Background

During the Euro 2020 football match between Denmark and Finland, Christian Eriksen, a Danish midfielder who also plays club football for Inter Milan in Italy, collapsed suddenly.

Interviews with the Danish club doctor confirmed that Eriksen experienced a sudden cardiac arrest. Thankfully, with prompt cardiopulmonary resuscitation (CPR) and defibrillation by the medical team, Eriksen managed to regain consciousness and is currently stable in the hospital.

▸ FIND OUT MORE: Erikson had cardiac arrest but test results are normal

A few days afterwards, it was reported that the Indonesian badminton player Markis Kido collapsed and passed away at age 36 from a heart attack during a casual badminton match. The Olympic doubles gold medalist was known to have high blood pressure according to his mother.

▸ FIND OUT MORE: Badminton doubles star kido collapses during a casual match dies of heart attack at 36

What is sudden cardiac arrest and is it different from a heart attack?

▸ READ ALSO: Exercises-related cardiac death. How does it happen?

Sudden cardiac arrest occurs when the heart stops beating abruptly, leading to a loss of consciousness and sudden collapse. This is also known as an “electrical” problem. If not attended to promptly, it will rapidly result in brain damage and even death in minutes. 

A heart attack occurs when there is obstruction of blood flow to the heart muscles resulting in damage and weakening of the heart muscle. This is also known as a “circulation” problem and can take place over minutes to hours.

Are sudden cardiac arrest and heart attacks common?

Despite being captured on camera in some instances, sudden cardiac arrest is actually very rare. It occurs in around 1 in 50,000 competitive athletes and much less often in the general population.

Heart attacks occur much more frequently than sudden cardiac arrest. In 2018, there were 3.5 heart attacks per 1,000 population in Singapore.

What are the symptoms of sudden cardiac arrest and heart attack?

Those who experience sudden cardiac arrest may:

• lose consciousness (pass out)
• appear to be having a seizure with jerking of the limbs
• have up-rolling of the eyes
• appear to be gasping, or
• be completely unresponsive even to pain

Those who are experiencing a heart attack may:

• have chest discomfort or pain
• report difficulty breathing
• have cold sweats, nausea and/or vomiting
  

In certain situations, a heart attack may be serious enough to make the heart stop beating, leading to sudden cardiac arrest.

What can be done to help those in sudden cardiac arrest and/or heart attack?

If one is suspected of having a heart attack, he or she should be sent to the nearest emergency department as soon as possible. The earlier treatment is initiated, the lesser heart damage occurs and the better the outcome.

If you encounter someone with sudden cardiac arrest, every second counts!

• Recognise that this is a medical emergency
• Call for help (995 to activate emergency medical services in Singapore)
• If there is no pulse, commence CPR immediately
• Retrieve an Automated External Defibrillator (AED) to assess and deliver an electrical shock as needed – this can be done by another person so as not to interrupt CPR

Anyone can experience a sudden cardiac arrest, whether an elite athlete or someone walking down the street.

Recognition is vital as every minute of delay in CPR and/or defibrillation by AED leads to 7-10% decrease in survival.

Various initiatives have been rolled out in Singapore that have more than doubled the survival rates for affected individuals:

• “Save-A-Life” initiative
• Dispatcher-assisted CPR
• myResponder mobile application

Although there has been significant improvement over the years, more can still be done to improve the rates of bystander CPR – 61.8%, and bystander defibrillation – 7.2% (both in 2018).

▸ CHECK OUT: Singapore’s Out-of-Hospital Cardiac Arrest Data Report (2011-2018)

Do consider equipping yourself with life-saving skills that may come in handy by signing up for any CPR and AED course.

You can also find out where AEDs are located in Singapore here.

Should I continue exercising? 

You most definitely should. Regular exercise is largely safe when performed at low to moderate intensity. In addition, the benefits of exercise far outweigh the risks of sudden cardiac arrest. These benefits include prolonged lifespan as well as reduced heart disease and cancer risks. Very large studies have shown that there is no evidence of harm even if one exercises at 10 times the recommended amount.

▸ READ: Leisure Time Physical Activity and Mortality: A Detailed Pooled Analysis of the Dose-Response Relationship

However, if you have any chronic illness (eg. diabetes, high blood pressure, high cholesterol) and intend to engage in high intensity physical activity, please visit a healthcare professional for an individualised discussion before you commence.

▸ READ: 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease

Article contributed by:

Dr Yeo Tee Joo
MBBS, MRCP (UK), MMED (int Med), MCI (Singapore)
Consultant Cardiologist
Director, Cardiac Rehabilitation Unit
National University Heart Centre Singapore

Edited by:

Associate Professor Jason Lee Kai Wei
PhD, FACSM
Human Potential Translational Research Programme
Yong Loo Lin School of Medicine
National University of Singapore