Is One Kind of Sudden Cardiac Arrest Survivor Better Than Another?

All sudden cardiac arrests are caused by some preceding disease, disorder, or circumstance, examples of each include atherosclerosis, Brugada syndrome and drug overdose, respectively. For some sudden cardiac arrests, the exact cause is a mystery, due to the current limitations of medical science and forensics, and the lag in time between when the event occurred and when medical personnel can do a proper and full diagnosis. If the cause cannot be identified, it is called idiopathic.

There appears to be an ill-informed idea that a sudden cardiac arrest is not a “real” sudden cardiac arrest if the result of coronary artery disease (blocked cardiac arteries) or a myocardial infarction (heart attack). In fact, while engaged in strenuous exercise, a blocked artery can deny the heart sufficient oxygen, putting it under stress and provoking ventricular fibrillation and sudden cardiac arrest. It’s unpredictable and sudden. And it is an arrhythmia, often a fatal arrhythmia, that stops the heart and not a blocked artery, per se. A real sudden cardiac arrest. Coronary artery disease (CAD) and heart attacks are the direct cause of most sudden cardiac arrests. That’s a fact.

This absurd notion about sudden cardiac arrests may be the result of misinterpreting the campaign to educate the public on the difference between a cardiac arrest and a heart attack. Many people are ignorant about the difference, likely just as many who are ignorant about sudden cardiac arrests caused by coronary artery disease and/or heart attacks. People have heart attacks and survive, it is true, but most of the people who die from a heart attack actually die from a sudden cardiac arrest. Yes, they are two different phenomena, but every sudden cardiac arrest has its own cause, even if it cannot easily be identified and heart attacks are just one cause of many.

But there is another reason why people subscribe to this fiction that cardiac arrests caused by CAD and heart attacks are not “real” sudden cardiac arrests: there is a negative stigma attached to heart attacks with which people don’t want to be associated. People appear to believe that heart attacks and CAD are exclusively the result of a moral failure. That is, people who have heart attacks or CAD have poor impulse control, bad diets, eat too much, avoid exercise, drink excessively and/or smoke. It is a stereotype. Under this flawed set of beliefs, having a heart attack or occluded arteries is a choice, a bad choice, based on a lack of willpower or moral fibre. This being the case, the outcome is predictable and avoidable, therefore not a “real” sudden cardiac arrest. Judgmental? Yes. Factual? Absolutely not.  

All types of people can experience a heart attack, from athletes who follow good dietary advice to “couch potatoes” who love Ben & Jerry’s to soccer moms who enjoy a few drinks at the golf club. But that isn’t the real issue, whether or not someone caused their sudden cardiac arrest, especially inside of a group intended to support survivors of such an experience. Anyone who thinks they are somehow better than that person with heart disease, or that their sudden cardiac arrest was somehow more “pure” or “real” than others’, may have more issues than whatever precipitated their sudden cardiac arrest. As Chaucer wrote in 1385, “who that hath an heed of verre, fro cast of stones war him in the were” (Translation: “people with glass heads should be wary of thrown stones” or more popularly “People in glass houses shouldn’t throw stones”). Judging others isn’t a good look. This attitude is less a question of whether some sudden cardiac arrests are real but more a statement that some survivors of sudden cardiac arrest are superior to others. If that sounds absurd, it is, because it is absurd. And it is sad.

But perhaps this stereotype and attitude about heart attacks explains why some survivors are repulsed and angry when a friend or acquaintance mistakenly asks how they are coping after their “heart attack”. The fear of being judged as responsible for their sudden cardiac arrest because of their personal failings is overwhelming. It provokes anger. It brings out the colorful poster explaining the difference. Would the response be the same if the friend or acquaintance asked how they were coping after their kidney failure? I suspect they’d respond with a polite correction: “Oh no, not kidney failure. I had a sudden cardiac arrest”. To my knowledge, there isn’t a readily accessible stereotype about kidney failure, like there is for heart attacks and coronary artery disease.

This aversion to being associated with or being labelled as having had a sudden cardiac arrest caused by a heart attack may be behind the campaign to promote the difference between the two medical issues. In terms of fund-raising, which would you rather contribute to: a charity helping people struck by lightning or a charity that helps people who are overweight, eat junk food, smoke cigarettes, and drink Pabst all day? A charity that helps people struck at random by illness or a charity that helps people who willingly embrace the risks of the same illness? For a charity focused on sudden cardiac arrests, seeking donations and support, the choice is obvious: differentiate from heart attacks or face being confused with them. Thus, the campaign explaining the difference between a sudden cardiac arrest and a heart attack. I’m certain there are other motivations as well.

Every year or so this issue crops up in Facebook groups related to sudden cardiac arrests. Unlike a sudden cardiac arrest, it is predictable. Someone declares – “There must be plenty of groups for heart attack survivors, so why are they in our group for sudden cardiac arrest survivors? – and a few others support the notion with a blue thumbs up. If the motivation behind this declaration is about needs not being met because of the inclusivity of the group, rather than some obscene form of elitism and exclusivity, I don’t really know. No one has yet made the case for the former, whereas there are strong signals of the latter. And that is sad. But the group will survive because that is what survivors do. And we are all sudden cardiac arrest survivors, no matter how we got here.

DISCLAIMERS: These are just my opinions and do not necessarily represent those of any Facebook group nor its Administrators. I am not a medical doctor nor expert of any kind. I do use Google, but not for medical advice. I have coronary artery disease and had a sudden cardiac arrest 200 meters or so from the finish line of a half-marathon. They wouldn’t let me join the heart attack Facebook group because I had a sudden cardiac arrest.*

*That’s just a stupid joke.

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