Sudden Cardiac Arrest in India : A Growing Concern

Sudden Cardiac Arrest(SCA) is a sudden and unexpected life-threatening emergency that results from an electrical disturbance in the heart. In such cases heart stops the pumping action, stopping the blood flow to rest of the body.

The rhythm of the heartbeat is controlled by an internal electrical system in the heart. There are problems that can cause abnormal heart rhythms, called as Arrhythmias.

Heart Arrhythmias is a condition where the heart may beat too fast, too slow or it can stop beating.

Now Sudden Cardiac Arrest(SCA) happens when the heart develops an arrhythmia condition which results in sudden stop of the heart beat. This condition is different from Heart Attack where there is a blockage of the coronary arteries. It is often caused by blood clot, but the heart normally continues to beat even though the blood supply to the heart is disrupted. 

What causes SCA?

 Sudden Cardiac Arrest have several potential causes:

  • The most common cause of cardiac arrest is a condition of arrhythmia called Ventricular Fibrillation – an abnormal heart rhythm where the lower chamber of the heart(ventricles) beat irregularly i.e when rapid, electrical impulses causes the heart to quiver instead of pumping blood.
  • Other Medical causes such as – Coronary heart diseases, choking, hypothermia, electrocution.
  • External Causes such as – Drowning, trauma, asphyxia, drugs overdose, dramatic drop in blood pressure.

 Heart conditions that can lead to sudden cardiac arrest?

The heart has its own Electrical Stimulation unlike other muscles in the body, which rely on nerve connections to receive the electrical stimulation to function called sinus node. The sinus node generates electrical impulses and also coordinate the pumping of blood from heart to rest of the body.

A person with pre-existing heart conditions such as :

Coronary artery disease : Most cases of SCA happens to the people who have coronary artery disease. CAD is a disease in which the blood supplying artery get clogged with cholesterol and other waxy deposits, limiting the blood supply to the heart.

Risk Factors for CAD can be:

  • High LDL Cholesterol
  • Low HDL Cholesterol
  • High Blood Pressure
  • Diabetes
  • Smoking
  • Family History
  • After a age of 45
  • Obesity or overweight

Cardiomyopathy : Often known as enlarged heart. This is a disease which affects the heart muscles making it hard to pump blood to rest of the body. This disease results in making the heart muscle abnormal which leads to damage of heart tissue.

Congenital Heart Disease : Now a days even small kids are also getting CAD problem. Congenital Heart Disease is a defect from the birth in the structure of the heart. The problem can affect the – the heart walls, the heart valves or the blood vessels.

Heart Attack : The heart is a muscle, and like all muscles it requires an oxygen – rich blood supply. This is provided to the heart by coronary arteries. Heart Attack occurs if there is a blood clot in these arteries which results in blockage resulting to heart attack.

 Prevention : Diagnosis and Test

 There is no 1 way to know the risk of SCA, so reducing the risk is the best strategy : No single test can diagnose Heart disease but getting a regular checkup done can help you to live longer and healthier.

Tests that one should do if he/she feels that they are having the symptoms and complications:

ECG : is a routine test that is used to check the electrical activity of the heartbeat. This test shows how fast is the heart beating and its rhythm( regular or irregular).

Blood Test : A blood test is required which will check the level of fat, cholesterol, sugar and protein in the body. The things should always be normal. Abnormal levels may be the cause and might increase the risk for SCA.

Stress Test : Tension and Stress affects a lot to a body.

A stress test can come up with possible signs of heart related problems, such as:

  • Abnormal changes in the heart rhythm
  • Abnormal changes in the blood pressure
  • Chest Pain

 Stay physically active by exercising daily

 Eat a Nutritious and balanced diet

 Don’t smoke and use alcohol ( more than one to two times a day )

 

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A Guide to Supra Ventricular Tachycardia & its Survival Chances with instant diagnosis

Supra Ventricular Tachycardia is abnormal fast heartbeat or heart rate of more than 100 beats per minute for reason other than stress, exercise or high fever. In some cases, the heart beat may cross 300 beats a minute.

It’s actually a very broad term that includes various forms of heart arrhythmias originating from the area above the ventricles (supraventricular) in the atria or AV node. That is why it’s named as supraventricular tachycardia. It is also called SVT, paroxysmal atrial tachycardia (PAT), atrial tachycardia or paroxysmal supraventricular tachycardia (PSVT).

