WEBVTT - Sudden Cardiac Death: When does it strike?

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<v Speaker 1>Now,

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<v Speaker 1>health matters with Daniel Martin.

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<v Speaker 2>It's health matters right here on CN A 938. Welcome

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<v Speaker 2>aboard everybody. Now, of course, it is

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<v Speaker 2>very tragic to hear about the recent death of a

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<v Speaker 2>race participant

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<v Speaker 2>at the recently concluded Singapore Marathon. The ST Charter Singapore Marathon,

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<v Speaker 2>the announcement did come out that one individual did die.

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<v Speaker 2>We're not going to go into details about the cause

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<v Speaker 2>for this individual, obviously,

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<v Speaker 2>but we want to understand what people participating in such

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<v Speaker 2>events really need to bear in mind before participating. Incidentally,

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<v Speaker 2>this is the third death in the 23 year history

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<v Speaker 2>of the race in 2016, a 28 year old British

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<v Speaker 2>National collapsed and was found to have suffered from sudden

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<v Speaker 2>cardiac death due to the onset of arrhythmia.

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<v Speaker 2>In 2011,

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<v Speaker 2>a 22 year old died after running the half marathon

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<v Speaker 2>later found to have a heart condition and had died

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<v Speaker 2>from acute coronary insufficiency. I want to find out more

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<v Speaker 2>about the heart in particular and taking part in these races.

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<v Speaker 2>Welcoming back Dr Reginald Liu, a senior consultant cardiologist at

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<v Speaker 2>the Harley Street Heart and Vascular Center at Glen Eagles.

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<v Speaker 2>Doctor Liu it's a pleasure to have you back on

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<v Speaker 2>the show. Thanks for being here.

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<v Speaker 1>Thank you, Daniel. It's great to be back on the show.

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<v Speaker 2>So, before we go any further, can we just those

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<v Speaker 2>two conditions that I described earlier on? Just give me

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<v Speaker 2>a quick understanding. They're quite different, right? One is sudden

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<v Speaker 2>cardiac death. One was said to be acute coronary insufficiency,

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<v Speaker 2>not the same

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<v Speaker 2>thing.

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<v Speaker 1>Yes. Correct. They're both different. Uh both unfortunately can occur

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<v Speaker 1>in young people and lead to sudden death but quite

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<v Speaker 1>different things. The the first case you mentioned, the arrhythmia

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<v Speaker 1>is often due to an abnormal heart rhythm problem or

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<v Speaker 1>electrical problem that is often genetic in younger people.

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<v Speaker 1>And it can sometimes be picked up from an ECG

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<v Speaker 1>or from symptoms if one has it before, before such

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<v Speaker 1>a tragic event. The second um case that you mentioned

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<v Speaker 1>is more an anatomical problem with, with abnormal or anatomical

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<v Speaker 1>variation of the blood vessels in the person that would,

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<v Speaker 1>would have been there from birth.

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<v Speaker 1>So again, that's more of a structural problem. But unfortunately,

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<v Speaker 1>both can lead to sudden death. So

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<v Speaker 2>the thing is if somebody could have an unknown heart

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<v Speaker 2>condition

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<v Speaker 2>and still be training regularly fit healthy, active exercising all

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<v Speaker 2>the time and it never turned up.

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<v Speaker 1>That's right. Yes. Yeah. Sometimes the first presentation of such

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<v Speaker 1>a problem may be sudden collapse or, or sudden death.

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<v Speaker 1>Uh but often people may have warning signs, some people

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<v Speaker 1>get very dizzy or feel very strong or abnormal heartbeats

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<v Speaker 1>during exercise. And that, that's a warning sign that there

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<v Speaker 1>could be something wrong and that person should probably have

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<v Speaker 1>a check up beforehand.

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<v Speaker 2>We will be talking about the importance of screening later.

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<v Speaker 1>That's right. Yes. The other common

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<v Speaker 1>um or more common problem causing sudden death in younger

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<v Speaker 1>people that is often undetected. It is a heart muscle

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<v Speaker 1>problem called cardiomyopathy. Again, these may not be detected until

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<v Speaker 1>quite late, but they can be picked up from an ECG.

