Cardiac Arrest: Lessons from a Friend’s Sudden Passing

I’ve just come from the memorial of a friend who tragically and suddenly died while mountain biking with another friend in the Santa Monica mountains.  Lukas was an accomplished triathlete and ultrarunner.  More importantly, he was a husband, father, son, brother, respected colleague, and loyal friend.  His sudden passing has left many of us shocked and heartbroken.

Mid-conversation during his ride, Lukas collapsed, and while the autopsy is still pending, the circumstances suggest it may have been due to sudden cardiac arrest (SCA). He wasn’t doing anything particularly strenuous at the time.  SCA strikes without warning, even in the healthiest individuals, underscoring the importance of understanding this silent killer. 

Through Lukas’ story, I hope to raise awareness about SCA and the steps we can take to protect ourselves and those we love.

What is Sudden Cardiac Arrest (SCA)?

According to the Cleveland Clinic, cardiac arrest happens because of an electrical issue that makes your heart stop beating. When your heart stops pumping blood, you become unconscious. Cardiac arrest can be fatal in minutes.  Symptoms start without warning.  350,000 cardiac arrests occur outside the hospital each year.  The NIH also reports that Sudden Cardiac Death is the leading cause of death in athletes, occurring in 1 in 40,000 to 1 in 80,000 athletes per year.  Sudden cardiac arrest happens in people with and without heart disease, though having a heart attack or other heart condition can significantly increase your risk.  

The Sudden Cardiac Arrest Foundation reports that the survival rate for Out-of-Hospital Cardiac Arrests (OHCA) is just 10%.  Survival rates from an SCA increase 3x if a bystander performs immediate CPR (30% survival rate) or 5x if there is access to an automated external defibrillator (AEC) (50% survival rate when combined with CPR).  As you can see, the odds are stacked against survival even if all the right steps are taken.  At best, the survival of an out-of-hospital cardiac arrest is a coin toss. 

There have been some well-publicized sports-related cardiac arrests where the athletes survived, including Buffalo Bills Safety Damar Hamlin, who had an SCA after making a tackle in January 2023, and Bronny James – USC athlete and the son of basketball legend Lebron James – who had an SCA in July 2023 during a practice session.  Fortunately, both Damar and Bronny survived.  Runner’s World published an interesting article: 5 Runners Who Survived Sudden Cardiac Arrest Share What It Really Feels Like that provides unique insight into the SCA experience.

Underlying Causes of Sudden Cardiac Arrest

As noted above, Sudden Cardiac Arrest is an electrical issue that causes one’s heart to stop beating. However, other factors can cause that electrical issue.  The American Heart Association notes the following underlying issues that can cause SCA:

• Scarring of the heart tissue—It may be the result of a prior heart attack or another cause. A heart that’s scarred or enlarged from any cause is prone to develop life-threatening ventricular arrhythmias. The first six months after a heart attack are a high-risk period for sudden cardiac arrest in patients with atherosclerotic heart disease (the buildup of fatty deposits, or plaque, in the arteries).
• Thickened heart muscle (cardiomyopathy)—Damage to the heart muscle can result from high blood pressure, heart valve disease, or other causes. A diseased heart muscle can make you more prone to sudden cardiac arrest, especially if you also have heart failure. Learn more about cardiomyopathy. 
• Heart medications – Under certain conditions, some heart medications can set the stage for arrhythmias that cause sudden cardiac arrest. (Oddly, antiarrhythmic drugs that treat arrhythmias can sometimes produce ventricular arrhythmias even at normal doses. This is called a “proarrhythmic” effect.) Significant changes in blood levels of potassium and magnesium (from using diuretics, for example) can also cause life-threatening arrhythmias and cardiac arrest.
• Electrical abnormalities – These, including Wolff-Parkinson-White syndrome and long QT syndrome, may cause sudden cardiac arrest in children and young people.
• Blood vessel abnormalities – These rare cases occur particularly in the coronary arteries and aorta. Adrenaline released during intense physical activity can trigger sudden cardiac arrest when these abnormalities are present.
• Recreational drug use – This can be associated with cardiac arrest in otherwise healthy people.
• Commotio cordis—Commotio cordis occurs when a blow to the left side of the chest occurs during a narrow window in the heart rhythm. This is what caused Damar Hamlin’s SCA which you can read about here.  Learn more about commotio cordis.

It’s worth noting that Lukas had atherosclerosis, as do I.  There are levels of severity and mine is managed and below the level where there is cause for concern.  ​​Atherosclerosis can be passed genetically, and research has linked it to endurance sports, as you can see in this report by the American College of Cardiology.  While not always mentioned explicitly, atherosclerosis plays a significant role in many of the conditions that lead to sudden cardiac arrest. 

Atherosclerosis is the buildup of fatty deposits, or plaque, in the arteries. This can lead to coronary artery disease, heart attacks, and scarring of heart tissue. These conditions, in turn, increase the risk of life-threatening arrhythmias that can cause SCA. Managing atherosclerosis through a heart-healthy lifestyle and medical intervention is crucial in reducing the risk of SCA.

