Assessment of a patient by a physician.
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Each year in the United States, more than 350,000 cardiac arrests occur outside of a hospital setting. What is cardiac arrest? Is a heart attack the same as cardiac arrest? What is a heart attack? What is the link? What to do: Heart Attack What to do: Sudden Cardiac Arrest Introduction to sudden cardiac arrest What are the causes of sudden cardiac arrest? What about sudden cardiac arrest in the young? What are the symptoms of sudden cardiac arrest? How is sudden cardiac arrest diagnosed? What is the treatment for sudden cardiac arrest? Can sudden cardiac arrest be prevented? What is the prognosis sudden cardiac arrest? |
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What is cardiac arrest?
Cardiac arrest is the abrupt loss of heart function in a person who may or may not have been diagnosed with heart disease. It can come on suddenly, or in the wake of other symptoms. Cardiac arrest is often fatal, if appropriate steps aren’t taken immediately. Each year in the United States, more than 350,000 cardiac arrests occur outside of a hospital setting. Is a heart attack the same as cardiac arrest? No. The term “heart attack” is often mistakenly used to describe cardiac arrest. While a heart attack may cause cardiac arrest, the two terms don’t mean the same thing. Heart attacks are caused by a blockage that stops blood flow to the heart. A heart attack (or myocardial infarction) refers to death of heart muscle tissue due to the loss of blood supply. Heart attack can be understood as a “circulation” problem. A heart attack is quite serious, sometimes fatal. By contrast, cardiac arrest is caused when the heart’s electrical system malfunctions. The heart stops beating properly. Hence the name: The heart’s pumping function is “arrested,” or stopped. In cardiac arrest, death can result quickly if proper steps aren’t taken immediately. Cardiac arrest may be reversed if CPR (cardiopulmonary resuscitation) is performed and a defibrillator is used to shock the heart and restore a normal heart rhythm within a few minutes. Cardiac arrest may be caused by irregular heart rhythms, called arrhythmias. A common arrhythmia associated with cardiac arrest is ventricular fibrillation. Ventricular fibrillation means that the heart’s lower chambers suddenly start beating chaotically and don’t pump blood. People often use these terms interchangeably, but they are not synonyms. A heart attack is when blood flow to the heart is blocked, and sudden cardiac arrest is when the heart malfunctions and suddenly stops beating unexpectedly. A heart attack is a “circulation” problem and sudden cardiac arrest is an “electrical” problem. What is a heart attack? A heart attack occurs when a blocked artery prevents oxygen-rich blood from reaching a section of the heart. If the blocked artery is not reopened quickly, the part of the heart normally nourished by that artery begins to die. The longer a person goes without treatment, the greater the damage. Symptoms of a heart attack may be immediate and intense. More often, though, symptoms start slowly and persist for hours, days or weeks before a heart attack. Unlike with sudden cardiac arrest, the heart usually does not stop beating during a heart attack. The heart attack symptoms in women can be different than men. What is cardiac arrest? Sudden cardiac arrest occurs suddenly and often without warning. It is triggered by an electrical malfunction in the heart that causes an irregular heartbeat (arrhythmia). With its pumping action disrupted, the heart cannot pump blood to the brain, lungs and other organs. Seconds later, a person loses consciousness and has no pulse. Death occurs within minutes if the victim does not receive treatment. What is the link? These two distinct heart conditions are linked. Sudden cardiac arrest can occur after a heart attack, or during recovery. Heart attacks increase the risk for sudden cardiac arrest. Most heart attacks do not lead to sudden cardiac arrest. But when sudden cardiac arrest occurs, heart attack is a common cause. Other heart conditions may also disrupt the heart’s rhythm and lead to sudden cardiac arrest. These include a thickened heart muscle (cardiomyopathy), heart failure, arrhythmias, particularly ventricular fibrillation, and long Q-T syndrome. Fast action can save lives. Find out what to do if someone experiences a heart attack or cardiac arrest. What to do: Heart Attack Even if you're not sure it's a heart attack, call 911 or your emergency response number. Every minute matters! It’s best to call EMS to get to the emergency room right away. Emergency medical services staff can begin treatment when they arrive — up to an hour sooner than if someone gets to the hospital by car. EMS staff are also trained to revive someone whose heart has stopped. Patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital, too. What to do: Sudden Cardiac Arrest Cardiac arrest is reversible in most victims if it's treated within a few minutes. First, call 911 for emergency medical services. Then get an automated external defibrillator if one is available and use it as soon as it arrives. Begin CPR immediately and continue until professional emergency medical services arrive. If two people are available to help, one should begin CPR immediately while the other calls 911 and finds an AED. Sudden cardiac arrest is a leading cause of death – over 320,000 out-of-hospital cardiac arrests occur annually in the United States. By performing Hands-Only CPR to the beat of the classic disco song “Stayin’ Alive,” you can double or even triple a victim’s chance of survival. Learn the two easy steps to save a life at heart.org/handsonlycpr. * Introduction to sudden cardiac arrest * What are the causes of