perspective. The experienced sonographers who carry out the scans are able to assess and measure the function of the valves and heart muscle from the images formed on the screen. The heart is imaged from many different angles, so that all areas can be seen. The type of information that can be acquired includes muscle thickness and contractility, valve structure, cavity size and the presence of any abnormal connections between chambers. In addition, Doppler studies are performed using colour images and sound. This gives further information about the direction and velocity of blood flow and is used to calculate pressures within the heart and the degree of narrowing of the valves.

Generally, a simple ECG and Echo will be all that is required. However, a �Stress ECG� or �Stress Echo� may also be performed. In the former, the same test is carried out, but under conditions of exercise on a treadmill. For the latter, stress is induced pharmaceutically. The results of these tests will generally allow a cardiologist to identify any underlying conditions and determine the level of risk. In certain cases, further investigations, including specialised cardiac CT or MRI scans or cardiac catheterisation, may be required to confirm a diagnosis. However, these should only be undertaken under the direction of a cardiologist. CT scans, in particular, deliver relatively high doses of ionising radiation and should not be used as a standard screening tool.

Recognition by professional bodies

Due to the potential seriousness of cardiac conditions, professional sports bodies are now making the simple and effective tests compulsory for their members. The Union of European Football Associations (UEFA) recently upgraded the compulsory screening for all players. Their panel met and discussed the situation stating that �one is too many�. They also highlighted the need for regular resuscitation training. The International Olympic Committee has also recommended that all athletes have regular cardiac screening in a bid to prevent further premature deaths of apparently very fit athletes. For non-professionals exposed to high stress situations, a regular check-up is equally important.

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