Dr Nityanand Tripathi – Director & Unit Head – cardiology & Electrophysiology, Fortis Hospital, Shalimar Bagh
Cardiac arrest is a condition where the heart stops beating, and when it happens, the essential organs no longer get oxygenated blood leading to collapse and loss of life. In contrast, a heart attack is a condition wherein part of the heart stops getting oxygenated blood because of sudden clot formation in a blood vessel supplying blood to that part of the heart. Both condone are life-threatening and lead to significant loss of life.
Most people spend a relatively short time (on an average 30min or 2% of the time per day) in the toilet. However, the toilet seems to be where heart attack and cardiac arrests happen at a disproportionately high frequency – 8 t0 11%. The toilets and bathroom are particularly peculiar from the discovery of events and resuscitation prepose. As bathrooms are supposed to be the most private place – detection and resuscitation are almost always delayed, and therefore outcomes are poor. Similarly, the frequency of collapse is 8%, and the chances of revival to a dismal 13% only, which is far lower than out-of-bathroom cardiac arrest.
The most common cause of heart attack and sudden cardiac death in toilet and bathroom are a consequence of defecation/micturition syncope, where there is a paradoxical decrease in blood pressure during straining because of an imbalance between the sympathetic and parasympathetic autonomic nervous system; this imbalance leads to decrease blood flow to brain and loss of consciousness. These events and inequality in the autonomic nervous system may also lead to a sudden surge in blood pressure, heart attacks, and sudden cardiac arrest in the toilet and bathroom. The other cause may be a person rushing to the toilet/bathroom after feeling sick, nausea/ vomiting, and collapsing.
Taking a shower, either too cold or too hot, can impact heart rate, blood pressure, and distribution of blood flow in our body. Taking a bath with too cold water leads to blood flow from all sides towards the head, and it increases the stress on arteries and capillaries, which might be another cause of increased cardiac events in the bathroom.
One must not strain too much during defecation or passing urine to avoid such incidence. Take your time while getting relieved of your natural call. Avoid bathing with too cold or too hot water. Do not start pouring water directly on the head; instead, start washing from the feet or shoulder and gradually involve the whole body. Avoid getting exposed to a too cold environment in the bathroom/toilet, especially in winters, as it may trigger a heart attack. If you fall in the vulnerable group, i.e., have a previous heart attack, angina, old age, your heart pumping power is weak, or have a stroke or multiple co-morbidities. It is prudent not to lock the toilet/bathroom while using it. Tell your immediate relative while using the bathroom/toilet so that help is handy if some events happen. Toilets/bathrooms used by vulnerable populations should have alarms handy there so that they can ask for help in time, and life could be saved.