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<v Speaker 1>So something that that one needs to consider

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<v Speaker 2>in is is sudden cardiac death common.

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<v Speaker 1>Actually, it's it's very rare. Um The estimates suggest about

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<v Speaker 1>um about between one and 10 per 100,000 people in

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<v Speaker 1>the younger people below the age of 35 but of course,

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<v Speaker 1>rare but tragic if it happens because it's, it's unexpected

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<v Speaker 1>and usually these people are hit and well, they're not

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<v Speaker 1>known to have any underlying medical problem.

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<v Speaker 2>One of my listeners is whatsapping across and asked this question,

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<v Speaker 2>why do we always talk about the heart and how

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<v Speaker 2>come it's not the heat, the heat in Singapore is

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<v Speaker 2>extremely strong and maybe that's a contributing factor. We do

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<v Speaker 2>seem to tend to mention the heart situation a lot

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<v Speaker 2>as well as opposed to environmental factors. So I think

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<v Speaker 2>that's surprising to a lot of us could the heat

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<v Speaker 2>exacerbate a heart condition?

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<v Speaker 1>Yes, it can do. I mean, certainly having heat very,

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<v Speaker 1>feel very hot. And um there are other medical problems,

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<v Speaker 1>not as heart related that can cause people to collapse.

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<v Speaker 1>Uh But they don't normally cause sudden death. Sudden death

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<v Speaker 1>is a very specific term that people die within one

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<v Speaker 1>hour of the onset of symptoms without any clear warning.

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<v Speaker 1>Whereas people have heat exhaustion, often they're very, very hot,

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<v Speaker 1>they're dehydrated, they have low thready pulse, but that can

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<v Speaker 1>be improved with intravenous fluids. So certainly heat exhaustion can

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<v Speaker 1>cause you to collapse, but to die suddenly and have

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<v Speaker 1>no pulse often that is related to a cardiac cause.

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<v Speaker 1>So

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<v Speaker 2>that's ok. So that's the difference. I do wanna read

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<v Speaker 2>out what happened um

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<v Speaker 2>at the Charter Singapore Marathon. The statement said that after

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<v Speaker 2>the completion of the race, the participant required and received

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<v Speaker 2>intermediate medical attention on site before being transported to the

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<v Speaker 2>Singapore General Hospital. Let's talk about that. Emergency medical services

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<v Speaker 2>are at all these major race events with the onset

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<v Speaker 2>of sudden cardiac death. What is there? No pulse?

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<v Speaker 1>Yeah. So usually uh these people who collapse, they, they,

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<v Speaker 1>if it's a sudden cardiac arrest, then yes, they would,

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<v Speaker 1>they would have no pulse and they would be unconscious and,

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<v Speaker 1>and look very pale and it's, it's essential that the

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<v Speaker 1>emergency medical services are on standby. The the the team would,

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<v Speaker 1>would have checked for a pulse check for the signs

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<v Speaker 1>of breathing.

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<v Speaker 1>Um They would have put on a special uh defibrillator,

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<v Speaker 1>electric electrode pads to check the heart rhythm. And likely

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<v Speaker 1>if the patient or the person had an abnormal rhythm

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<v Speaker 1>that was ventri fibrillation, they may have administered emergency shock treatments.

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<v Speaker 1>Um and they would have started cardiopulmonary resuscitation if there

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<v Speaker 1>was no pulse. So essential that the team were there

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<v Speaker 1>administered urgent treatment and then send the patient to hospital

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<v Speaker 1>for uh for a secondary care.

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<v Speaker 2>Is it is there

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<v Speaker 2>is there generally if it is true, sudden cardiac death,

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<v Speaker 2>is there truly very little that can be done in

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<v Speaker 2>terms of medical intervention to turn it back or to to, to,

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<v Speaker 2>to stop

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<v Speaker 2>it.

