Gender, Warnings and Sudden Heart Stoppage

The Buffalo-Cincinnati (American) football game this past weekend re-introduced viewers to sudden cardiac arrest (SCA). This is an event that kills approximately 6 million people across the planet every year.

SCA is not the same as a heart attack. The latter is caused by a stoppage in the flow of blood to the heart, typically caused by a blockage in a coronary artery. Instead, SCA is caused by an aberrant electrical signal that simply causes the heart to stop beating. If you think of the nerve system as a complex electrical circuit, which in fact is what it is, anything that might cause wires to cross can mess up a pattern of signals, including a hard hit on a football field.

However, what we are learning from a European study of SCA events, the 5-year ESCAPE-NET project which concluded just this week, is that

• There often are warnings in advance of SCA events. More than half of people experiencing an event made an unusual visit to their doctor in the two weeks prior to the event. By unusual, the visit was outside their normal pattern of doctor consultations. Unfortunately, the care provider failed to recognize whatever symptoms the patient reported as a precursor to an SCA.
• Women are more at risk when an SCA occurs than are men.

There are several hypotheses about why women have lower survival rates:

• Women may be more likely to ignore symptoms, perceiving SCA as a “male” disease.
• Bystanders are more reluctant to initiate CPR on a female, and are less likely to make the forceful chest compression on the smaller female chest that CPR requires. How fast chest compressions start and how forceful they are make a huge difference in results. Sensitivity to touching a woman’s breasts in this instance may be less a sign of respect than a death warrant.

The symptoms of an SCA include:

• fainting or loss of consciousness
• dizziness
• racing or irregular heartbeat
• chest pain
• shortness of breath
• nausea.

Unfortunately, as usual, other diseases can cause some of these symptoms. That’s why when a doctor sees a patient, the physician may first consider other causes and not think about SCA.

Sources:

1. https://www.medicalnewstoday.com/articles/why-are-women-less-likely-to-survive-a-heart-attack-than-men?utm_source=Sailthru%20Email&utm_medium=Email&utm_campaign=MNT%20Daily%20News&utm_content=2023-01-04&apid=32823411&rvid=1d7fc4fbc41da35ed0d96c59f74ddf89434ecc148ef542006495aeba1450e27c#What-is-sudden-cardiac-arrest?
2. https://www.ahajournals.org/doi/10.1161/JAHA.121.021827
3. https://academic.oup.com/eurheartj/article/40/47/3824/5492041?login=false

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