隨著港隊在東京奧運會及殘奧會屢創佳續,全城掀起一股運動熱潮。然而,近年出現不少年輕人在運動時猝死的個案,即使是運動健將,也難逃厄運。大部分猝死個案由心臟問題引起,心臟科專科醫生黃民樂提醒,年輕人猝死多與隱性心臟病有關,患者日常生活並無特別病徵,難以察覺1;高風險人士應定期心臟檢查,如心臟超聲波、運動心電圖等1, 2,以便及早獲得適切診斷和治療,減低因心臟問題而猝死的機會3

 

40歲以下猝死 多屬先天原因

隱性心臟病病徵不明顯,病人在病發前完全不知自己患上心臟病1。黃民樂醫生表示,40歲以下人士猝死多屬先天原因4:「過去家族曾有猝死、先天性心肌肥厚症(HOCM)或先天性心律不正等病史者,他們或帶有疾病基因,大大增加患病的風險5。由於隱性心臟病病徵不明顯,患者難以察覺自己的心臟出現問題,一旦病發,若沒有及時得到適當治療,可導致隨時休克以至死亡,令人防不勝防6。」至於40歲以上的猝死個案,則多屬於後天成因,如冠心病及心瓣疾病等7

心臟科專科醫生黃民樂指出,年輕人運動後猝死個案多與隱性心臟病有關(1),高風險人士應定期檢查(1),以便及早獲得適切診斷和治療(3)。

心臟科專科醫生黃民樂指出,年輕人運動後猝死個案多與隱性心臟病有關(1),高風險人士應定期檢查(1),以便及早獲得適切診斷和治療(3)。

 

勿忽視 定期檢查心臟加以提防

近年,年輕藝人、運動員及學生猝死事件時有所聞,喚起大眾對隱性心臟病的關注。黃醫生指出,罹患隱性心臟病的機率少於1%,並不算高8:「一般人患上隱性心臟病的機會極微,如剛才提及的先天性心肌肥厚症,並非普遍心臟疾病,100人中未必有1個患者,甚至可能幾百人中才有1個。不過,它能危及生命,絕不能忽視9。」

他建議病人,有高危隱性心臟病因素(如家族病史、直系親屬曾出現猝死)、運動或行斜坡時出現心口痛、心悸、作休克等情況,應盡快看醫生且接受心臟檢查,及早確診並接受治療5。「他們可透過心臟超聲波、運動心電圖、基因測試等,有效診斷是否患有隱性心臟病5。」

 

根據病因治療

治療方面,要視乎病因而定,與治療一般心臟病分別不大。「如心肌肥厚症患者會使用血管緊張素II受體拮抗劑(ARB),有助減緩病情惡化和控制血壓10, 11;心律不正患者可透過β受體阻斷藥(Beta blockers)減少心律不正情況12;惡性心律不正有機會致命,高危人士可考慮安裝植入式心臟除顫器,當偵測到心律不正時,就會輸出電流進行除顫來糾正心跳,預防猝死13。」至於40歲以上冠心病患者,最常處方抗血小板藥,防止血塊在血管內形成;情況嚴重時,或需考慮接受冠狀動脈介入治療術(俗稱:「通波仔手術」)14

黃醫生強調,服用藥物要依循醫生指示,否則有機會帶來心跳太慢或太快、血壓控制欠佳等副作用15。「服用抗血小板藥人士要留意,避免外傷、出血及進行過份劇烈的運動16, 17。」

他補充,大部分心臟病都是長期病,尤其是40歲後患的冠心病、心臟衰弱及心瓣疾病,病人需定期覆診及定時服藥18。而先天性心漏症、先天性血管畸形等,均有根治方法19, 20

 

如有隱性心臟病 運動前須諮詢醫生

做運動有益身心,能提升心肺功能,亦是減壓良方21。究竟帶有隱性心臟病基因、已知自己較易患上先天性心律不正或先天性心肌肥厚症者,做運動前有哪些注意事項?黃醫生建議:「須先諮詢醫生的意見;宜做輕度運動,避免進行過份劇烈的碰撞式或競技式運動(如足球比賽)22。若途中出現心口痛、頭暈、心跳過快,就要立即看醫生23。」

心臟病患者接受治療後,又該如何安全又有效地做運動?他希望,病人經過復康過程,待病情穩定後,能回復昔日的生活質素。但是,每人的身體狀況不一,他們做運動同樣應先諮詢醫生的意見,制定一套適合自己的運動計劃,量力而為24

 

護心有法

自60年代起,心臟病已成為本港第三號殺手25。要維持心臟健康,黃醫生提供以下貼士:

