Preventing Sudden Deaths: Early Diagnosis and Treatment for Hypertrophic Cardiomyopathy and Cerebral Aneurysms

Preventing Sudden Death: Identifying and Treating Hypertrophic Cardiomyopathy and Cerebral Aneurysms

The Silent Threats Lurking Within

In South Korea, cancer has long held the top spot as the leading cause of death. However, another silent killer is steadily claiming lives: heart disease and cerebrovascular disease. The good news is that early detection and treatment can significantly reduce the risk of sudden death associated with these conditions.

Experts from the esteemed Chung-Ang University Hospital’s Department of Cardiovascular Medicine, Cardiovascular and Thoracic Surgery, and Cerebrovascular Center shed light on two of these deadly diseases: hypertrophic cardiomyopathy and cerebral aneurysms.

Hypertrophic Cardiomyopathy: A Genetic Time Bomb

Hypertrophic cardiomyopathy is a congenital heart condition where the heart muscle becomes excessively thick, disrupting its normal structure and function. This condition, affecting approximately 1 in 500 individuals, poses a high risk of sudden death, particularly for people in their 20s to 40s.

It is crucial to watch out for warning signs such as chest pain or abnormal heartbeat after exercise. A detailed examination, including an echocardiogram, is needed if there is a family history of sudden death or hypertrophic cardiomyopathy. Recently, an extended ECG monitoring method has been developed, improving the accuracy of diagnosis.

Proper medication, such as beta-blockers or anti-arrhythmic drugs, and avoiding excessive exercise are essential for managing hypertrophic cardiomyopathy. In severe cases where the heart muscle thickening obstructs the outflow tract, surgical intervention like myocardial resection may be necessary to prevent sudden death.

A Deadly Time Bomb: Cerebral Aneurysms

Cerebral aneurysm, a vascular disease that causes a part of the brain’s artery to swell, can be likened to a ticking time bomb within the head. Unlike hypertrophic cardiomyopathy, cerebral aneurysms often manifest with no observable symptoms until they rupture. Tragically, around 20% of patients with a ruptured brain aneurysm do not survive long enough to receive medical attention.

Early diagnosis is crucial as treatment can prevent the catastrophic consequences of a ruptured brain aneurysm. CT angiography and MRA (magnetic resonance angiography) are commonly used to diagnose brain aneurysms. Individuals with a family history of cerebrovascular disease should consider undergoing cerebrovascular examinations in their 30s or 40s.

Once diagnosed, treatment options such as coil embolization or ligature clip surgery may be considered based on factors like the size, location, shape, age, and health status of the patient. Not all aneurysms rupture, and the risk varies, so a comprehensive evaluation by a healthcare professional is vital.

The Importance of Early Intervention

Take charge of your health and don’t let these silent threats catch you off guard. Remember, a premature diagnosis can make all the difference in preventing sudden death. If you experience symptoms like chest pain, dizziness, pulse irregularities, or shortness of breath during or after exercise, seek immediate medical attention from a specialist.

By staying vigilant and prioritizing routine screenings, we can confront these deadly diseases head-on and save lives.

Journalist: Jae-beom Kim | oldfield@donga.com

Kang Ki-woon, professor of cardiology at Chung-Ang University Hospital, treats patients with hypertrophic cardiomyopathy, a heart disease. Hypertrophic cardiomyopathy and cerebral aneurysms, which are cerebrovascular diseases, are dangerous diseases with a high risk of sudden death, but if diagnosed in advance, the risk of death can be adequately prevented by various treatment methods. Photo provided by Chung-Ang University Hospital

1 in 500 people suffer from ‘hypertrophic cardiomyopathy’
Suspect chest pain or abnormal heartbeat immediately after exercise
A brain aneurysm is like a ticking time bomb in the head
If you have a family history, even people in their 30s need to be tested.

