Navigating the Unforeseen: Understanding Sudden Cardiac Arrest and the Story of Ambareesh Murty

The sudden and unfortunate demise of Ambareesh Murthy, co-founder of Pepperfry, due to a sudden cardiac arrest (SCA) at high altitude has sparked discussions about the prevalence of such incidents even among physically fit individuals. This tragic incident prompts us to delve into the factors that contribute to sudden cardiac arrests at high altitudes, particularly among individuals who appear to be in good health. It also highlights the importance of proactive heart health assessments and precautions when engaging in physically demanding activities in such environments.

The Paradox of Physical Fitness

Ambareesh Murthy’s case serves as a reminder that physical fitness does not always translate to heart health, especially as individuals age. After the age of 40, many Indians fail to undergo comprehensive heart tests to assess their cardiovascular health. This neglect can be detrimental when attempting physically demanding activities or facing unfamiliar stressors, such as high altitudes. Even individuals who maintain an active lifestyle and engage in endurance sports can harbor hidden heart conditions.

High Altitude and Cardiac Risk

The low ambient oxygen levels prevalent in high-altitude regions, like Leh, can act as triggers for sudden cardiac arrest in individuals with pre-existing heart conditions. The reduced oxygen supply to the heart can exacerbate underlying issues, leading to irregular heart rhythms and cardiac arrest. This risk can be amplified when individuals choose to take direct flights to high-altitude locations instead of acclimatizing through road travel.

Specific Risks at High Altitudes

One potential risk at high altitudes is High Altitude Pulmonary Edema (HAPE), a condition where blood vessels in the lungs constrict, causing fluid leakage into air sacs. This can lead to low oxygen saturation in the blood and even sudden cardiac arrest. To mitigate this risk, medical experts recommend starting a course of the diuretic Diamox a week before travel to reduce fluid retention and protect against edema.

Endurance Sports and Heart Health

Engaging in extreme sports, such as cross-country biking and trekking, without awareness of underlying heart conditions can increase the risk of sudden cardiac arrest. Intense physical exertion, particularly in activities like professional cycling, can strain the heart and even lead to permanent damage. Studies have shown that such activities can overstretch the heart muscle and result in scarring or other structural changes.

Understanding Sudden Cardiac Arrest

A sudden cardiac arrest occurs when the heart abruptly ceases functioning due to irregular heart rhythms or electrical impulses. This disruption prevents the heart from effectively pumping oxygenated blood to the body’s organs. This condition differs from a heart attack, which is caused by blockages in arteries. Sudden cardiac arrest does not necessarily provide the time for ECG changes, making its onset swift and often fatal if not promptly treated.

Triggers for Sudden Cardiac Arrest in Normal Individuals

  • Stress: Stress, both emotional and physical, can trigger sudden cardiac arrest, especially in those with underlying heart conditions. Stress impacts the heart’s electrical properties and can lead to arrhythmia or irregular heartbeats.
  • Genetic Conditions: Hypertrophic Cardiomyopathy (HCM), a genetic disorder leading to thickened heart muscles, and other electrolyte channel-related genetic conditions can increase susceptibility to irregular heart rhythms.
  • Endothelial Dysfunction: Non-obstructive coronary artery disease, where blood vessels narrow instead of dilating, can lead to abnormal heart rhythms and sudden cardiac arrest.
  • Viral Infections: Viral infections causing myocarditis can scar heart tissue and interfere with heart rhythm, leading to sudden cardiac arrest.

Preventing Sudden Cardiac Arrest

To prevent sudden cardiac arrest, individuals should prioritize their heart health through regular check-ups and maintenance of blood pressure, cholesterol, and blood sugar levels. Additionally, early heart health evaluations and awareness of family history are essential. Monitoring these factors from the mid-30s onward can significantly reduce the risk of sudden cardiac arrest, particularly in the Indian population, where heart disease symptoms may manifest earlier than in other groups.


The tragic passing of Ambareesh Murthy sheds light on the silent risks that can exist within seemingly healthy individuals. Engaging in strenuous activities at high altitudes or participating in endurance sports can exacerbate underlying heart conditions, leading to sudden cardiac arrest. It underscores the importance of comprehensive heart health assessments, particularly after the age of 40, and adopting preventive measures to safeguard against the unpredictable and potentially fatal occurrence of sudden cardiac arrest.

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