DOOMSDAY: SUDDEN
CARDIAC
DEATH
Dr Guy Wright-Smith | Interventional Cardiologist
M ost people know of, or have heard of someone who has ‘dropped
“WRITE IT ON YOUR
dead’, that is, died of sudden cardiac death, mostly due to a
myocardial infarction. As a 15 year old on my way to school I
witnessed a business man drop dead on the train station platform. It
was a distressing scene, which I discussed with my father - a general practitioner, who
casually said, “People drop dead every day- it is not uncommon.” So why do some
people, even those who seem fit and active, simply “drop dead”?
The most common cause in adults is acute myocardial infarction, commonly known
as a heart attack. Myocardial infarction is the death of cardiac muscle due to lack of
oxygen, usually from a blocked coronary artery resulting in decreased blood supply to an
area of heart muscle.
For centuries it has been known that people who ‘drop dead’ have no palpable cardiac
output, i.e. their heart has stopped beating, however full understanding of what caused
the heart to stop beating was a mystery. Scientists over the centuries had suspected that a
blocked coronary artery might be the cause of a myocardial infarction. In 1958, the new
procedure of cardiac catheterisation and coronary angiography, where dye is directly
injected into the coronary arteries under X-ray control, allowed visualisation of coronary
arteries. This enabled doctors to confirm the cause of myocardial infarction was indeed
blocked coronary arteries.
So why do coronary arteries suddenly become blocked? We know that coronary arteries
are very prone to developing atherosclerosis, but it is not yet completely understood
why this occurs. Atherosclerosis is a process where cholesterol is deposited on the inside
walls of arteries, forming what is known as a plaque. These plaques can be likened to a
pimple, and similar to a pimple on the face, are prone to rupture. When a plaque ruptures
a clot can form at the site of the rupture and in some cases the clot is big enough to block
the artery. This process can occur rapidly - within minutes.
HEART THAT EVERY
DAY IS THE BEST DAY
IN THE YEAR. NO
MAN HAS LEARNED
ANYTHING RIGHTLY,
UNTIL HE KNOWS
THAT EVERY DAY IS
DOOMSDAY.”
- RALPH WALDO
EMERSON, 1803-1882
26 | Pindara Magazine ISSUE 12 | 2018