Aloke Finn, MD, Associate Professor of Medicine, University of Maryland School of Medicine, Expertise in Interventional Cardiology, talks about a drug that brings cholesterol levels to such a low point they are able to prevent some heart diseases.
Could you describe what is cardiac arrest?
FINN: Cardiac arrest is the sudden sensation of the heart beating and basically leads to death unless it’s intervened upon.
What are the symptoms or signs?
FINN: Sometimes it can be preceded by symptoms of a heart attack – chest pain, light-headedness, dizziness. Those are the most frequent things that occur prior to sudden cardiac arrest.
Does the heart completely stop beating in cardiac arrest? How long does a person have to be resuscitated or have medical help in that case?
FINN: That’s an interesting question. Usually, it’s variable, probably on the order of minutes is all somebody has to start giving CPR before the brain and other vital organs start to die. It’s an irreversible process then.
Is there any indication as to what might cause cardiac arrest?
FINN: There are many causes of cardiac arrest. It really depends upon the age of the individual. Younger individuals suffer from cardiac arrest due to things such as intrinsic heart diseases, or what we call channelopathies. Whereas, in individuals 35 or older, they usually have sudden cardiac arrest due to things like heart attacks, which are the most frequent cause of sudden cardiac arrest.
What were you and your colleagues looking to determine with this study?
FINN: We were specifically interested in a subtype of sudden cardiac arrest, which is called unexplained sudden cardiac death. Essentially, that means that someone dies suddenly and goes to autopsy and at the autopsy we cannot find a clear pathologic cause of death. That is, the heart is normal. The other organs look normal. There’s no clear understanding of why they died.
Are these people who may have had few symptoms, or no symptoms before, so it’s a mystery?
FINN: Sometimes even more of a mystery because you have to have somebody around you to know whether you’re having symptoms. A lot of times these people can be found dead, and we don’t really understand what the process was that preceded the sudden death.
Tell me about what you and your colleagues did.
FINN: We were interested in understanding the genetics of underlying unexplained sudden cardiac death. We wanted to know of the people in our database we had that had unexplained sudden cardiac death, how many of them carry genes that were considered pathologic or likely pathologic for certain known serious cardiac disorders. What we can do is extract DNA from the organs of those people and sequence that DNA for certain cardiac genes. By sequencing the DNA, we can try to figure out whether there were mutations that were important mutations that could be considered pathologic mutations. We found about 20% of the people dying of so-called unexplained sudden cardiac death carried pathologic or likely pathologic mutations in certain cardiac genes, which suggests they had underlying undetected cardiac disorders that were leading to their cause of death.
Is twenty percent considered a significant number?
FINN: I think 20% is a significant number. That would be a substantial number of people every year we could save. We have over 300 to 500,000 people every year dying of sudden cardiac death. We really don’t know the exact causes in a lot of those people. So, understanding this mystery and making progress is extremely important in terms of saving lives.
What did the findings suggest? Perhaps there’s a blood work or DNA test that can be done ahead of time?
FINN: I think the findings are research findings and have to be translated into the clinic. But genetics is playing an important role in the clinical understanding of heart disease. I think we will get to the day where we will understand and need to get our genes screened, especially in somebody with a family history of sudden cardiac death, or themselves have had aborted sudden cardiac death. Having a gene look up in those kinds of individuals is the beginning to being able to save lives.
When you know you have this mutated gene, are there preventative measures you can take?
FINN: Certain disorders are known to cause sudden cardiac death. If you have one of those, it would be worth seeing a cardiologist to figure out whether or not you might be a candidate for something like an ICD, implantable cardio cardiac defibrillator, which can be used to shock the heart back into a normal rhythm should it go into a dangerous rhythm. We do treat people with those routinely in this day and age.
What did the findings suggest that perhaps might be beneficial?
FINN: I think it suggests that we need to do more investigation. When we have somebody who dies suddenly and don’t know the causes, getting genetic screening is an important aspect of completing the exam to try to save lives in family members where those genes may have been passed down. It’s important for the next generation to try to understand what the causes of death were in those individuals.
What’s the next step in the research?
FINN: The next step is to try to understand how many people who are walking around have this kind of problem. We chose a database where people had died and used the tissues from those people. We want to understand in the normal general population of people how many we can save by getting this genetic screening done.
Is that study something you’re looking into?
FINN: It’s something that’s in the works and we’re just underway planning it.
What were the conditions you mentioned where ICDs are implanted?
FINN: I actually want to rephrase that because it depends on the type of genetic disorder we find what the treatments are. Some genetic disorders require treatments as simple as a medicine that can help prevent sudden cardiac death. Some are more complex and need either interventions with implantable cardiac defibrillators or some type of surgery. So, it really depends on the type of disorder that individual has in terms of treatment.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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