KUALA LUMPUR -The crowd went wild as the Portuguese Liga match reached its peak in Guimaraes, with Lisbon's football club Benfica leading 1-0 against Vitoria S.C.

Broadcasted live on television on Jan 25, 2004, Benfica's player, Miklos Feher received a yellow card in the injury time.

The cameras followed the Hungarian on the pitch as he suddenly bent forward, face contorted in pain, and then fell backwards to the ground.

The match was put to a stop as Feher's teammates rushed to his aid and medical personnel soon swarmed over the striker performing CPR.

His teammates were in disbelief over their friend's sudden collapse. It was later announced that Feher, at the age of 24, died from cardiac arrhythmia, also known as sudden cardiac arrest (SCA).

The tragic death of Feher, who appeared to be the picture of health is not an isolated case.

SCA occurs when the heart abruptly stops working, and is one of the most common causes of death in developed countries.

It is a condition that causes 350,000 deaths a year in Europe and affects more than 400,000 people in the United States, and accounts for 63 percent of all cardiac related deaths in the U.S.

And according to Dr Razali Omar - Director of Electrophysiology & Pacing Unit, National Heart Institute (IJN) Kuala Lumpur, SCA is a real national threat.

Not a heart attack

Contrary to popular belief, Dr Omar highlighted the important differences of SCA and other cardiovascular diseases.

"SCA is NOT a heart attack, where blockage in blood vessel prevents blood flow to the heart. Lack of blood causes damage to the heart muscle and scar tissue.

"SCA on the other hand happens when the heart's electrical system malfunctions. The heart has a built-in electrical system, and if the heart is not electrically shocked within minutes, death occurs, and only 10 to 20 percent of those who had SCA survive," he said.

He added that in a healthy heart, our very own 'pace-maker' triggers the heartbeat, then electrical impulses run along pathways in the heart causing it to contract in regular in a rhythmic way. When the heart contracts, blood is pumped.

Arrhythmia occurs when the electrical signals that control the heartbeat is delayed or blocked.

Out of rhythm

Heart failure is usually due to damaged or stretched heart muscle, which often impairs the electrical system that controls the normal timing of the heartbeat.

When the body realises that the heart is failing to pump normal amounts of blood, the heart will try to speed up to compensate.

Damaged heart muscle can make the heartbeat become too slow (bradycaria) or too fast (tachycardia) or just irregular. Thus, it is quite common to see heart failure patients have arrhythmia.

Furthermore, the most common cause of cardiac arrests is a form of arrhythmia, known as ventricular fibrillation (VF).

In VF, electrical signals that control the pumping of the heart suddenly become rapid and chaotic. As a result, the lower chambers of the heart, the ventricles, begin to tremble (fibrillate) instead of contracting.

Thus the blood is no longer pumping from the heart to the rest of the body, cutting off supply of oxygen to the brain and the person involved loses consciousness. Unless an emergency shock is delivered to restore its regular rhythm (using a machine known as a defibrillator), death can occur within minutes.

The silent killer

Unlike many heart problems that can be identified by symptoms, SCA is considered to be a silent killer.

Physical or athletic screenings do not usually signal conditions that can cause SCA, thus it can afflict outwardly healthy, active individuals with no known heart disease or other health complications.

But Dr Omar explained that SCA is not a random occurrence and most victims do have complications relating to their health or heart, although they may not know it.

He stated that any heart complications that damage the heart's electrical system can cause arrhythmia. This includes smoking, heavy alcohol intake, use of certain drugs and even emotional stress.

"Those who are at risk of being affected with SCA comprise of 80 per cent of patients with coronary artery disease (condition in which the arteries that supply blood to the heart are narrowed or blocked), 15 percent heart muscle disease and 5 per cent disease of the heart cells. 75 percent of the people who die of SCA show signs of a previous heart attack."

And with no warning signals, 95 percent of all SCA victims will die on the scene, and in the U.S, more than 70 percent of VF victims die before reaching the hospital.

Shocks to survive

In the absence of symptoms, prevention is of utmost priority to reduce the statistics for SCA deaths.

There are several options, Dr Omar said, among them is medication and the automatic external defibrillator (AED) which is a portable electronic device that stops cardiac arrhythmia by shocking the heart. Some countries provide AED for public use, especially in public places such as parks, schools and sport centres.

The implantable cardioverter defibrillators (ICD), are also very successful in preventing SCD in certain high-risk patients.

Implanted under the skin, the ICD monitors the heart to detect any abnormal rhythms and delivers an electric shock to restore the heart's normal rhythm.
It can also function as a pacemaker if the heart beats too slowly.

For congestive heart failure caused by complications with the heart muscle, cardiac resynchronization therapy are utilised. The therapy applies the use of a specialised pace-maker to re-coordinate action of the right and left ventricle in patients with heart failure.

Learning CPR a must

Every second is a ticking bomb for SCA victims. With every minute that passes, the chances of survival from SCA decreases by 7 to 10 percent.

While more than 70 percent of all sudden cardiac arrest victims are saved by defibrillators, Dr Omar advised that everyone should learn CPR if there is no defibrillator nearby.

"Of course, CPR is definitely life-saving, and important to maintain brain integrity of SCA victims. It doesn't matter whether you're in school or an elderly, CPR should be learnt by all. SCA can happen anytime, anywhere."

With patient demographics provided by the National Cardiovascular Disease Database point out that the minimum age for heart failure in the country is 18 years old and 100 years old being the oldest, it is best to take heed to that advise.