One of my favorite ER patients was a guy who got stabbed in the chest by his girlfriend with a 10" serrated bread knife. Came in with the knife still in him, buried to the handle. Bellowing that this proved ... something about him. He was clearly pumped. But not really bleeding. After a chest CT and removing the foreign object from his chest, there was still no real bleeding. The knife had gone in at a bit of an angle, but what really saved him was the fat. 10" of steel and it never made it to the pleural cavity.
First case report I'm aware of where fat was cardioprotective.
In the bad surprise category was the 50-ish guy I admitted as an intern for uncomplicated chest pain. He got married that day but left the ceremony in an ambulance instead of a limousine. The plan was cardiac enzymes and put him on a stress test in the morning. First set was negative and the anginal pain had abated. All the right things were done. Seemed straightforward.
Three hours later while I was trying to sleep I get a frantic call from the ED that he was coding. He was sitting up watching TV, suddenly turned grey and clutched his chest, and fell back in ventricular fibrillation. We shocked him into pulseless electrical activity and then did a three hour futile code because his new wife couldn't grasp the fact her new husband had died right in front of her. And really, who can?
The irony of surprise is misunderstanding in the HN context too. I too pictured the poor bloke got up, cracked open his laptop to do some coding in a hospital bed. LOL. Thought: poor guy can't even get a break from devops on his wedding day and even after a fucking heart attack.
This unfortunate person was probably in a different risk category than you (not knowing your personal history, and obviously diagnoses over HN are fraught with peril ;). He had fairly classic anginal symptoms, putting him at higher risk due to presumed pre-existing ischaemic heart disease, and most likely his heart simply chose that time to have the attack that killed him. Note I'm stating that cause of death clinically since I don't recall he ended up being autopsied and a heart attack can easily throw you into v-fib.
Sudden cardiac death can come from a massive heart attack, but it can just as easily arise from abnormal heart rhythms of other causes which aren't related to coronary artery disease (and the risk factors for same, such as diabetes, obesity, etc.). Essentially you're looking for conditions that would screw up the normal electrical function of the heart and its internal "wiring." The risk factors for that otherwise include pre-existing anatomical defects (bad valves, congenital abnormalities, abnormally large heart size such as hypertrophic cardiomyopathy), abnormal blood chemistry or electrolyte levels, history of abnormal cardiac rhythm (things like long QT syndrome, Wolff-Parkinson-White), and certain medications and recreational drugs.
If you fall into those categories, have a personal history of heart disease or are otherwise unsure, a simple EKG will rule in or out quite a number on that list. Similarly, if you have a family history of heart disease, you are probably in a higher risk category as well. While the USPSTF doesn't recommend EKGs in asymptomatic individuals at low risk, falling into one of those groups would probably not be low risk anymore. See https://www.uspreventiveservicestaskforce.org/Page/Document/... for more details.
Hopefully that was somewhat helpful. As always, this wouldn't replace asking your primary care doc about it.
>First case report I'm aware of where fat was cardioprotective.
Happens all the time. If all you have is one of those $80 handguns chambered in .3-something-weak and loaded with hollow-points (they were popular in the 80s and a lot of them are still floating around the streets) a fat person dressed for winter in a cold climate (hollow points don't like thick clothing) might as well be bulletproof.
First case report I'm aware of where fat was cardioprotective.