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<v Speaker 1>Well, the the the success rates or or survival rate

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<v Speaker 1>from true cardi death outside hospital is very low but

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<v Speaker 1>things can still be done. Uh I think the first

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<v Speaker 1>thing is the most important is to have urgent uh

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<v Speaker 1>facility to check the rhythm and to shock the the

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<v Speaker 1>heart back to normal if there's a shock or abnormal rhythm.

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<v Speaker 1>And of course, whilst waiting for emergency treatments, uh one

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<v Speaker 1>should administer CPR cardiopulmonary resuscitation, try to keep keep the

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<v Speaker 1>blood going to the brain to prevent long term brain damage. So,

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<v Speaker 1>so essential to have urgent treatment, but it can, it

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<v Speaker 1>can be treated if, if the emergency services are there

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<v Speaker 1>early and there's a rhythm or um cause that can

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<v Speaker 1>be reversed.

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<v Speaker 2>Another whatsapp whatsapp across 9631193. It says, why do you

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<v Speaker 2>always hear about it? With marathons. Is there something wrong

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<v Speaker 2>with the marathon? Is the distance too long? Why didn't

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<v Speaker 2>they show up in training? Yes, that's why I asked

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<v Speaker 2>at the beginning as well. Dr Lee, is there something

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<v Speaker 2>about exertion over such a long distance? Because one would

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<v Speaker 2>assume people going for these races have been training similar

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<v Speaker 2>distances or walking up to that distance. Why did it

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<v Speaker 2>show up prior?

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<v Speaker 1>Yeah, I think that's a good question. I mean, there, there,

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<v Speaker 1>there are certainly different types of exercises that seem to

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<v Speaker 1>trigger different problems. So endurance sports like the marathon triathlons,

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<v Speaker 1>they do tend to throw up a different type of

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<v Speaker 1>heart rhythm problem. I mean, these, these people may have

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<v Speaker 1>trained and most people do train very carefully for, for,

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<v Speaker 1>for a number of weeks and months beforehand.

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<v Speaker 1>But the additional, you know, the buzz, the excitement, the

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<v Speaker 1>adrenaline rush during the events,

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<v Speaker 2>the masses of people around you as

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<v Speaker 2>well.

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<v Speaker 1>Yes, that's right. There's a whole different environment with the

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<v Speaker 1>actual race can trigger and one is pushing themselves even

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<v Speaker 1>harder to try to improve their personal best. All of

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<v Speaker 1>those can, can tip one over the edge if they

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<v Speaker 1>have an underlying heart problem on top of that. Um,

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<v Speaker 1>so it doesn't always show up until the event and,

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<v Speaker 1>and, and that, that's unfortunately a problem with the endurance

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<v Speaker 1>type races. But also you hear about other cases like

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<v Speaker 1>professional footballers collapse on the pitch. Um, they often they,

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<v Speaker 1>they have a different problem. They have a heart muscle

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<v Speaker 1>problem or cardiomyopathy. So it's not necessarily endurance sports that

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<v Speaker 1>will trigger an event, but some other uh cardiac problem

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<v Speaker 1>or heart muscle problem that can also trigger a sudden arrhythmia.

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<v Speaker 1>So there's different subtypes.

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<v Speaker 2>What does ejection fraction have to do with any of this?

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<v Speaker 1>Uh The ejection fraction is actually a statement of uh

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<v Speaker 1>or measure of how strong the heart is pumped in

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<v Speaker 1>or or or the the strength of contraction, normal ejection fraction.

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<v Speaker 1>It should be more, more than 55%. Uh It's an

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<v Speaker 1>important parameter because some people have some form of heart

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<v Speaker 1>problem or heart failure and the ejection fraction is reduced,

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<v Speaker 1>that will then increase the risk of a dangerous arrhythmia.

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<v Speaker 1>And some people are known to have rejection that are

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<v Speaker 1>reduced and they should certainly refrain or not do any

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<v Speaker 1>very strenuous or endurance sports.

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<v Speaker 1>But unfortunately, there's another group of patients, young people who

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<v Speaker 1>are fit and well, they may have a viral infection

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<v Speaker 1>or some other acute infection uh just prior to the event.

