Dr Han Naung @ Henry Han : Electrophysiology and Heart Rhythm : Cardiac arrest

How do you get action when you see cardiac arrest patient?

Sudden cardiac arrest is the sudden, unexpected loss of heart function, breathing and consciousness. Sudden cardiac arrest usually results from an electrical disturbance in your heart that disrupts its pumping action, stopping blood flow to the rest of your body.

Sudden cardiac arrest is different from a heart attack, which occurs when blood flow to a portion of the heart is blocked. However, a heart attack can sometimes trigger an electrical disturbance that leads to sudden cardiac arrest.

Sudden cardiac arrest is a medical emergency. If not treated immediately, it causes sudden cardiac death. With fast, appropriate medical care, survival is possible. Administering cardiopulmonary resuscitation (CPR), treating with a defibrillator — or even just compressions to the chest — can improve the chances of survival until emergency personnel arrive.

Symptoms

Sudden cardiac arrest symptoms are immediate and drastic and include:

Sudden collapse

No pulse

No breathing

Loss of consciousness

Sometimes other signs and symptoms precede sudden cardiac arrest. These may include fatigue, fainting, blackouts, dizziness, chest pain, shortness of breath, weakness, palpitations or vomiting. But sudden cardiac arrest often occurs with no warning.

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.

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.

When to do : Sudden Cardiac Arrest ?

If you have frequent episodes of chest pain or discomfort, heart palpitations, irregular or rapid heartbeats, unexplained wheezing or shortness of breath, fainting or near fainting, or you're feeling lightheaded or dizzy, see your doctor promptly. If these symptoms are ongoing, you should call 911 or emergency medical help.

When the heart stops, the lack of oxygenated blood can cause brain damage in only a few minutes. Death or permanent brain damage can occur within four to six minutes. Time is critical when you're helping an unconscious person who isn't breathing. Take immediate action.

Call 911, or the emergency number in your area, if you encounter someone who has collapsed or is found unresponsive. If the unconscious person is a child and you're alone, administer CPR, or chest compressions only, for two minutes before calling 911 or emergency medical help or before using a portable defibrillator.

Perform CPR. Quickly check the unconscious person's breathing. If he or she isn't breathing normally, begin CPR. Push hard and fast on the person's chest — at the rate of 100 to 120 compressions a minute. If you've been trained in CPR, check the person's airway and deliver rescue breaths after every 30 compressions.

If you haven't been trained, just continue chest compressions. Allow the chest to rise completely between compressions. Keep doing this until a portable defibrillator is available or emergency personnel arrive.

Use a portable defibrillator, if one is available. If you're not trained to use a portable defibrillator, a 911 or emergency medical help operator may be able to guide you in its use. Deliver one shock if advised by the device and then immediately begin CPR starting with chest compressions, or give chest compressions only, for about two minutes.

Using the defibrillator, check the person's heart rhythm. If necessary, the defibrillator will administer a shock. Repeat this cycle until the person recovers consciousness or emergency personnel take over.

Portable automated external defibrillators (AEDs) are available in an increasing number of places, including airports, casinos and shopping malls. You can also purchase them for your home. AEDs come with built-in instructions for their use. They're programmed to allow a shock only when appropriate.

Risk factors

Because sudden cardiac arrest is so often linked with coronary artery disease, the same factors that put you at risk of coronary artery disease may also put you at risk of sudden cardiac arrest. These include:

A family history of coronary artery disease

Smoking

High blood pressure

High blood cholesterol

Obesity

Diabetes

A sedentary lifestyle

Drinking too much alcohol (more than two drinks a day)

Other factors that may increase your risk of sudden cardiac arrest include:

A previous episode of cardiac arrest or a family history of cardiac arrest

A previous heart attack

A personal or family history of other forms of heart disease, such as heart rhythm disorders, congenital heart defects, heart failure and cardiomyopathy

Age — the incidence of sudden cardiac arrest increases with age

Being male — men are two to three times more likely to experience sudden cardiac arrest

Using illegal drugs, such as cocaine or amphetamines

Nutritional imbalance, such as low potassium or magnesium level

Why It is caused ?