sudden cardiac arrest? * What about sudden cardiac arrest in the young? * What are the symptoms of sudden cardiac arrest? * How is sudden cardiac arrest diagnosed? * What is the treatment for sudden cardiac arrest? * Can sudden cardiac arrest be prevented? * What is the prognosis sudden cardiac arrest? * Patient Discussions: Sudden Cardiac Arrest: Experience Introduction to sudden cardiac arrest A natural disaster hits, the power goes off and the lights go out. It's a common scene that plays out during hurricane and tornado seasons, and it's very similar in trying to explain sudden cardiac arrest. The heart sustains an insult, the electricity is short circuited, the heart can't pump, and the body dies. The heart is an electrical pump, where the electricity is generated in special pacemaker cells in the upper chamber, or atrium, of the heart. This electrical spark is carried through pathways in the heart so that all the muscle cells contract at once and produce a heart beat. This pumps blood through the heart valves and into all the organs of the body so that they can do their work. This mechanism can break down in a variety of ways, but the final pathway in sudden death is the same: the electrical system is irritated and fails to produce electrical activity that causes the heart to beat. The heart muscle can't supply blood to the body, particularly the brain, and the body dies. Ventricular fibrillation (V Fib) is the most common reason for sudden death in patients. Without a coordinated electrical signal, the bottom chambers of the heart (ventricles) stop beating and instead, jiggle like Jello. Ventricular Fibrillation is treated with electrical shock, but for it to be effective, the shock usually needs to happen within less than four to six minutes, not only for it to be effective, but also to minimize brain damage from lack of blood and oxygen supply. Automatic external defibrillators (AEDs) are commonly available in public places to allow almost anybody to treat sudden death. Less commonly, the heart can just stop beating. The absence of a heart beat is known as asystole (asystole: a=no + systole=beat). What are the causes of sudden cardiac arrest?
•Illicit drug use is – directly and indirectly – responsible for over 750,000 deaths per year. •Illicit drug use is responsible for 585,000 premature deaths by increasing the risk of particular disease and injury. •Over 166,000 die from drug overdoses each year. •More than half of those who die from drug overdoses are younger than 50 years old. •Opioids are responsible for the largest number of overdoses from illicit drugs. •It is estimated that around 1% of the world has a drug use disorder. •The US had the highest overdose rates from all three leading illicit drugs: opioids, amphetamine and cocaine. Sudden death is most often caused by heart disease. When blood vessels narrow, the heart muscle can become irritated because of lack of blood supply. In heart attack (acute myocardial infarction), a blood vessel becomes completely blocked by a blood clot, and there is enough irritability of the muscle to cause ventricular fibrillation. In fact, the reason many people with chest pain are admitted to the hospital is to monitor their heart rate and rhythm for signs that might lead to ventricular fibrillation. Sudden death may also be the first presentation of heart disease. Congestive heart failure and heart valve problems, like aortic stenosis (narrowing of the aortic valve) also increase the risk of sudden cardiac arrest. Cardiomyopathy is a broad category of heart disease where the heart muscle does not contract properly for whatever reason. Often it is ischemic, where part of the heart muscle doesn't get an adequate blood supply for a prolonged period of time and no longer can efficiently pump blood. People whose ejection fractions (the amount of blood pumped out of the heart with each heart beat) is less than 30% are at greater risk for sudden death (a normal ejection fraction is above 50%). In some people, cardiomyopathy may develop in the absence of ischemic heart disease. Inflammation of the heart muscle, known as myocarditis (myo=muscle + card=heart + itis= inflammation), can also cause rhythm disturbances. Diseases like sarcoidosis, amyloidosis, and infections can cause inflammation of the heart muscle. Some people are born with electrical conducting systems that are faulty, which place them at higher risk for rhythm disturbances. Some are due to the wiring, or electrical conduction system, like Wolff-Parkinson-White syndrome, while others are due to the structural basic structural problems within the heart, like Marfan syndrome. Pulmonary embolus, a blood clot to the lung, can also cause sudden death. Clots form in the leg or arm and may break off and flow to the lung where they decrease the lung's ability to get oxygen from the air to the body. Risk factors for blood clots include surgery, prolonged immobilization (for example, hospitalization, long car rides or plane trips), trauma, or certain diseases like cancer. Blunt chest trauma, such is in a motor vehicle accident, may result in ventricular fibrillation. (please see commotio cordis below) What about sudden cardiac arrest in the young? In younger people, sudden death is a rare event, but since it often involves people involved in athletics, cases are often reported in the press. The most common cause is hypertrophic cardiomyopathy (hypertrophy=to grow abnormally large + cardio=heart + myopathy = diseased muscle). This disease is often hereditary, and the walls of the ventricle are larger than they should be. This makes the pumping chamber of the heart smaller, and the heart has to work harder to pump blood out of the heart. As well, the thickened muscle narrows the space for the blood to flow through the aortic valve and