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<v Speaker 1>And that can sometimes attack the heart. The the infection

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<v Speaker 1>can attack the heart and reduce the ejection fraction,

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<v Speaker 1>which will then put them at risk of an event

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<v Speaker 1>as well if they were to do any running whilst

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<v Speaker 1>they were still unwell. So one always has to be mindful.

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<v Speaker 1>Even young people with no prior history of poor ejection

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<v Speaker 1>fraction can still be at

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<v Speaker 1>risk.

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<v Speaker 2>Isn't that though? The reason I ask is, could it

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<v Speaker 2>not be an important number or, or figure for us

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<v Speaker 2>to all know, is it very easy to determine one's

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<v Speaker 2>ejection fraction? Or is it very challenging?

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<v Speaker 1>It's uh quite straightforward. Uh We usually, most doctors will

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<v Speaker 1>look at the ejection fraction and measure it through an

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<v Speaker 1>ultrasound of the heart called an echocardiogram. So it's actually

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<v Speaker 1>quite straightforward. It does involve a specialist test and usually

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<v Speaker 1>uh one of the uh cardiologist would have to read

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<v Speaker 1>the report and, and come up and measure the ejection fraction.

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<v Speaker 1>Uh But certainly, I think it's, it's a useful parameter

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<v Speaker 1>to have as well as even just a basic ecg

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<v Speaker 1>that many people do as part of a health check up.

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<v Speaker 1>Also gives some useful information on arrhythmias and, and risk

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<v Speaker 1>of any underlying

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<v Speaker 1>inherited heart rhythm problem.

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<v Speaker 2>So let's talk about that and whether or not we

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<v Speaker 2>can minimize the risk of something like this through proper

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<v Speaker 2>screening before major races like this. Is that advisory, is

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<v Speaker 2>that important for these athletes or aspiring athletes or, or

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<v Speaker 2>race enthusiasts to bear in mind? Go for a check before?

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<v Speaker 1>Mm. I think that's a very good question and it's

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<v Speaker 1>still a very controversial topic. Uh And the reason is

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<v Speaker 1>that uh some people would not want to do a

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<v Speaker 1>checkup because they're worried what they, they may find or

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<v Speaker 1>not sure how to interpret the results. Uh But certainly

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<v Speaker 1>from a medical point of view. It does make sense

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<v Speaker 1>if one's gonna do endurance sports or something very strenuous

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<v Speaker 1>or if one hasn't exercised for a long time and

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<v Speaker 1>starts to

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<v Speaker 1>do more regular exercise, it makes sense to do some

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<v Speaker 1>basic tests just to be sure there's no obvious on

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<v Speaker 1>the line problem. And the basic, you know, simple tests

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<v Speaker 1>that are noninvasive could include an ecg uh, echocardiogram to

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<v Speaker 1>check the ejection fraction and check the heart muscle

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<v Speaker 1>and um maybe a treadmill test. And some people when

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<v Speaker 1>they exercise, we, we pick up other things on the

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<v Speaker 1>treadmill test. But of course, there's issues with, with access

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<v Speaker 1>to such tests, with interpretation and with what to do

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<v Speaker 1>with the result that may be abnormal, but the patient

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<v Speaker 1>or person may not yet have any symptoms. So that

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<v Speaker 1>opens up a whole extra dimension that one has to

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<v Speaker 1>consider

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<v Speaker 2>if somebody were taking was regularly doing marathons and they've

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<v Speaker 2>taken the test one time. Is that enough to cover

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<v Speaker 2>them for a couple of years or should you check

0:12:07.030 --> 0:12:08.380
<v Speaker 2>before every major race?

0:12:09.419 --> 0:12:12.359
<v Speaker 1>Yeah, I think that the baseline ecg uh if it's

0:12:12.369 --> 0:12:17.539
<v Speaker 1>completely normal, that will be uh essentially reassuring. Um that

0:12:17.549 --> 0:12:20.679
<v Speaker 1>there's no uh there's no obvious problem at that stage.