Types of supraventricular tachycardia

Supraventricular tachycardia is of following types:

  • Atrioventricular nodal reentrant tachycardia (AVNRT)
  • Atrioventricular reciprocating tachycardia (AVRT)
  • Atrial tachycardia
  • Sinus tachycardia
  • Inappropriate sinus tachycardia (IST)
  • Multifocal atrial tachycardia (MAT)
  • Junctional ectopic tachycardia (JET)
  • Nonparoxysmal junctional tachycardia (NPJT)

Causes of SVT

In most cases, SVT occurs due to faulty electrical connections in the heart resulting in faster than normal heart beat. Other than this, SVT can be caused by following:

  • Certain medicines like digoxin or the lung medicine theophylline.
  • Genetics as some forms of SVT like Wolff-Parkinson-White syndrome run in families.
  • Drinking large amounts of alcohol or caffeine
  • Extreme stress
  • Smoking lots of cigarettes etc.

Signs and symptoms of supraventricular tachycardia

SVT is mostly an episodic condition that can last for few or more seconds, minutes, hours or even days. In addition, it may occur once or several times a day, or only once or twice a month or year. It may come and go suddenly without making the person feel it. Most of the times, there are stretches of normal heart rates in between fast heartbeats.

Some people with SVT may have no symptoms at all and require no treatment. But in some cases SVT occurs frequently and is ongoing, particularly in patients with heart damage or other coexisting medical problems. In such cases, patient can complain of following symptoms:

  • A fluttering in the chest
  • A pounding or racing sensation in the neck
  • Palpitations
  • Shortness of breath
  • Chest pain
  • Light-headedness
  • Sweating
  • Throat tightness
  • Fainting (syncope) or near fainting

In infants and very young children, signs and symptoms may be difficult to identify. Sweating, poor feeding, pale skin and infants with a pulse rate greater than 200 beats per minute may have supraventricular tachycardia.

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Diagnosis of SVT

Though in most of the cases SVT is not life threatening, but a person should contact a cardiologist or general physician as soon as possible on experiencing any symptoms.

The diagnosis of SVT involves thorough history taking of the patient by asking questions related to patient’s health and symptoms. This is followed by a physical examination to hear the heart sounds and record heartrate. An electrocardiogram (EKG, ECG) is then performed to measure and record the heart’s electrical activity. An ECG can show abnormalities indicating SVT in patients who are experiencing an episode of SVT at the time of ECG. But the real challenge is to identify abnormalities in ECG that suggest SVT, when the heart rhythm has returned to normal. 

Other than ECG there are various other diagnostic methods that can be done to find out SVT like:

    • Holter monitor
    • Event monitor
    • Echocardiogram
    • Implantable loop recorder
    • Stress test
    • Tilt table test
  • Electrophysiological testing and mapping

Instant Diagnosis of SVT plays an important role in patient survival

Although it is not a life threatening condition but an episode of supraventricular tachycardia may cause unconsciousness or cardiac arrest. In addition to this, if the episodes become frequent and remain untreated for long, SVT can weaken the heart and lead to heart failure. In both the situations, it is very important to get an ECG done to make a diagnosis and start appropriate treatment right away. As there are so many other diagnostic methods too that can be done to find out SVT but the one that gives quick results is ECG. So ECG must be done for every patient with symptoms related to heart.

It is rightly said for heart conditions that an early shift to the hospital’s emergency department and a quick ECG can save a patient’s life.

Treatment of SVT

Treatment of SVT may include:

  • Medicine to take during an episode of SVT
  • Manoeuvres, such as the Valsalva manoeuvre
  • Electric shock treatment called cardioversion
  • Catheter ablation

Can an ECG Diagnose All Heart Attacks?

Heart attack is one of the most common emergencies in every hospital. It occurs due to obstruction of the coronary artery by a blood clot formed due to rupture of an atherosclerotic, cholesterol plaque. Coronary artery supply blood and oxygen to the heart muscles and when it gets blocked, blood and oxygen could not reach the muscles and muscles die. This condition is termed as Heart Attack or Myocardial infarction.

It is an emergency situation that requires quick action from the medical team to save the life of the person. The most common complications of a heart attack are heart failure and ventricular fibrillation. It may even lead to death of the person. That is why emergency team are specially trained to recognise the signs and symptoms of a heart attack, perform diagnostic tests and do the treatment at the earliest. Survival from a heart attack is more than 90% with modern emergency treatment.

Signs and symptoms of a heart attack

  • The most common symptom of heart attack is chest pain/fullness/squeezing, shortness of breath and excessive sweating.
  • It may sometimes cause no symptoms and is called as silent heart attack.
  • Though heart attacks can occur at any time, it has been found that more heart attacks occur between 4 A.M. and 10 A.M. due to higher blood levels of adrenaline during this period. High adrenaline may contribute to rupture of cholesterol plaques.
  • Almost half of patients show warning signs like exertional angina or rest angina before heart attacks, but these signs are so mild that they are ignored as unimportant.

