The loving wife and sudden cardiac death

Last month, we went to the wake of a friend’s wife. The wife was only 53 years old, who died in her sleep. Our friend could not believe it because she was a “superwoman,” who did everything in the house, and felt no discomfort whatsoever in doing all the house chores.

That evening she just complained of a vague chest discomfort and thought it was just due to fatigue. She should be back to her usual self when she wakes up in the morning, she told her husband as she kissed him good night. He didn’t realize it was not a good night, but a goodbye, kiss.

She was already lifeless in the morning when he tried to wake her up for breakfast.

Not isolated

Incidents like this are not isolated. We encounter it a little more frequently than what was previously believed as mere exceptions to the rule. A not infrequent scenario is that a heart doctor would be closely monitoring and treating the husband for heart disease only to learn later that the wife has succumbed to a heart attack or stroke or even sudden death.

All the time, the wife has been dutifully attending to the husband, buying his medicines, organizing them in plastic medicine containers so the hubby won’t have difficulty sorting them out when he takes them. She accompanies her husband to the doctor’s clinic, nary a complaint of her own so the doctor never bothers to check on the wife’s status.

The Philippine Heart Association has a very active council on women’s cardiovascular health aiming to correct the misconception—sadly still highly prevalent worldwide—that cardiovascular disease is a men’s disease and women are considerably spared from it.

Research data have now established that after the menopause, women in general tend to have a higher cardiovascular risk than men. And women who have heart disease, specifically that of the arteries supplying the heart muscles, have a much higher risk of sudden cardiac death or SCD, which is defined as death within one hour of symptoms.

In July this year, a new study from the Perelman School of Medicine at the University of Pennsylvania reaffirmed the finding that postmenopausal women with coronary artery disease and other risk factors are at an increased risk for SCD.

The new analysis, published in the Archives of Internal Medicine, gave a further startling finding that SCD made up 54 percent of the cardiac-related deaths in the women involved in the study. This finding is upsetting, to say the least, because it means that practically every other death in women who die from their heart disease is within one hour of onset symptoms that there’s hardly time to pull them from the clutches of imminent death.

Identify postmenopausal women

Our best bet to prevent this tragic scenario is to identify postmenopausal women who are at high risk for SCD. For me, all postmenopausal women should be suspect. Whether one has symptoms or not, she should get herself checked to make sure she does not have the ingredients ready to be simmered to a catastrophic stew.

The good news is that there is a simple way to identify women at high risk for SCD. “We have identified a series of clinical risk factors that may eventually help clinicians better counsel women on how to manage their overall health to avoid SCD,” said Rajat Deo, MD, assistant professor of Medicine, Cardiovascular Division, at the Perelman School of Medicine, and the lead author of the study we cited earlier.

Dr. Deo reported that based on analysis of the women’s baseline characteristics, previous heart attack, heart failure, irregular heart rhythm (atrial fibrillation), physical inactivity or sedentary living, diabetes, and reduced kidney function were all closely associated with the SCDs in the study. The presence of three risk factors or more confers a ten-fold greater risk of SCD than women with none of the risk factors.

Women identified as “high risk” should be the targets of aggressive treatment to control their risk factors, and they should be convinced to take their prescribed medicines religiously. They should also give equal priority in buying her and her husband’s medicines.

Frequently we encounter wives who would say, “Unahin ko na muna po ang mga gamot ni mister. Kung may matira na lang sa budget saka ako bibili ng gamut ko (I’ll buy first my husband’s medicines, and if there’s money left, then that’s when I buy my medicines).”

The show of poignant love so touches the doctor, and he readjusts his prescription for both—even calling the pharmacists for the price of medicines—to fit into the couple’s budget the prescribed treatments for both husband and wife.

So we would like to resound the trumpet call for all postmenopausal women with known cardiovascular risk factors to get themselves checked by their family physicians. The husband will be much happier in his sunset years with his loving wife beside him.