The immediate cause of sudden cardiac arrest is usually an abnormality in your heart rhythm (arrhythmia), the result of a problem with your heart's electrical system.

Unlike other muscles in your body, which rely on nerve connections to receive the electrical stimulation they need to function, your heart has its own electrical stimulator — a specialized group of cells called the sinus node located in the upper right chamber (right atrium) of your heart. The sinus node generates electrical impulses that flow in an orderly manner through your heart to synchronize the heart rate and coordinate the pumping of blood from your heart to the rest of your body.

If something goes wrong with the sinus node or the flow of electric impulses through your heart, an arrhythmia can result, causing your heart to beat too fast, too slow or in an irregular fashion. Often these interruptions in rhythm are momentary and harmless. But some types of arrhythmia can be serious and lead to a sudden stop in heart function (sudden cardiac arrest).

The most common cause of cardiac arrest is an arrhythmia called ventricular fibrillation — when rapid, erratic electrical impulses cause your ventricles to quiver uselessly instead of pumping blood.

Most of the time, cardiac-arrest-inducing arrhythmias don't occur on their own. In a person with a normal, healthy heart, a lasting irregular heart rhythm isn't likely to develop without an outside trigger, such as an electrical shock, the use of illegal drugs or trauma to the chest at just the wrong time of the heart's cycle (commotio cordis).

Heart conditions that can lead to sudden cardiac arrestA life-threatening arrhythmia usually develops in a person with a pre-existing heart condition, such as: Coronary artery disease. Most cases of sudden cardiac arrest occur in people who have coronary artery disease. In coronary artery disease, your arteries become clogged with cholesterol and other deposits, reducing blood flow to your heart. This can make it harder for your heart to conduct electrical impulses smoothly. Heart attack. If a heart attack occurs, often as a result of severe coronary artery disease, it can trigger ventricular fibrillation and sudden cardiac arrest. In addition, a heart attack can leave behind areas of scar tissue. Electrical short circuits around the scar tissue can lead to abnormalities in your heart rhythm. Enlarged heart (cardiomyopathy). This occurs primarily when your heart's muscular walls stretch and enlarge or thicken. In both cases, your heart's muscle is abnormal, a condition that often leads to heart tissue damage and potential arrhythmias. Valvular heart disease. Leaking or narrowing of your heart valves can lead to stretching or thickening of your heart muscle or both. When the chambers become enlarged or weakened because of stress caused by a tight or leaking valve, there's an increased risk of developing arrhythmia. Congenital heart disease. When sudden cardiac arrest occurs in children or adolescents, it may be due to a heart condition that was present at birth (congenital heart disease). Even adults who've had corrective surgery for a congenital heart defect still have a higher risk of sudden cardiac arrest. Electrical problems in the heart. In some people, the problem is in the heart's electrical system itself instead of a problem with the heart muscle or valves. These are called primary heart rhythm abnormalities and include conditions such as Brugada's syndrome and long QT syndrome.

Mnemonic for reversible causes "Hs and Ts" is the name for a mnemonic used to aid in remembering the possible treatable or reversible causes of cardiac arrest.

Hs

Hypovolemia – A lack of blood volume
Hypoxia – A lack of oxygen
Hydrogen ions (Acidosis) – An abnormal pH in the body
Hyperkalemia or Hypokalemia – Both excess and inadequate potassium can be life-threatening.
Hypothermia – A low core body temperature
Hypoglycemia or Hyperglycemia – Low or high blood glucose

Ts

Tablets or Toxins
Cardiac Tamponade – Fluid building around the heart
Tension pneumothorax – A collapsed lung
Thrombosis (Myocardial infarction) – Heart attack
Thromboembolism (Pulmonary embolism) – A blood clot in the lung
Traumatic cardiac arrest