According to data released by Statistics Korea in 2021, the leading cause of death in Korea is cancer, followed by heart disease, pneumonia, and cerebrovascular disease. Among these diseases, there are diseases that can prevent the risk of sudden death through treatment if detected in advance. Representative examples include hypertrophic cardiomyopathy, a heart disease, and cerebral aneurysm, a cerebrovascular disease. We looked at the preliminary symptoms and prevention methods of both diseases with the help of experts from Chung-Ang University Hospital’s Department of Cardiovascular Medicine, Cardiovascular and Thoracic Surgery, and Cerebrovascular Center.

● ‘Hypertrophic cardiomyopathy’ linked to sudden death in people in their 20s to 40s

Hypertrophic cardiomyopathy is a congenital heart disease in which the heart muscle becomes too thick, disrupting the normal structure and function of the heart. It can cause symptoms such as shortness of breath and can lead to arrhythmia and associated sudden death or heart failure. It is found at a rate of 1 in 500 people, and around 70% of them are at risk of sudden death.

In particular, it is closely associated with sudden death among young people in their 20s to 40s. If there is a genetic influence and a member of the immediate family has died suddenly or had hypertrophic cardiomyopathy, it is necessary to confirm the presence of the disease through a detailed examination such as an echocardiogram.

A diagnostic method that allows a definitive preliminary diagnosis of hypertrophic cardiomyopathy has recently been developed. Kang Ki-woon, professor of cardiology at Chung-Ang University Hospital, said, “There is a study by the European Society of Cardiology that shows that a 30-day extended ECG monitor is more effective in diagnosing hypertrophic cardiomyopathy than the current 24-day. an hourly Holter ECG monitor.” “Diagnosis by continuous extended electrocardiogram monitoring can prevent arrhythmias from occurring and the associated risk of sudden death or heart failure,” he said.

For patients with hypertrophic cardiomyopathy, it is important to continue taking medication such as beta-blockers or anti-arrhythmic drugs as prescribed by the doctor because excessive exercise can stress the heart and lead to fatal consequences. If symptoms do not improve and the outflow tract is completely blocked due to thickening of the heart muscle, a ‘myocardial resection’, which surgically cuts the heart muscle, should be considered to prevent sudden death.

Hong Jun-hwa, a professor of cardiovascular and thoracic surgery at Chung-Ang University Hospital, said, “If you feel chest pain, dizziness, pulse abnormalities, feel sick, or are too short of breath during or immediately after exercise, you should visit a specialist and get a diagnosis of hypertrophic cardiomyopathy.”

● A ‘brain aneurysm’ with no symptoms until it bursts

Cerebral aneurysm is a vascular disease in which part of the brain’s artery swells like an artery. If an aneurysm with a weak blood vessel wall ruptures, it can lead to brain haemorrhage and even death, so it is known as a ‘time bomb in the head’. Although it is a frightening cerebrovascular disease, it often goes unnoticed because there are no symptoms until it erupts. It is said that around 20% of patients with ruptured brain aneurysms die before reaching hospital.

Early diagnosis of brain aneurysms is also important as sudden death can be prevented by treatment if detected in advance. Brain aneurysms are often diagnosed using CT angiography and MRA (magnetic resonance angiography). If you have never had a cerebrovascular examination before, you need to have either an MRA or CT angiography around the age of 50. In particular, if a family member has cerebrovascular disease such as cerebral aneurysm or cerebral haemorrhage, a cerebrovascular examination is necessary even in the 30s or 40s.

Choi Hyun-ho, professor of neurosurgery at the Cerebrovascular Center at Chung-Ang University Hospital, said, “When a brain aneurysm is diagnosed, the size, location, shape, age, etc. are considered to decide whether to conduct a follow-up appointment. observe or perform coil embolization or ligature clip surgery, which are procedures to prevent rupture.” “Not all tears occur, and the risk varies depending on the location, shape, size, age of the patient, and health status, so a treatment policy is determined based on a comprehensive consideration,” he said. He then advised, “If cerebral aneurysm or cerebral hemorrhage occurs, more than 50% of patients die or it is impossible to return to normal life, so it is effective to make a preliminary diagnosis and treat before the bleeding.”

Reporter Jae-beom Kim oldfield@donga.com See more articles from this reporter

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