0:12:20.969 --> 0:12:24.900
<v Speaker 1>Um But, and the echocardiogram as well, if that's normal,

0:12:24.909 --> 0:12:27.729
<v Speaker 1>completely normal with no heart muscle problem, then that's also

0:12:27.739 --> 0:12:31.159
<v Speaker 1>very reassuring. Uh So I don't think one necessarily needs

0:12:31.169 --> 0:12:31.840
<v Speaker 1>to repeat

0:12:32.150 --> 0:12:35.640
<v Speaker 1>those tests before every race unless one developed new symptoms

0:12:35.830 --> 0:12:38.890
<v Speaker 1>or say someone is, has been unwell one or two

0:12:38.900 --> 0:12:41.979
<v Speaker 1>weeks before the race with a recent infection or cough

0:12:41.989 --> 0:12:44.669
<v Speaker 1>or fever. Then it might be worth having a check

0:12:44.679 --> 0:12:47.919
<v Speaker 1>up before going through a strenuous or long race.

0:12:48.219 --> 0:12:50.079
<v Speaker 2>Doctor Li, you also mentioned earlier on, for example, it's

0:12:50.090 --> 0:12:52.539
<v Speaker 2>even happened in other sports. The football, we're not just

0:12:52.549 --> 0:12:56.348
<v Speaker 2>isolating it to the marathon, um, team sports, field sports,

0:12:56.359 --> 0:12:58.669
<v Speaker 2>it does come up as well. It has occurred.

0:12:59.409 --> 0:13:03.039
<v Speaker 1>Yes. Yes, that's right. And uh and athletes and you know,

0:13:03.049 --> 0:13:07.409
<v Speaker 1>on the field, uh uh people playing football, basketball that

0:13:07.419 --> 0:13:09.728
<v Speaker 1>they can collapse suddenly as well. So I think that

0:13:09.739 --> 0:13:13.450
<v Speaker 1>the same applies. One can consider screening for these uh

0:13:13.719 --> 0:13:16.190
<v Speaker 1>heart problems even though rare, but they can be picked

0:13:16.200 --> 0:13:18.359
<v Speaker 1>up from screening tests. So what to do

0:13:18.380 --> 0:13:18.489
<v Speaker 2>from

0:13:18.570 --> 0:13:18.710
<v Speaker 1>there.

0:13:18.729 --> 0:13:20.520
<v Speaker 2>So it's very hard for us to tell whether are

0:13:20.530 --> 0:13:25.689
<v Speaker 2>we talking about exertion due to long exertion or is

0:13:25.700 --> 0:13:28.140
<v Speaker 2>it about short sharp bursts of exertion or is it

0:13:28.150 --> 0:13:28.630
<v Speaker 2>all the same?

0:13:30.049 --> 0:13:33.940
<v Speaker 1>So it depends on the underlying heart problem. Um So certainly,

0:13:33.979 --> 0:13:37.580
<v Speaker 1>um short sharp bursts are potentially dangerous for those who

0:13:37.590 --> 0:13:40.590
<v Speaker 1>have heart muscle thickening because when you, when you suddenly

0:13:40.599 --> 0:13:43.950
<v Speaker 1>exert yourself and push yourself really hard, the the thickened

0:13:43.960 --> 0:13:47.030
<v Speaker 1>heart muscle can, can actually restrict blood leaving the heart

0:13:47.039 --> 0:13:49.609
<v Speaker 1>going into the brain and, and people collapse on that.

0:13:49.940 --> 0:13:53.190
<v Speaker 1>Uh But long distance running, if you have an inherited

0:13:53.200 --> 0:13:57.159
<v Speaker 1>heart rhythm problem or abnormal anatomy of the blood vessels

0:13:57.169 --> 0:13:57.789
<v Speaker 1>of the heart

0:13:58.200 --> 0:14:02.099
<v Speaker 1>can also increase risk of arrhythmias. So, so not all

0:14:02.109 --> 0:14:05.200
<v Speaker 1>the same and the different problems depending on the underlying

0:14:05.210 --> 0:14:06.059
<v Speaker 1>heart problem.