Role of ECG in diagnosis of heart attack

ECG is performed with priority in all the patients of severe chest pain with a suspicion of a heart attack. It is the quickest possible test to find out a heart attack. It hardly takes 5 minutes to perform the test and 5 more minutes to interpret its readings and confirm the diagnosis. It basically records the abnormal electrical activity of the heart that usually occurs with heart attack and can identify the areas of heart muscle that are deprived of oxygen and/or areas of muscle that have died.

ECG can confirm heart attack in almost 90% cases. The presence and degree of ST elevation in ECG tells about the severity of blockage in the blood flow to heart.

Depending upon ECG findings, Heart attack or MI is basically of following types:

    • ST-segment elevation myocardial infarction (STEMI)
    • Non-ST segment elevation myocardial infarction (NSTEMI)
  • Unstable Angina

Establishing diagnosis through ECG

ECG identifies changes to the pattern of a normal heart beat and shows following possible scenarios:

  • ST elevation:
    • New ST elevation at the J-point in two contiguous leads with the cut-off points: ≥0.2 mV in men or ≥ 0.15 mV in women in leads V2–V3 and/or ≥ 0.1 mV in other leads
  • ST depression and T-wave changes
    • New horizontal or down-sloping ST depression >0.05 mV in two contiguous leads; and/or T inversion ≥0.1 mV in two contiguous leads with prominent R-wave or R/S ratio ≥ 1
  • Pathologic Q waves

The ECG changes are dynamic and evolve over minutes to hours and indeed, days. While the initial changes are found in the ST-T segments, the last to appear is a Q wave in the leads which were showing ST – T changes.

ECG Findings for the Diagnosis of Culprit vessel of Acute Coronary Syndrome

ECG is such a powerful diagnostic tool that it can also help in finding out the culprit vessel that has resulted in heart attack. This may help in making the most appropriate treatment plan for the patient.

ECG findings Lesion
ST-segment elevation greater in lead III than in lead II plus ST-segment depression of > 1 mm in lead I, lead aVL, or both Right coronary artery
Absence of the above findings plus ST-segment elevation in leads I, aVL, V5, and V6 and ST-segment depression in leads V1, V2, and V3 Left circumflex coronary artery
ST-segment elevation in leads V1, V2, and V3 plus any of the features below:

  • ST-segment elevation of > 2.5 mm in lead V1, right bundle branch block with Q wave, or both
  • ST-segment depression of > 1 mm in leads II, III, and aVF
  • ST-segment depression of ≤ 1 mm or ST-segment elevation in leads II, III, and aVF
Proximal LAD (left anterior descending) coronary artery
Proximal LAD coronary artery
Distal LAD coronary artery

ECG is thus the quickest way to find out heart attack and can save a person’s life by being a deciding factor for the type of treatment required. Though it is easy to interpret ECG changes in symptomatic patients but the real challenge is to identify heart attack in asymptomatic or previous heart attack patients. Team Tricog excels in this scenario and has successfully interpreted ECGs for heart attack diagnosis in various difficult situations.

Deficiencies of ECG

  • Some of the heart attacks go undetected on electrocardiograms (ECG)
  • In asymptomatic patients or patients with vague or atypical symptoms, ECG interpretation can be difficult.
  • ECG in patients with pre-existing ECG abnormalities from old heart attacks or abnormal electrical patterns is difficult to be interpreted as fresh changes or previous changes.
  • Unstable angina is usually not detected by a routine ECG. In fact, more than half of people with angina have a normal resting ECG.

Additional tests to confirm diagnosis of heart attack

Along with ECG, following tests are performed by the doctor to confirm heart attack

  • Blood test for cardiac markers
  • Chest X-ray to check the size of heart and its blood vessels and to look for fluid in the lungs.
  • Echocardiogram to identify the exact areas of damage in the heart and how this damage has affected functioning of heart.
  • Coronary angiography to determine if there is any blockage or narrowing of coronary arteries and, if so, then finds out the exact location of the blockage or narrowing.

Wolf Parkinson White Syndrome: A rare heart syndrome diagnosed by Tricog with ECG interpretation

Introduction

Wolff-Parkinson-White (WPW) syndrome is a very rare congenital heart disorder that causes abnormal heartbeat rhythms (arrhythmias) and faster than normal heartbeats (tachycardia). This occurs due to an abnormal alternate electrical pathway (accessory pathway) between the atrium and the ventricle of the heart. The extra electrical pathway is called a bypass tract as it bypasses the AV node and it could not control the heartbeat making it beat very fast.

