"Betelnut (BUAI) chewing can cause sudden cardiac death!"

By Dr. Sam Yockopua 

At Port Moresby General Hospital Emergency Department (ED), we quite often fill in the death-on-arrival (DOA) Forms, as part of the process of certifying deaths. Over the years, we have seen and certified numerous sudden deaths. The typical history is that the subject was chewing betelnut, then suddenly collapsed and passed on. When brought in, they only contribute to the statistics; no way to be revived.

And so, the question is therefore, how does this happen? We hear of the common problems of diseases such as mouth cancer, apart from spreading TB and poor oral hygiene; but not many have known that it indeed can cause sudden deaths. In fact, it can!

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 generalized dilatation of blood vessels (vasodilatation) of the body, that's why you feel hot and sweaty. However, inside the blood vessels that supply the heart (coronary arteries), it causes them to constrict especially with a background of diseased vessels such as 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. Some people may lead to abnormal fast heart rhythms to be developed as a result (paroxysmal dysrhythmias), which 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 and then 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.

So that's how betelnut can suddenly kill us, so be careful. Think twice while chewing betelnut (buai).

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.
- breath in, deep breaths, hold and 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 breath 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.

And yet, another free medical advise.

Dr Sam Yockopua
Chief - Emergency Medicine
Department of Health