0:14:06.070 --> 0:14:07.989
<v Speaker 2>Ok. Gonna end off with this question from one of

0:14:08.000 --> 0:14:11.159
<v Speaker 2>our listeners. Thank you for accepting across you say apologies

0:14:11.169 --> 0:14:13.539
<v Speaker 2>if this was covered earlier. But what is the difference

0:14:13.549 --> 0:14:16.809
<v Speaker 2>between this and a heart attack? Ok. They're quite different. So, yes,

0:14:16.820 --> 0:14:17.340
<v Speaker 2>Doctor Liu.

0:14:18.330 --> 0:14:23.030
<v Speaker 1>Yeah. So good, good question actually, because both sudden death

0:14:23.039 --> 0:14:26.640
<v Speaker 1>in with the conditions we've mentioned and a heart attack

0:14:26.650 --> 0:14:29.950
<v Speaker 1>can lead to sudden cardiac death or the person can

0:14:29.960 --> 0:14:33.429
<v Speaker 1>collapse suddenly with an abnormal dangerous rhythm. The main difference

0:14:33.440 --> 0:14:35.789
<v Speaker 1>is a heart attack is due to a sudden blockage

0:14:35.799 --> 0:14:38.450
<v Speaker 1>of the blood vessel outside the heart leading to a

0:14:38.460 --> 0:14:42.109
<v Speaker 1>acute myocardial infarction. And then that sudden blockage then leads

0:14:42.119 --> 0:14:45.429
<v Speaker 1>to the dangerous arrhythmia. Heart attacks tend to occur in

0:14:45.440 --> 0:14:47.950
<v Speaker 1>older people, particularly above the age of 40.

0:14:48.320 --> 0:14:51.320
<v Speaker 1>And if they have other risk factors like high cholesterol diabetes,

0:14:51.330 --> 0:14:54.679
<v Speaker 1>high blood pressure. So certainly we, you know, as cardiologists

0:14:54.690 --> 0:14:57.580
<v Speaker 1>and general doctors, we often look for risk factors for

0:14:57.590 --> 0:15:01.380
<v Speaker 1>heart attack or coronary artery disease. Uh whereas younger people

0:15:01.390 --> 0:15:04.099
<v Speaker 1>tend to have these other rarer conditions like this, these

0:15:04.109 --> 0:15:08.590
<v Speaker 1>abnormal heart blood vessels from birth or heart muscle thickening,

0:15:08.840 --> 0:15:12.140
<v Speaker 1>but the final result both can lead to sudden death.

0:15:12.979 --> 0:15:15.590
<v Speaker 2>Doctor Liu, thank you for helping our listeners understand this,

0:15:15.599 --> 0:15:18.760
<v Speaker 2>this tragic situation. I wish we didn't have to talk

0:15:18.770 --> 0:15:21.380
<v Speaker 2>about it. Of course, this coming on the heels of

0:15:21.390 --> 0:15:23.599
<v Speaker 2>a death being announced for one of the participants at

0:15:23.609 --> 0:15:28.580
<v Speaker 2>the recent Singapore Marathon. And this being the third death

0:15:28.590 --> 0:15:32.559
<v Speaker 2>in the 23 year history of the Singapore marathon. Dr

0:15:32.669 --> 0:15:35.690
<v Speaker 2>Reginald Liu was here on health matters, helping us understand

0:15:35.989 --> 0:15:39.090
<v Speaker 2>the concept of sudden cardiac death. He's a senior consultant,

0:15:39.099 --> 0:15:42.059
<v Speaker 2>cardiologist at the Harley Street Heart and Vascular Center, Glen Eagles.

0:15:42.080 --> 0:15:44.559
<v Speaker 2>And I thank you for your whatsapps and questions that

0:15:44.570 --> 0:15:45.280
<v Speaker 2>came through

0:15:50.409 --> 0:15:54.070
<v Speaker 2>before making any decisions. Based on the information in our program,

0:15:54.080 --> 0:15:56.109
<v Speaker 2>please consult a medical professional.