Betelnut linked to sudden death

Awareness on betelnut in the country has been about common problems like mouth cancer but never linked to sudden deaths.

Now, chief of Emergency, Doctor Sam Yokopua, Department of Health, has warned that betelnut chewing can cause sudden cardiac death.

This awareness comes after seeing numerous sudden deaths at the Port Moresby General Hospital Emergency Department (ED), most with the history of chewing betelnut and suddenly collapsing.

While this may come as a shock to many, Dr Yokopua gives a medical explanation of this cause.

He says betelnut or areca nut contains an alkaloid known as arecoline. This chemical causes a variety of direct actions to the heart, which may explain the cause(s) of sudden deaths:

(1) Paradoxical coronary vasoconstriction

Betelnut causes generalised dilatation of blood vessels (vasodilatation) of the body, meaning it expands or enlarges the blood vessel. This causes you to feel hot and sweaty.

However, inside the blood vessels that supply the heart (coronary arteries), it causes them to constrict or become narrower, especially for those with a background of diseased vessels like cholesterol (artheromatous) plugs.

This is known as paradoxical vasoconstriction, which can suddenly stop blood flow to your heart, leading to sudden death.

(2) Tachycardias & Paroxysmal dysrhythmias

Betelnut chewing causes sympathetic nervous system stimulation, which causes the heart rate to go fast. In some people it may lead to abnormal fast heart rhythms to be developed as a result (paroxysmal dysrhythmias), where the subject will experience chest discomforts, racing of the heart (palpitations), being flushed and feel dizzy. If uncorrected, it will disintegrate into severe life-threatening rhythms, eventually leading to death.

There are others that may have blockage of the coronary blood vessels, for which the heart is just maintaining adequate supply. When there is a sudden rise of heart rate (tachycardia) due to betelnut, it will affect the supply-demand balance. The raised heart rate on a blocked blood vessel means an imbalance of the supply-demand, which is exactly what happens in heart attack. The subject suddenly develops chest pain, as that of heart attack. If not treated, he quickly succumbs to death.

Dr Yokopua also stated simple emergency & first aid responder actions.

Simple things to do, if anything happens as described above (while you are chewing):

- Spit out betelnut, rinse mouth. Drink some water, not too much!

- Sit down, relax, calm down. Lie down if dizzy.

- Breathe in, deep breaths, hold and "push" with your mouth and nose closed. Repeat 2-4 times or so.

- Get help quickly. Call ambulance. St John Ambulance is 111 (free call).

- If the subject does not breathe or gets a "black-out", give a big blow to the chest. Check for response, and commence immediate CPR.

- Mouth-to-mouth breaths and cardiac or chest compressions at the scene for good 20 minutes or so is very crucial.

“Do not rush to the hospital, you do things right there, at the scene. Get someone else to arrange the ambulance while you focus on the subject,” stated Dr Yockopua.  

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Gloria Bauai