Sudden cardiac death: unexpected and tragic

The shocking event comes out of the blue - but a sick heart is often the cause. What leads to sudden cardiac death and how immediate first aid can save lives

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It comes so quickly, so unexpectedly - sudden cardiac death kills people from life

© Shotshop / Kallejipp

It can happen to anyone and anytime. All of a sudden a person collapses, loses consciousness, his heart stops - sudden cardiac death occurs. It is estimated that around half of deaths from cardiovascular disease can be attributed to sudden cardiac death. The tragic incident repeatedly made headlines in the media when a seemingly healthy high-performance athlete collapsed dead during a competition.

However, this rarely affects young, well-trained people. Much more often, fate overtakes middle-aged and older people. Men are affected three times as often as women.

Causes: what causes sudden cardiac death?

By far the most common cause is coronary artery disease (CHD), in which there is calcification of the coronary arteries. It mainly affects people of middle and older age. In addition, other congenital and acquired heart diseases can be considered as triggers. These include certain arrhythmias such as long QT syndrome and Brugada syndrome. Heart failure, a past heart attack and certain heart valve defects can also increase the risk of sudden cardiac death.

If the event occurs in a young person - which happens very rarely - a congenital heart defect such as so-called hypertrophic cardiomyopathy may be behind it. This is a pathologically thickened heart muscle. Partly an inflamed heart muscle is to blame - doctors call it myocarditis. It is often the result of a flu-like infection.

Although cardiac death is almost always based on a sick heart, the event occurs unexpectedly in most of those affected. Because up to this point the ailment remained undiscovered.

Symptoms: Is the event looming?

For some of the patients, the event is not announced. In other cases, however, there are harbingers of sudden cardiac death. They occur a few hours before the event, sometimes days to weeks before. These include: New or suddenly worsening symptoms such as chest pain, clouding of consciousness, fainting, palpitations, and shortness of breath. A study with 839 participants published in the specialist magazine Annals of Internal Medicine has been published shows: Sudden cardiac death was heralded by symptoms in every second person. They occurred predominantly within 24 hours before heart failure. Mostly it was chest pain and shortness of breath.

Only 19 percent of the study participants had called the emergency doctor. He could have saved lives in the process. It is therefore important: If you notice such complaints, call the emergency doctor immediately or dial 112 (more on this in the first aid section).

The direct trigger of sudden cardiac death is usually ventricular fibrillation. Due to this cardiac arrhythmia, the heart no longer pumps regularly, but only twitches in an uncoordinated manner. It no longer carries blood into the circulation. The first thing the brain suffers is. If there is a lack of blood and thus oxygen, the brain stops functioning - the person concerned loses consciousness. Shortly before this, symptoms such as sweating, shortness of breath and tightness in the chest can occur.

Instead of ventricular fibrillation, immediate cardiac arrest can more rarely trigger cardiac death.

Saving Lives: Providing First Aid

If a person collapses out of the blue, lies unconscious on the ground and does not breathe, then give first aid! The victim will only have a chance to survive if resuscitation measures are taken immediately.

Call 112

Do chest compressions

Let others help you with this

If there is a defibrillator on site, use it

You can't go wrong with this. The device usually shows the correct steps automatically. This video explains the processes in detail: First aid for cardiac arrest.

In many cases, doctors advise those who survive the incident to have an implantable defibrillator.Among other things, it monitors the heart rhythm and delivers an electric shock if ventricular fibrillation occurs. Sometimes other measures are also required, such as a bypass, which improves the blood flow in the heart again, or a special catheter ablation. Specialists use a catheter to track down the origin of the cardiac arrhythmia and turn it off.

Prevention: Can you protect yourself against sudden cardiac death?

People who suffer from coronary artery disease should specifically target its cause. Most of the time, cholesterol deposits in the blood vessels play a causal role. In addition to taking medication, a lot can be achieved through a healthier lifestyle: Don't smoke, drink only small amounts of alcohol, eat a balanced diet. If you have diabetes or high blood pressure, it is important to treat it effectively.

Young people who are committed to sports and perhaps also take part in competitions should regularly undergo a sports medical examination. Heart problems can be identified in many ways. For high-performance athletes, this is sometimes already mandatory.

Anyone who has never been actively involved or has paused for a long time should also do a check-up. From the age of 35, the statutory health insurance companies cover the costs of a health check-up every three years, during which the heart and circulatory system are also checked. Younger adults aged 18 and over receive a one-off payment for the examinations. In some cases, insurers now also offer to bear the costs of a sports medical examination. Ask at your cash register.

Regular exercise is considered one of the best ways to lower your risk of sudden cardiac death. Experts emphasize: Even if the fatal incident rarely occurs as a result of excessive physical strain, the protective effects of appropriate sport far outweigh the consequences. Discuss the individual workload with the doctor. Exercise only moderately - so that you can still talk. Do not exercise if you have a cold and then wait until you have recovered.

Brush up on your first aid skills. Especially if your partner or a close relative is known to be at high risk of sudden cardiac death, you should be trained in first aid.

Our expert: Professor Wolfram Delius, specialist in internal medicine and cardiology

© W & B / Bernhard Huber

Consulting expert: Professor Dr. med. Wolfram Delius, specialist in internal medicine and cardiology with a practice in Munich


Böhm M, Hallek M, Schmiegel W (eds): Internal medicine, limited by Classen M, Diehl V, Kochsiek K, 6th edition, Munich Elsevier Urban & Fischer Verlag 2009

Mayo Foundation for Medical Education and Research (Mayo Clinic): Sudden Cardiac Arrest. Online: (accessed on November 11, 2013)

German Heart Foundation: Sudden cardiac death: is sport dangerous or does sport protect against the fatal event? Online: (accessed on November 11, 2013)

Federal Institute for Sports Science and the German Sports Confederation - Competitive Sports: Sudden cardiac death during sports. Online:ötzlicher_Herztod_beim_Sport.pdf (accessed on November 11, 2013)

World Medical Library (Medscape): (accessed on November 11, 2013)

Bonow, Mann, Zipes, Libby: Braunwald´s Heart Disease, 9th edition Elsevier 2012

Annals of Internal Medicine 2016:

Important note: This article contains general information only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor. Unfortunately, our experts cannot answer individual questions.

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