When Health Checks are No Guarantee

Preventive health checks, while picking up some diseases at an early stage and paving the way for timely corrective measures, do not unfortunately guarantee against sudden natural deaths as we learnt recently.

Mr DC, who had undergone a comprehensive executive health check-up a month earlier, died in a dramatic manner. This 59 year old fitness freak had gone to the club pool at 6.30 in the morning for his routine swim, had done his usual 5 laps and was then spotted by some fellow swimmers to be standing in one corner with uncustomary quietness. When the guards hauled him out of the pool, he was dead.

The sense of disbelief among family and friends was especially stunning as his recent health check had been normal and the doctor had given him a thumb’s up. He was not a smoker, did not suffer from diabetes or high blood pressure and was not overweight. His cholesterol levels were normal. His ECG, both at rest as well as during the 9 minutes that he ran sprightly on the treadmill (TMT test) had been normal. The aortic valves of his heart had however shown calcification, which the doctor had passed off as “incidental”, not requiring any therapy.

The heart’s ability to beat continuously and unobtrusively 100,000 times a day or 36 million times a year is often taken by us for granted.  But quite like the engine of a car that can stop unpredictably on the road (as indeed happened to thecar in which Mr Rajiv Gandhi was travelling during Mrs Indira Gandhi’s funeral procession), the heart can surprise us.

The commonest cause of natural sudden death is abrupt stopping of the heart. If it occurs during sleep, the person just fails to wake up. If it occurs to a pilot or driver at work, it can cause fatal accidents. I remember watching a couple waltzing on the dance floor on the eve of new-year, and moments later, seeing the gentleman collapse on the ground with a “cardiac arrest”.

A “heart attack” or myocardial infarction (MI) as we commonly understand is due to an abrupt blockage of arteries that carry blood to the muscles of the heart. It is usually associated with pain or heaviness in the chest.

On the other hand, a bolt-from-the-blue “cardiac arrest”, even before the person has had a chance to complain, is often caused by arrhythmias or rhythm disturbances that sometimes prove fatal. With heart muscles going into a state of rapid irregular twitching, called ventricular fibrillation, pumping of blood halts abruptly and death occurs within seconds to minutes.Those with calcified heart valves are ten times more prone.

Fatal cardiac arrhythmias, though rare, can take us by surprise, and remind us of our vulnerability as mortals. TS Eliot might well have said “And that’s the way some lives end, not with a bang or whimper, but with a twitch!”
As published in HT City ( Hindustan Times) dated 2 June, 2013.