WPW is a type of supraventricular tachycardia called atrioventricular reciprocating tachycardia (AVRT).

The disorder is usually not life-threatening, but can cause serious heart problems. That is why further evaluation is recommended before children with WPW pattern participate in high-intensity sports.

Cause of WPW syndrome

Although there is no exact cause known for the development of extra pathway but an abnormal gene is found to be the cause of WPW in a small percentage of people. It may be inherited in some cases. It is also associated with some forms of congenital heart disease, such as Ebstein’s anomaly.

Wolf-Parkinson-White

Symptoms of Wolff-Parkinson-White (WPW) syndrome

Most of the person’s with WPF usually do not feel any fast heartbeat. Although the symptoms most often appear for the first time in the teenagers but people of all ages, including infants, can experience its symptoms. The symptoms may come as an episode of rapid heartbeat that may begin suddenly. The episode can occur during exercise or while at rest and may last for few seconds or several hours. It can be triggered by caffeine or other stimulants including alcohol.

The most commonly found symptoms of WPW syndrome include:

  • Palpitations
  • Chest pain
  • Chest tightness
  • Shortness of breath
  • Difficulty breathing
  • Dizziness
  • Fainting
  • Fatigue
  • Anxiety

A person with WPW can have a heart rate of 160 to 220 beats per minute. They can also have atrial fibrillation or atrial flutter resulting in heartbeat to cross more than 250 to 300 times per minute. This may result in syncope or cause sudden death.

It can also trigger ventricular fibrillation that can be life-threatening, although this is extremely rare.

Symptoms of WPW syndrome in infants

  • Rapid breathing
  • Ashen color
  • Restlessness
  • Irritability
  • Poor feeding
  • Evidence of congestive heart failure if the episode has been untreated for several hours

Physical findings of WPW syndrome

  • Mostly normal cardiac examination
  • During tachycardia, the patient is cool, diaphoretic, and hypotensive
  • Pulmonary vascular congestion (during or following an SVT episode)
  • Clinical features of associated cardiac defects like:
    • Cardiomyopathy
    • Ebstein anomaly
    • Hypertrophic cardiomyopathy

Diagnosis of WPW

WPW syndrome is usually discovered by chance during a heart exam for any other problem. A 12-lead electrocardiogram (ECG) is the best diagnostic tool for WPW syndrome. The classic ECG features include:

  • A shortened PR interval
  • A slurring and slow rise of the initial upstroke of the QRS complex (delta wave)
  • A widened QRS complex (total duration >0.12 seconds)
  • ST segment–T wave (repolarization) changes, generally directed opposite the major delta wave and QRS complex, reflecting altered depolarization

The ECG morphology in WPW syndrome varies widely and it is not easy to diagnose WPW syndrome. But the team of Tricog has achieved this rare success by diagnosing WPW syndrome in a 24 year old male patient with his ECG interpretation only. 

Management of WPW syndrome

In almost 25 percent of people with WPW syndrome, symptoms disappear on their own. In the rest of persons, following techniques may manage the disorder:

  •      Vagal maneuvers like coughing, bearing down or putting an ice pack on face etc. to slow a rapid heartbeat.
  •      Medications like injection of an anti-arrhythmic medication.
  •      Cardioversion i.e. use of paddles or patches over chest to electrically shock heart and restore a normal rhythm.
  •      Radiofrequency catheter ablation to permanently correct the heart-rhythm problems.

 

A complete guide about Dextrocardia & its ECG interpretation

Dextrocardia is a rare congenital heart condition that is characterized by presence of heart on right side instead of the normal left side. It is estimated that less than 1% of the people may be born with Dextrocardia.

Quick facts about Dextrocardia

  •   The cause of Dextrocardia is not known.
  •   Only right side location of the heart without any other defect is termed as Isolated Dextrocardia
  •   Dextrocardia can be accompanied by anatomical defects of other organs too.
  •   Dextrocardia may be present in a condition called Situs Inversus. It is characterized by opposite side location of many or all visceral organs like liver, spleen, etc.
  •   Heterotaxy is a very serious syndrome that may appear with Dextrocardia. It is characterized by wrong positioning or improper functioning of various organs. For example, in some cases of Heterotaxy, spleen may be completely absent or there can be several small spleens. In these conditions, baby becomes prone to various infections.
  •   Kartagener syndrome is a condition that may occur in some people with mirror-image Dextrocardia. It is characterized by problem with the cilia that filter the air going into the nose and air passages.

