‘Bangungot’ in family? See a heart specialist

Inquirer Libre - - FRONT PAGE - By Tessa Salazar

IT’S RARE in the Western world, and appears to occur more commonly among young men in Southeast Asia.

Sudden Unexpected Death Syndrome (SUDS), called bangungot in the vernacular, has claimed many young Asian men’s lives while they sleep, and it has only been recently that the scientific world has begun to understand this syndrome.

SUDS, called lai tai in Thailand and hukuri in Japan has been cloaked in superstition. In Thailand it is believed to be linked to eating rice cakes. Filipinos believe ingesting high levels of carbohydrates just before sleeping causes bangungot.

Victims of bangungot have not been found to have any organic heart diseases or structural heart problems. However, cardiac activity during SUDS episodes indicates irregular heart rhythms and ventricular fibrillation, which causes the victim to lose consciousness during sleep. The victim survives this episode if the heart’s rhythm goes back to normal.

Ongoing genetic studies by Spanish electrophysiologist Dr. Josep Brugada Terradellas show that SUDS results from mutations in the cardiac sodium channel gene. This means that it is a chromosomal problem, which is why it runs in families.

Thus, doctors say that families who have kin that have suffered from or died of SUDS must see a heart specialist.

Genetic test

Cardiologist and electrophysiologist Dr. Belen Carisma, Philippine Heart Association (PHA) director, says a patient undergoes an electrocardiogram (ECG) to establish a pattern for SUDS. A genetic test clinches the diagnosis.

For people who test positive for this pattern, an electrophysiologic study is done.

“We put catheters into the heart and induce irregular heart rhythms—the actual symptoms of SUDS—while the patient is awake,” Carisma said.

An electrophysiologic study is the recommended course of action before the patient receives an intracardiac cardioverter defribillator (ICD), a miniaturized defibrillator.

Prohibitive cost

But for the ordinary Filipino, the cost of preventing SUDS can be quite prohibitive. The diagnostic test alone costs between P30,000 and P50,000.

Still, doctors find it their moral responsibility to urge the patient to acquire an ICD once tests show he could be at risk for SUDS.

An ICD, which is a long-term implant, can set back the patient by half-a-million pesos.

An ICD, Carisma stresses, is not a cure but a preventive instrument. It is implanted underneath the skin just above the heart, and senses when the heart has irregular rhythms. It then sends out electrical pulses to force the heart to beat normally.

The ICD stays in place for as long as the patient needs it, and requires battery changes every four to six years. The ICD requires maintenance checks, which could cost up to another million pesos.

“While we know how SUDS can be prevented, we also know that it is not within reach of the majority,” Carisma said.

Brugada Syndrome

SUDS expert Terradellas was in the country last May to speak before members of the PHA. He had stressed that SUDS, or the Brugada Syndrome, is a genetic, not a lifestyle, disease.

He said the physical symptoms associated with SUDS can lie dormant for up to 40 years.

It had been previously believed that SUDS was caused by pancreatitis (inflamation of the pancreas). This belief went on for years, until Terradellas and his siblings started their studies with pediatric patients and found that SUDS was genetically linked.

Terradelas also stressed during the convention that eating rice did not cause bangungot.

“SUDS happens at night probably because at night, the heart beats slowly since we’re sleeping. Probably, this creates the conditions for sudden death,” he said.

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