to the rest of the body. During exercise, this decreased blood flow can irritate the heart muscle itself and cause ventricular fibrillation, collapse, and sudden death. Anomalous coronary arteries can also cause sudden death in the young. The heart is a muscle itself, and like any muscle, it needs blood supply to provide oxygen for it to work. Normally, the coronary arteries lie on the surface of the heart. Anomalous arteries dive into the heart muscle itself and may be occluded when the heart muscle that surrounds the abnormally placed artery squeezes aggressively, as with exercise, shutting off blood supply to part of the heart. This irritates the electrical system and can cause ventricular fibrillation and sudden death. The pre-participation athletic physical examination is a useful tool to screen children and adolescents for their risk of sudden cardiac arrest. Commotio cordis is a situation in which the heart stops when the chest is hit by an object. News stories occasionally report of baseball players who are hit in the chest by a ball and collapse because their heart stops beating. The heart sits behind the breastbone, and the electrical system can be short circuited when a direct blow is sustained. What are the symptoms of sudden cardiac arrest? In sudden cardiac arrest, the heart stops beating, and blood is not supplied to the body. The presentation is not subtle. Almost immediate loss of consciousness occurs, and the affected person will not be able to be aroused. The person will fall or slump over. No pulse will be able to be palpated, and there will be no signs of breathing. What is the diagnosis for sudden cardiac arrest? Sudden cardiac arrest is an unexpected death in a person who had no known previous diagnosis of a fatal disease or condition. The person may or may not have heart disease. What is the treatment for sudden cardiac arrest? The vast majority of people whose heart stops beating unexpectedly have ventricular fibrillation. The definitive treatment for this is defibrillation using electricity to shock the heart back into a regular rhythm. With technological advances, AEDs are now a routine sight wherever people congregate. Communities which institute public CPR education, use of AEDs, and rapid activation of 911 emergency medical services have dramatically increased survival rates from sudden cardiac arrest. Unfortunately, because the brain is so sensitive to the lack of oxygen and blood flow, unless treatment occurs within four to six minutes, there is a high risk of some permanent brain damage. Should the patient survive to be transported to the hospital, the reason for collapse and sudden death will need to be diagnosed. Regardless, the ABCs of resuscitation will be re-evaluated. Airway, Breathing, and Circulation (heart beat and blood pressure) will be supported, and admission to an intensive care unit is most likely. Diagnostic tests may include repeated electrocardiograms (EKGs), echocardiogram (ultrasounds of the heart), and cardiac catheterization and electrophysiologic studies, in which the electrical pathways of the heart are mapped. Recent research involving the treatment of survivors of cardiac arrest suggests that prompt institution of hypothermia (cooling of the body) may prevent or lessen the degree of brain injury. Can sudden cardiac arrest be prevented? Death is best treated by prevention. Most sudden death is associated with heart disease, so the at-risk population remains males older than 40 years of age who smoke, have high blood pressure, and diabetes (the risk factors for heart attack). Other risks include syncope (fainting or loss of consciousness) and known heart disease. Syncope, or loss of consciousness, is a significant risk factor for sudden death. While some reasons for passing out are benign, there is always a concern that the reason was an abnormal heart rhythm that subsequently spontaneously corrected. The fear is that the next episode will be a sudden cardiac arrest. Depending on the healthcare provider's suspicion based on the patient's history, physical examination, laboratory tests, and EKG, the healthcare practitioner may recommend inpatient or outpatient heart monitoring to try to find a clue as to whether the passing out was due to a deadly heart rhythm. Unfortunately, the potentially suspect rhythm may not recur and depending on the situation, prolonged outpatient monitoring lasting weeks and months may be necessary. Use of electrophysiologic testing may help identify high risk patients (the electrical pathways are mapped using techniques similar to heart catheterization). In people who present to their doctor with chest pain, aside from making the diagnosis, monitoring both the heart rate and rhythm are emphasized. The purpose of watching people with chest pain in a hospital setting is to prevent sudden cardiac arrest. Using implantable defibrillators in high risk patients, especially those with markedly decreased ejection fractions can reduce the incidence of sudden cardiac arrest. These devices are placed under the skin in the chest wall and have wires that are attached to the heart itself. When they detect ventricular fibrillation, a shock is automatically delivered to the heart, restoring a heart beat and averting sudden death. What is the prognosis for sudden cardiac arrest? The frequency of sudden cardiac arrest is related to the frequency of coronary artery disease. If public health initiatives work to decrease risk the factors for heart disease, the risk for sudden death should decrease as well. In the adolescent population, increased awareness of hypertrophic cardiomyopathy and appropriate screening may decrease the frequency of sudden death. Public education and widespread availability of AEDs will increase survival. |
A person suddenly fell unconscious.