Heart defects associated with Dextrocardia

  • Double outlet right ventricle (connection of aorta to the right ventricle instead of left ventricle)
  • Endocardial cushion defect (poorly formed or completely absent walls that separate heart’s four chambers)
  • Pulmonary stenosis (pulmonary valve narrowing) or atresia (improper formation of pulmonary valve)
  • Single ventricle instead of two ventricles
  • Transposition of the great vessels (switching of the aorta and pulmonary artery)
  • Ventricular septal defect (hole in the wall that separating right and left ventricles)

Symptoms of Dextrocardia

There may not be any symptoms associated with Dextrocardia and it could be accidentally diagnosed during a chest X-ray or MRI chest.

Isolated Dextrocardia increases the risk of lung infections, sinus infections, or pneumonia due to improper functioning of cilia.

Dextrocardia that affects functioning of heart can cause following symptoms:

  •   Breathing difficulties
  •   Bluish discoloration of lips and skin
  •   Extreme fatigue even on minor physical activity
  •   Improper growth and development
  •   Jaundice
  •   Increased risk of infections

Diagnosis of Dextrocardia

Apart from scanning of chest, ECG can also diagnose Dextrocardia. But it requires an expert and experienced eye like the Team of Tricog who have successfully detected Dextrocardia only by interpreting the ECG readings.

Dextrocardia

ECG Features of Dextrocardia

  • Right axis deviation
  • Positive QRS complexes (with upright P and T waves) in aVR
  • Lead I: inversion of all complexes, i.e. ‘global negativity’ (inverted P wave, negative QRS, inverted T wave)
  • Absent R-wave progression in the chest leads (dominant S waves throughout)
  • Low voltage in leads V3-V6

Treatment of Dextrocardia

Dextrocardia that is a complete mirror image of normal heart with no other symptoms need no treatment at all. But the person needs to be educated to share this information with every physician and technician he visits for any medical assistance.

Other than this, treatment depends upon the problem of the person. Surgery may be required if there is any heart defect or any problem in the organs of the abdomen.

Prognosis of Dextrocardia

Dextrocardia without any organ abnormality have a normal life expectancy but Dextrocardia with organ abnormality needs treatment and its prognosis depends upon the severity of the other problems. In these cases long term use of drugs to manage the condition may help the patient.

Complications of Dextrocardia

  • Blocked intestines (due to intestinal malrotation)
  • Heart failure
  • Recurrent Infection (due to Heterotaxy with no spleen)
  • Infertility in males (due to Kartagener syndrome)
  • Repeated pneumonias
  • Repeated sinus infections (Kartagener syndrome)
  • Death

Tricog: Mission to save million hearts

India is a huge country with one-fifth of the world’s population. However, when it comes to doctor to patient ratio the figure is substantially grim. According to a recent report by parliamentary committee on functioning of medical council of India – “The total number of doctors in India is much smaller than the official figure and we may have one doctor per 2,000 population, if not more.” Analysing these figures one can imagine the plight of doctors who works their day out to save precious lives of those in need. On the other side are the patients who perish due to their rural placements resulting in lack of infrastructure facilities.  Tricog – A Bangalore based healthcare startup identified this problem and introduced its technology enabled instant ECG analysis solution making life easier for doctors and their patients.

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Why Heart Attack?

According to a survey heart attack is one of the most common causes of death in India taking lives of 17.5 million people every year. It is also a matter of fact that most of these deaths are attributed to poor infrastructure facility and lack of specialist doctors at remote healthcare centers resulting to delayed diagnostics and treatment.

Why Tricog?

Tricog, founded in 2014, is not only revolutionising the way ECG analysis is done in India but also making heart attack diagnosis and coordination easier at remote healthcare centers across the country. Tricog uses technology, artificial intelligence and an expert medical team that works 24*7 to provide the fastest and most accurate real time diagnosis for heart patients. Tricog makes every received ECG go through multiple levels of check through algorithms, thereafter the accuracy of each ECG diagnosis is vetted by a qualified medical team of ECG experts specifically available at the centrally located Tricog hub round the clock.

Today, Tricog is providing its services to healthcare centers across India and working with some of the biggest brands in healthcare industry. The company aims at changing the 80% chance that a heart attack will take one’s life, to an 80% chance that the patient survives. Thus, guarding thousands of accelerating hearts for it’s pace everyday with a message – “Listening to your heat”.