Damar Hamlin, sudden cardiac death and the importance of CPR

Damar Hamlin’s story has been circulating the internet lately. On Jan. 2, Hamlin of the Buffalo Bills was playing the Bengals in Cincinnati.

There was huge hype that day, but everyone was devastated when Hamlin sustained a cardiac arrest on the field. His condition was critical and associated with a lot of concern and emotion that everyone across the country was feeling.

What happened to Damar Hamlin?

It all started when Hamlin was tackling Tee Higgins of the Bengals. Hamlin was hit in the chest, and there was concern that “Commotio Cordis” may have been the reason for his cardiac arrest. This is a rare situation during which trauma to the chest wall can trigger a life-threatening arrhythmia in the heart.

The heart is vulnerable to this during a short time period of around 20 milliseconds as it relaxes to get ready for next contraction. Hamlin was given prompt CPR on the field, and fortunately, his heartbeat was revived. He was rushed to the University of Cincinnati Medical Center, where he was managed.

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Sudden cardiac death in athletes

Cardiac arrest is when the heart stops beating, usually associated with sustained rhythm problems affecting the ventricle, which is the bottom chamber of the heart.

Sudden cardiac death in athletes is a rare but devastating event. There is significant research ongoing in this area to detect individuals at risk and minimize occurrence of this catastrophic event in athletes.

Athletes go through regular screening and examinations to prevent this. Certain cardiologists, known as sports cardiologists, have primary interest in this field. There is a significant body of medical literature and guidelines to help doctors and health care providers in management of heart conditions affecting athletes.

In general, athletes can be considered young athletes if they are less than 35 years old and adult or master athletes if they are older than 35. Athletes can be further characterized as competitive or recreational athletes.

Competitive athletes are those who participate in organized teams with regular competition and are rewarded related to victories. Competitive athletes usually have more aggressive practice schedules, participating in more strenuous physical activity.

On the other hand, recreational athletes participate more for fun and health reasons. The incidence of sudden cardiac death is more in competitive athletes; the total number of sudden cardiac deaths is higher in recreational athletes just based on the overall greater number of people participating in recreational activity.

The incidence of sudden cardiac death is around 1 in 50,000 and 1 in 100,000 per year in young athletes, and it’s closer to 1 in 7,000 healthy older adult athletes per year.

Reasons for sudden cardiac death in athletes

Usually, sudden cardiac death is related to structural heart disease. These are conditions affecting the anatomy of various components that make up the structure of the heart.

The most common and well-known structural heart disease is hypertrophic cardiomyopathy (HCM), in which the athlete/individual may be born with a thick heart muscle and may have scar tissue in the heart as well. This disease may affect 1 in 500 individuals in the general population and can predispose to life threatening rhythm problems or obstruction to flow of blood as it is exiting the heart muscle to enter aorta.

Other diseases may include anomalous origin of a coronary artery (arteries supplying blood to the heart originate in abnormal locations), arrhythmogenic right ventricular cardiomyopathy (ARVC, which can affect the right sided ventricle or pumping chamber but can also affects the left ventricle), myocarditis (inflammation of the heart muscle that may occur after a viral infection) and Marfan syndrome (can affect aorta or valves) to name a few.

In addition to structural heart disease problems, the way electricity flows through the heart may cause sudden cardiac death. Long or short QT syndrome, Brugada syndrome and Catecholaminergic polymorphic ventricular tachycardia are a few examples and all can lead to life threatening heart rhythm called ventricular tachycardia or ventricular fibrillation.

In the master/adult athletes older than 35, coronary artery disease, or blockages in the arteries of the heart, or heart attacks are the predominant cause of SCD.

Power of CPR

Without good quality cardiopulmonary resuscitation (CPR), the chances of survival are almost non-existent. Hamlin’s survival is a testament and proof of what high quality and effective CPR can achieve.

CPR is a process in which rapid and adequate chest compression, combined with delivery of breaths to an unconscious individual, keeps oxygen flow to the body and most importantly to the brain. The brain is very sensitive to oxygen, and without blood flow for more than a few minutes, irreparable anoxic brain injury can ensue.

CPR is simple enough to be learned by almost anyone, but it is so powerful that when executed promptly and effectively, it could mean the difference between life and death.

Hamlin's incident sheds light on the power of high-quality CPR, and this skill should be systematically taught to the masses. When cardiac arrest occurs outside of a hospital, CPR may be provided in less than a third of patients.

We can have a huge public health impact if this number can be increased by teaching the public how to perform CPR, especially at an early age, and increase accessibility to defibrillators.

What about non-athletes? Can they have sudden cardiac death?

Sudden cardiac death can also occur in non-athletes.

Heart attacks or coronary artery disease is the most important cause, and incidence increases with age and with underlying cardiac disease. In addition, it can be related to causes noted above.

To minimize your changes of experiencing cardiac arrest, it’s important to prioritize healthy lifestyle choices, address risk factors to minimize development of blockages in the arteries and use appropriate medications following recommendations by your health care provider if you already have heart disease.

Dr. Ataul Qureshi is a cardiologist with Aultman Deuble Heart & Vascular Hospital in Canton.

This article originally appeared on The Repository: Damar Hamlin, sudden cardiac death and the importance of CPR