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What should those who attended him on the spot have accomplished? Those who saw him suddenly fall unconscious should have started cardiopulmonary resuscitation on the spot. How do you start cardiopulmonary resuscitation in adults who suddenly fall unconscious? Start by asking, “How are you?” You can translate this into the local language. If there is no reply, tap or shake the person’s shoulder and loudly ask, “Are you okay?” If there is no reply, place the person on the ground. Check to see if the person can hear, see, and talk. Verify if there is a pulse and breathing. If there is no pulse and no breathing for 10 seconds, begin chest compressions. Give 30 chest compressions before giving two rescue breaths. Call for emergency or more help. Give them the location. When should you intubate a patient under emergency conditions? When the pulse oximetry (O2 saturation) is less than 90%, without any underlying respiratory conditions or hypoxemia. Severe hypoxemia occurs when the O2 saturation falls below 85%. If there is a history of suddenly falling unconscious, intubate the patient. Place the patient on a mechanical ventilator. See further guidelines. Cardiopulmonary resuscitation What is cardiopulmonary resuscitation? Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful when someone’s breathing or heartbeat has stopped. Why is cardiopulmonary resuscitation important? These examples will help you understand. Case Scenario What apparently happened? 
Date: Thursday, October 1, 2020 Name: Javid Ahmad Age: 31 Incident: Suddenly fell unconscious. He was travelling in a passenger bus. Location of incident: Pattan area in Kashmir. He was on his way to Srinagar from the Watergam area of the Baramulla district. Javid was a resident of the Watergam area of Rafiabad. He was rushed to a nearby hospital, where doctors declared him dead. He was a senior correspondent of a Srinagar-based English daily. He died on October 1, 2020. The causes and circumstances of his death mentioned heart attack. This needs further investigation. A young man rarely has a heart attack (myocardial infarction). Cardiac arrest is the last scenario in all human deaths. There can be other causes and circumstances. Questions that need further answers from specific physicians: What were the causes and circumstances of his death? How did you verify the causes and circumstances of his death? What should those who attended him on the spot have accomplished? Those who saw him suddenly fall unconscious should have started cardiopulmonary resuscitation on the spot. > How do you start cardiopulmonary resuscitation in adults who suddenly fall unconscious? Start by asking, “How are you?” You can translate this into the local language. If there is no reply, tap or shake the person’s shoulder and loudly ask, “Are you okay?” If there is no reply, place the person on the ground. Check to see if the person can hear, see, and talk. Verify if there is a pulse and breathing. If there is no pulse and no breathing for 10 seconds, begin chest compressions. Give 30 chest compressions before giving two rescue breaths. Call for emergency or more help. Give them the location. When should you intubate a patient under emergency conditions? When the pulse oximetry (O2 saturation) is less than 90%, without any underlying respiratory conditions or hypoxemia. Severe hypoxemia occurs when the O2 saturation falls below 85%. If there is a history of suddenly falling unconscious, intubate the patient. Place the patient on a mechanical ventilator. See further guidelines. Who officially received remuneration, income, and grants to circulate these guidelines on or before October 1, 2020? Stop their income, remuneration, and grants. Suspend them from services. Terminate the services of those who were alerted ahead of time. Record the findings in their service book on or before October 1, 2020. Failure to provide public health guidelines publicly at least through internet that they have responsibilities. Circuit Court supervision of all grants resources, income, salary, human resources for these services including for www.grants.gov. They are taking salaries, grants, resources and keeping quite without public services that is not justified. Here are further guidelines. |