Sudden Cardiac Deaths in Women Under Scrutiny After Actress Shefali Jariwala's Untimely Demise

The recent passing of Indian actress Shefali Jariwala has prompted widespread concern. While the official cause of death is pending post-mortem and forensic analysis, initial reports point to cardiac arrest. This tragic event underscores a growing trend of sudden heart issues affecting seemingly healthy, middle-aged women.

The Increasing Crisis of Sudden Cardiac Death

Sudden Cardiac Death (SCD) was once considered rare, especially among young adults. However, its increasing prevalence, particularly in India, demands urgent attention. Cardiovascular diseases account for approximately 28% of all deaths in India, with nearly 10% attributed to SCD. A significant portion of these fatalities occur in individuals between 30 and 50 years old.

India's evolving socioeconomic landscape has led to lifestyle changes, including:

• Sedentary behavior
• Processed diets
• Tobacco use
• Elevated stress levels

These factors contribute to a rise in hypertension, obesity, diabetes, and coronary artery disease, all major risk factors for SCD. While historically more common in men, recent studies emphasize the unique and often overlooked risks women face. Unlike men, women who experience SCD often have no prior cardiac diagnoses. Structural abnormalities, such as myocardial scarring and ischemic heart disease, often remain undetected until post-mortem examinations. Many women do not exhibit classic warning signs like chest pain or ECG anomalies, making early detection incredibly challenging.

The Silent Threat to Women in Midlife

Women in their 40s and 50s, like Shefali Jariwala, face a silent but serious risk from underlying cardiac conditions. In younger populations, SCD is frequently associated with inherited or electrical disorders, including:

• Hypertrophic Cardiomyopathy
• Arrhythmogenic Right Ventricular Cardiomyopathy
• Long QT Syndrome
• Brugada Syndrome
• Catecholaminergic Polymorphic Ventricular Tachycardia

These conditions may remain asymptomatic until a fatal arrhythmia occurs. Factors such as left ventricular hypertrophy, obesity, and myocardial fibrosis also increase vulnerability in this age group. The progression of myocardial scarring and fibrosis can be attributed to cumulative exposure to cardiovascular risks, repeated micro-ischemic events, and hormonal changes, especially during perimenopause. Additionally, conditions like Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA), more prevalent in younger women, often leave no trace in autopsies, making diagnosis even more difficult.

Stress played a significant role in Shefali's life, beginning with her early fame. Takutsobo cardiomyopathy (Broken Heart Syndrome) or Stress-induced Cardiomyopathy is a major cause of SCD in women. Her divorce, anxiety, depression, and epilepsy likely impacted her cardiovascular health. Psychiatric medications, especially those prolonging the QT interval, have also been linked to an increased risk of SCD.

A Call for Focused Prevention and Awareness

Despite the severity of the issue, women are underrepresented in preventive heart care. Symptoms like fatigue, palpitations, or breathlessness are often dismissed or misattributed, delaying critical intervention. Cardiac arrest, resulting from electrical disturbances that cause the heart to stop suddenly, requires immediate CPR and defibrillation for survival, highlighting the need for early risk identification.

Medical experts urge for targeted public health strategies and enhanced early screening tools tailored to women, especially during perimenopause when cardiac risks increase.

Remembering a Star, Inspiring Action

The entertainment industry and fans mourn the loss of Shefali Jariwala. Her tragic passing serves as a reminder of the urgent need for systemic change in addressing women's heart health. Shefali captivated audiences, and her untimely death may serve as a symbol of awareness, a reminder that a silent heart can be fatal, and that women's cardiac health demands immediate attention, investment, and action.

Dr. Sarita Rao, MD, DM, FACC, FSCAI, Senior Interventional Cardiologist & Director Cathlab, Apollo Hospitals, Indore President, WINCARS Association, Co-chair, EAPCI International Affairs, SCAI International Board member, WIN-APSIC Board member