.都市人由於日常工作忙碌,生活節奏快速,往往缺乏運動及休息,應培養恆常運動的習慣,同時保持充足睡眠26

.肥胖問題越來越普遍,要留意自己的體重及腰圍,少坐多走路26

.不要吸煙,盡量避免進食煎炸油膩食物26

.高血糖有礙心臟健康,而亞洲人較易出現血糖過高情況,應定期進行身體檢查,監察是否患上早期糖尿病26

 

This article is supported by Sanofi Hong Kong Limited

MAT-HK-2100924-1.0-11/2021

參考資料:

  1. Mayo Clinic. Sudden death in young people: Heart problems often blamed. Available at: https://www.mayoclinic.org/diseases-conditions/sudden-cardiac-arrest/in-depth/sudden-death/art-20047571. Accessed November 10, 2021.
  2. Banerjee A, et al. Int J Clin Pract. 2012;66(5):477-492.
  3. Chugh SS. Nat Rev Cardiol. 2010;7(6):318-326.
  4. Drory Y, et al. Am J Cardiol. 1991;68(13):1388-1392.
  5. Stojanovska J, et al. Radiographics. 2013;33(7):1977-2001.
  6. Barletta V, et al. J Cardiovasc Echogr. 2014;24(2):41-51.
  7. Sparrow PJ, et al. Radiographics. 2009;29(3):805-823.
  8. Ormondroyd E, et al. Eur J Med Genet. 2020;28(11):1486-1496.
  9. Familial hypertrophic cardiomyopathy. Available at: https://medlineplus.gov/download/genetics/condition/familial-hypertrophic-cardiomyopathy.pdf. Accessed November 10, 2021.
  10. Ommen SR, et al. Circulation. 2020;142:e558-e631.
  11. Axelsson A, et al. Lancet Diabetes Endocrinol. 2015;3(2):123-131.
  12. American Heart Association. Medications for Arrhythmia. Available at: https://www.heart.org/en/health-topics/arrhythmia/prevention–treatment-of-arrhythmia/medications-for-arrhythmia. Accessed November 11, 2021.
  13. American Heart Association. Implantable Cardioverter Defibrillator (ICD). Available at: https://www.heart.org/en/health-topics/arrhythmia/prevention–treatment-of-arrhythmia/implantable-cardioverter-defibrillator-icd. Accessed November 11, 2021.
  14. NHS. Coronary Heart Disease Treatment. Available at: https://www.nhs.uk/conditions/coronary-heart-disease/treatment/. Accessed November 11, 2021.
  15. Cramer JA. Heart. 2002;88:203-206.
  16. Drugs.com. Safe Use of Antiplatelet Medication. Available at: https://www.drugs.com/cg/safe-use-of-antiplatelet-medication.html. Accessed November 11, 2021.
  17. Brunner S, et al. Int J Sports Med. 2018;39(08):646-652.
  18. Heart and Stroke Foundation of Canada. Valvular heart disease. Available at: https://www.heartandstroke.ca/heart-disease/conditions/valvular-heart-disease. Accessed November 11, 2021.
  19. Centers for Disease Control and Prevention. Facts about Ventricular Septal Defect. Available at: https://www.cdc.gov/ncbddd/heartdefects/ventricularseptaldefect.html. Accessed November 11, 2021.
  20. Vascular Cures. What is Congenital Vascular Malformation?. Available at: https://vascularcures.org/congenital-vascular-malformation/. Accessed November 11, 2021.
  21. Mayo Clinic. Exercise: 7 benefits of regular physical activity. Available at: https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise/art-20048389. Accessed November 11, 2021.
  22. American Heart Association. Congenital Heart Defects and Physical Activity. Available at: https://www.heart.org/en/health-topics/congenital-heart-defects/care-and-treatment-for-congenital-heart-defects/congenital-heart-defects-and-physical-activity. Accessed November 11, 2021.
  23. Heart and Stroke Foundation of Canada. Congenital heart disease: What to watch for. Available at: https://www.heartandstroke.ca/heart-disease/conditions/congenital-heart-disease/what-to-watch-for. Accessed November 11, 2021.
  24. MedlinePlus. Being active when you have heart disease. Available at: https://medlineplus.gov/ency/patientinstructions/000094.htm. Accessed November 11, 2021.
  25. HeathlyHK. Department of Health. Coronary Heart Diseases. Available at: https://www.healthyhk.gov.hk/phisweb/en/chart_detail/24/. Accessed November 11, 2021.
  26. Mayo Clinic. Strategies to prevent heart disease. Available at: https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease-prevention/art-20046502. Accessed November 11, 2021.