Heart failure is a significant public health concern in terms of prevalence, mortality rates and economic burden. The most common single cause of death in the United States is Sudden Cardiac Arrest (SCA). It is a problem with heart’s electrical system that help keep the heart beating. According to the Centers for Disease Control and Prevention (CDC), 2,000 young seemingly healthy people under age 25 in the United States die each year of SCA. Cardiac arrests are not the same as heart failure in which the heart fails to function properly that affects the pumping power of the heart muscle. Patients with chest pain and non-obstructive coronary artery disease (NOCAD) are considered at low risk for cardiovascular events but evidence supporting this is scarce.

Typical signs of heart failure include excess fluid in body tissues (ankles, feet, legs or abdomen), weight gain, breathlessness or shortness of breath (dyspnea), general fatigue, chronic cough (Wheezing), rapid or irregular heartbeat, lack of appetite or feeling nauseated, mental confusion (impaired thinking or disoriented) etc. The first sign of SCA is loss of consciousness (fainting). Some possible causes of SCA in children and young adults with no previously known heart problems are [1].  Hypertrophic cardiomyopathy, [2]. Coronary artery abnormalities, [13] primary arrhythmias, [4] Long QT syndrome, [5] Wolff-Parkinson-White syndrome, [6] Arrhythmogenic right ventricular dysplasia, [7] myocarditis, [8] Marfan syndrome, [9] Commotio cordis, [10] stimulants and medications etc. LVD of the heart is usually followed by CHF which ultimately leads to multitude of cardiac disorders.

There is no one test to diagnose heart failure. The doctor will diagnose heart failure by doing a physical exam and heart tests. Electrocardiogram (EKG or ECG) records heart’s rhythm which could suggest that the walls of heart chamber are thicker than normal, chest X-ray, BNP (B-type natriuretic peptide) blood test can check for abnormal blood cells and infections, Echocardiogram uses sound waves to record the heart’s structure and motion, Doppler ultrasound, Holter monitor, Nuclear heart scan, exercise stress test, MUGA (multiple gated acquisition) test or cardiac MRI, Thyroid function tests, cardiac catheterization and electrophysiology study are used as diagnostic tests. Ibrahim et al. (2017) have developed a clinical and biomarker scoring strategy to reliably diagnose severe epicardial coronary artery disease. Patients suspected of stable angina pectoris and referred to coronary angiography, nearly two-thirds of women and one-third of men have NOCAD. Both normal coronary arteries and diffuse NOCAD were associated with significantly increased risks of future major adverse cardiovascular events (Jespersen et al., 2012). Coronary microvascular dysfunction (CMD) is a complicating factor in many patients with NOCAD and OCAD. The microvasculature may be affected by anatomic and functional derangements and combinations of those. Diagnosing the additional presence of CMD is difficult and often requires invasive diagnostic testing (Sechtem et al., 2020). SCA is usually called ventricular tachycardia (ventricles to start beating very fast) or ventricular fibrillation (fast and chaotically). Most SCA victims survive if they get help very quickly. Contractions are so close together that the heart can’t relax enough to fill with blood. Circulation stops. Lack of oxygen makes muscle twitch and activity stops in less than a minute. The only hope for survival is to start cardiopulmonary resuscitation (CPR) and follow it with a jolt from a defibrillator to shock the heart back into normal rhythm (Atkins, 2019). SCA is fatal 95% of the time, only about 5% survive long enough to get to the hospital alive. In a study conducted by Corrado et al. (2001), macroscopic heart features were normal in nearly one-third of young sudden cardiac death (SCD) victims. In 79% of them, however, histologic study unmasked concealed pathologic substrates such as focal myocarditis or cardiomyopathy and conduction system diseases. A total of 16 victims (6%) had no evidence of structural heart disease and the mechanism of their SCD remained unexplained.

The best way to avoid congestive heart failure is to avoid the conditions that contribute to it. Stop smoking, eat fruits and vegetable, whole grains, fish, avocadoes. Lose weight and adherence to prescribed medications. Some factors are based on genetics, but lifestyle can play a role. As little as 1 hour of moderate exercise per week can improve the heart health. In addition, regular well-child visits and sports physicals, know family history, and community life support training are recommended to help prevent SCA. An implantable cardioverter defibrillator (ICD) reduces the chances of dying from a second SCA. Even though there is much controversy as to the efficacy of Angiotensin-converting enzyme (ACE) inhibitors and β-blockers in African-Americans (Kamath and Yancy, 2005; Ghali et al., 2007).

There is no cure for heart failure, but the treatment aims to relieve symptoms and slow further damage. It includes treating the underlying conditions of heart failure, medicines (vasodilators, diuretics, aldosterone inhibitors, ACE inhibitors (ARB, ARNI widens blood vessels), digitalis glycosides, anticoagulants, anti-platelets, β-blockers, digoxin, tranquilizers, mineralocorticoid receptor antagonist, nitrates and hydralazine etc.), lifestyle modification (avoid salt and caffeine), maintain a balanced diet, avoid consuming foods rich in cholesterol and saturated fats and surgical procedures (open or bypass blocked arteries, replace heart valves, biventricular pacing therapy, implantable cardioverter defibrillator and ventricular assist devices therapy) β-blockers provide incremental benefit by reversing LVD and enhancing survival in patients already receiving ACE inhibitor treatment (Armstrong, 2000). A heart transplant is considered the last resort if other treatments fail. The majority of patients with angina (chest pain or discomfort) in the absence of OCAD have occult coronary abnormalities. A comprehensive invasive assessment of these patients at the time of coronary angiography can be performed safely and provides important diagnosis information that may affect treatment and outcomes (Lee et al., 2015). Rapid treatment of SCA with a defibrillator can be lifesaving. If diagnosed with ischemic heart disease, the treatment is percutaneous coronary intervention (coronary angioplasty or coronary artery bypass grafting). The combination of hydralazine and isosorbide dinitrate is advised specifically for African-Americans (Sharma et al., 2014).

Heart failure prevalence is rising and can be life threatening. Living with heart failure will worsen and may cause fear, anxiety, depression and stress. Early diagnosis and treatment can help people who have heart failure live longer and more active lives. One person dies every 36 seconds in the United States from cardiovascular disease. About 655,000 Americans die from heart disease each year which is 1 in 4 deaths. Heart disease costs the United States about $219 billion each year from 2014 to 2015. Almost 6.2 million people in the United States have congestive heart failure. It’s most common diagnosis in hospitalized patients over age 65. The aging of 78 million baby boomers will result in 1 in 5 Americans to be over the age of 65 years by 2050. African-Americans are at increased risk of congestive heart failure due to diabetes and high blood pressure. When diabetes and high blood pressure are factored out, they face no higher risk. Most cases of CHF are not hereditary. Future research should focus on the value of further risk stratification and treatment strategies of patients with stable chest pain associated with NOCAD. Also, EMS (emergency medical services) providers must make rapid assessments within the seconds before CPR initiation. The automated external defibrillators (AEDs) often are found in public places, can even be used by untrained bystanders to save the lives of people who are having SCA. People who are at risk for SCA may want to consider having an AED at home.