I mention this explicitly because some people who are active tend to underestimate their risk for heart disease, thinking that their frequent exercise will act as a shield, preventing heart disease that happens to “unhealthy” people, not to them.  I was one of those people who wasn’t diligent about basic physicals and heart screenings.  As I always say, you are never too healthy for heart disease.  It’s up to you to proactively engage with your doctor about your heart health.

Is a Death from a Heart Attack the Same as Sudden Cardiac Death?

People often use the terms interchangeably, but they are not the same.  As outlined by the American Heart Association (AHA), cardiac arrest, as noted above, is an electrical problem. It is triggered by an electrical malfunction in the heart that causes an irregular heartbeat (arrhythmia). With its pumping action disrupted, the heart cannot pump blood to the brain, lungs, and other organs.  Death occurs within minutes if the person doesn’t receive treatment. 

A heart attack is a circulation problem in which a blocked artery prevents oxygen-rich blood from reaching the heart. If the blocked artery is not reopened quickly, the part of the heart normally nourished by that artery begins to die. Heart attack symptoms include chest discomfort, shortness of breath, cold sweats, and nausea or vomiting. While heart attack symptoms may be immediate, they are more often likely to start slowly and persist for hours, days, or weeks before a heart attack.  The key is to get immediate treatment; The longer the person goes without treatment, the greater the damage.

Most heart attacks do not lead to cardiac arrest. But when cardiac arrest occurs, heart attack is a common cause. Other conditions may also disrupt the heart’s rhythm and lead to cardiac arrest.

Is Sudden Cardiac Arrest Preventable?

Sudden Cardiac Arrest happens suddenly and without warning and can be fatal within minutes.  However, as is the case with all matters of the heart, understanding family history is important for prevention.  The Cleveland Clinic suggests that if abnormal heart rhythms run in your family, you may want to talk to a genetic counselor.  

Genetic testing can assess your family history and potential risk for issues that cause arrhythmia and SCA. By understanding your genetic predisposition, you can take proactive steps to manage your heart health and potentially prevent life-threatening events.

You can help prevent cardiac arrest by working on your risk factors. That means managing conditions that put you at risk (like high cholesterol, high blood pressure, and diabetes) and living a healthy lifestyle. This includes:

• Avoiding tobacco products.
• Eating heart-healthy foods.
• Staying at a weight that’s healthy for you.
• Being physically active on most days of the week.

However, as noted above, SCA happens to the healthiest people – professional athletes and my friend Lukas, who lived what appeared to be a healthy lifestyle.  That highlights the importance of understanding family history related to abnormal heart rhythms and taking the appropriate preventative measures.

What Lessons Can We Learn from Lukas’ Tragedy?

The details of Lukas’ sudden death are still to come, and I will update you with any key learnings once I have any more information.  As mentioned, the suddenness of his death without warning suggests SCA.  

Reading stories about people whose time comes too soon is always horrible. However, these stories also provide an opportunity to learn and take stock of our health. I often say that people—healthy people in particular—tend to downplay heart health risks until they have a personal encounter with a heart-related tragedy.  I was one of those people…fortunately, I was lucky, and my potentially fatal aneurysm was caught and treated.  

So, in honor of Lukas and others who have been struck by a heart-related tragedy, I suggest:

1. Know your family health history
2. Don’t forget your annual physical, especially if you have a family history of heart disease
3. Have proactive heart-health conversations with your doctor 
4. Live a healthy lifestyle (healthy diet, exercise, sleep, etc.)
5. Learn CPR – the Red Cross and American Heart Association are good starting points

Those are the nuts and bolts of proactively managing heart health.  However, the more profound lessons that struck me as I sat through Lukas’ service were about spending time with friends.  Many of the people in the room were people who I’ve known for many years from the Los Angeles endurance community.  People who I’ve spent countless hours training and racing with.  Many of us have drifted apart, and while I remain very active today, most of my training is done solo.  

To be honest, Lukas and I were more casual training acquaintances. We had some memorable runs in the Santa Monica Mountains, and I was very aware of his athletic prowess, which defied his quiet demeanor, but some of my other friends spent a lot more time with him.

Hearing stories about Lukas’ proclivity to say yes at the drop of a hat to any athletic endeavor to support or spend time with a friend resonated most deeply. Whether it be a last-minute decision to do the Rim-to-Rim-to-Rim of the Grand Canyon with a friend or to support a friend’s first 100-mile “century” ride at the last minute, all reminded me of the importance of connection and selflessness. Ultimately, that’s all we have…our connections with our family and friends.  

I encourage you to make the most of your time. Despite our best efforts to do the right things to stay healthy, we don’t know when our time will come. Ultimately, we are left with our connections, how we treat others, and how we make them feel.  

In memory of Lukas and all those impacted by sudden cardiac arrest, let us honor their lives by advocating for heart health awareness and fostering deeper connections with those we cherish.  Feel free to share this article or discuss heart health (e.g., Do you know your family history?  Are you having your annual physicals?) with your loved ones.  Let’s all do our part to spread heart health awareness and action.

Lukas, it was an honor to know and be inspired by you…rest in peace.  Much love to all who took the time to read this.

P.S. Thank you to Lukas’ family for allowing me to share his story so others can learn from his tragedy.