Even after angioplasty, what leads to a sudden cardiac death, like in the case of Raju Srivastava?

Raju Srivastava‘s death has put the spotlight back on heart health. The comedian died earlier today after over 40 days of hospitalisation following a heart attack that he suffered on August 10 while working out at a gym. He was 58, and is survived his wife Shikha, and children Antara and Ayushman.
Srivastava was admitted at Delhi’s All India Institute of Medical Sciences (AIIMS), where he underwent angioplasty and was said to have been critical and on ventilator for over a month.
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The news of his demise was confirmed to the Indian Express his brother Dipoo, who said, “He passed away on Wednesday morning. His daughter Antara informed me right now. I’m in Mumbai, leaving for Delhi.” According to hospital sources, the comedian died around 10.30 am.

Srivastava’s nephew Kushal said he suffered a cardiac arrest on Wednesday morning, which he could not survive.
Is it possible for a patient to suffer a cardiac arrest after they have undergone angioplasty?
Dr Amit Patil, who is a consultant interventional cardiolog at Mumbai’s Wockhardt Hospital, told that a person who has been revived following a cardiac arrest through immediate medical intervention like CPR (cardiopulmonary resuscitation) can experience a cardiac arrest again.
“In fact, people who have survived an arrest once, are more prone to sudden cardiac arrest again,” he said, adding that experiencing a sudden cardiac arrest after angioplasty depends on the condition of the patient.
“Like, in Raju Srivastava‘s case, if he was in a ‘cardiogenic shock’ then even after performing an angioplasty there would be a 50 per cent chance that he would succumb to cardiac arrest. Only in 50 per cent of critical patients, there are chances of survival. Only in those patients who are stable — or those who do not have comorbidities — can angioplasty yield a good result with very low chances of sudden cardiac arrest,” Dr Patil explained.

Adding to this, Dr Pravin Kahale, consultant, cardiology at Kokilaben Dhirubhai Ambani Hospital, Mumbai said that cardiac arrest is an “abrupt and sudden loss of heart function, leading to unconsciousness due to disruption of the heart’s electrical system”.
He told this outlet that heart patients develop cardiac arrests in two scenarios: a major heart attack while the heart function is normal, or due to a blockage in the heart.
“Patients who have undergone angioplasty or pass surgery for cardiac blocks can face a cardiac arrest because of the re-occurrence of the block or weak pumping action of the heart. A heart showing a pumping capacity below 35-40 per cent has a 10-15 per cent chance of cardiac arrest. This is due to the presence of dead tissues that causes electrical durbances and sudden cardiac death. Even after angioplasty and pass surgery, weak heart pumping and a sudden heart attack can increase the risk of sudden cardiac death,” he explained.

What is angioplasty and when is it required?
As mentioned earlier, the actor-comedian had undergone a process called ‘angioplasty’ which, according to Dr Anish Chandarana, interventional cardiolog at Marengo CIMS Hospital, is a procedure done to enlarge the opening in a blood vessel or arteries that has become narrowed or blocked plaque, to enable normal blood flow in the heart.

When is it required? “When a patient suffers an acute heart attack or severe anginal pain while exerting during a physical activity — and they collapse — an angioplasty must be conducted. If there are significant blocks in the arteries in the heart that hamper the normal blood flow, and the anatomy of the patient is favourable for the procedure, then it is conducted,” he said.
Angioplasty a procedure done to enlarge the opening in a blood vessel or arteries that has become narrowed or blocked plaque, to enable normal blood flow in the heart. (Photo: Getty/Thinkstock)
Dr Chandarana added that usually, if a patient undergoes a planned (non-emergency) coronary angioplasty, they are able to return to work after a week. In a case of an emergency angioplasty following a heart attack, it may be several weeks or months before the patient recovers completely.
He concurred that in the event a patient’s index records “acute myocardial disease, or they suffer a severe heart attack leading to massive damage in the heart, it can lead to death”.

“Even after an angioplasty procedure is conducted, there could be a re-narrowing of the artery, which can lead to massive cardiac arrest again leading to fatal outcomes.”
He concluded with a warning, explaining that a heart attack patient can be saved within the ‘golden hour’ period of one hour if they are rushed to a hospital.
“A cardiac arrest happens when an abnormal heart rhythm (arrhythmia) takes place and your heart’s electrical system is not working correctly. The system controls the rate and rhythm of your heartbeat. A cardiac arrest gives no time for a person to survive and is 92 – 95 per cent fatalic,” said Dr Chandarana.
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