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.

Causes of Cardiac Arrest

Cardiac arrest may be caused by almost any known heart condition.

Most cardiac arrests occur when a diseased heart’s electrical system malfunctions. This malfunction
causes an abnormal heart rhythm such as ventricular tachycardia or ventricular fibrillation. Some
cardiac arrests are also caused by extreme slowing of the heart’s rhythm (bradycardia).

Irregular heartbeats such as these that can cause cardiac arrest should be considered life-
threatening arrhythmias.

Other causes of cardiac arrest include:

 Scarring of the heart tissue Such scarring may be the result of a prior heart attack or
another cause. A heart that’s scarred or enlarged from any cause is prone to develop life-
threatening ventricular arrhythmias. The first six months after a heart attack represents a
particularly high-risk period for sudden cardiac arrest in patients with atherosclerotic heart
disease.
 A thickened heart muscle (cardiomyopathy)Damage to the heart muscle can be the result
of high blood pressure, heart valve disease or other causes. A diseased heart muscle can
make you more prone to sudden cardiac arrest, especially if you also have heart failure.
Learn more about cardiomyopathy.
 Heart medications Under certain conditions, various heart medications can set the stage for
arrhythmias that cause sudden cardiac arrest. (As odd as it may sound, antiarrhythmic drugs
used to treat arrhythmias can sometimes produce ventricular arrhythmias even at normally
prescribed doses. This is called a “proarrhythmic” effect.) Significant changes in blood levels
of potassium and magnesium (from using diuretics, for example) also can cause life-
threatening arrhythmias and cardiac arrest.
 Electrical abnormalities Certain electrical abnormalities such as Wolff-Parkinson-White
syndrome and Long QT syndrome may cause sudden cardiac arrest in children and young
people.
 Blood vessel abnormalities In rare cases, congenital blood vessel abnormalities,
particularly in the coronary arteries and aorta, may cause cardiac arrest. Adrenaline released
during intense physical activity often acts as a trigger for sudden cardiac arrest when these
abnormalities are present.
 Recreational drug use Use of certain recreational drugs can cause sudden cardiac arrest,
even in otherwise healthy people.

Cardiac arrest can strike without warning

Do you suspect that someone is experiencing cardiac arrest? Here are the signs:

 Sudden loss of responsiveness The person doesn’t respond, even if you tap him or her
hard on the shoulders, or ask loudly if he or she is OK. The person doesn’t move, speak,
blink or otherwise react.
 No normal breathing The person isn’t breathing or is only gasping for air.
What to do
If you have tried and failed to get the person to respond, and you think the person may be suffering
cardiac arrest, here’s what to do:

 Yell for help Tell someone nearby to call 911 or your emergency response number. Ask that
person or another bystander to bring you an AED (automated external defibrillator), if there’s
one on hand. Tell them to hurry – time is of the essence.
o If you’re alone with an adult who has these signs of cardiac arrest, call 911 and get
an AED (if one is available).
 Check breathing If the person isn’t breathing or is only gasping, administer CPR.
 Give CPR: Push hard and fast Push down at least two inches at a rate of 100 to 120
pushes a minute in the center of the chest, allowing the chest to come back up to its normal
position after each push.
 Use an AED Use the automated external defibrillator as soon as it arrives. Turn it on and
follow the prompts.
 Keep pushing Continue administering CPR until the person starts to breathe or move, or
until someone with more advanced training takes over, such as an EMS team member.

Heart Attack or Sudden Cardiac Arrest: How Are They

Different?
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 9-1-1 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 9-1-1 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 9-1-1 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.

Overview

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

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

If not treated immediately, sudden cardiac arrest can lead to death. With fast, appropriate medical care,
survival is possible. Giving cardiopulmonary resuscitation (CPR), using a defibrillator — or even just
giving compressions to the chest — can improve the chances of survival until emergency workers arrive.

Symptoms
Sudden cardiac arrest signs and symptoms are immediate and drastic and include:

 Sudden collapse

 No pulse
  No breathing

 Loss of consciousness

Sometimes other signs and symptoms occur before sudden cardiac arrest. These might
include:

 Chest discomfort

 Shortness of breath

 Weakness

 Palpitations

But sudden cardiac arrest often occurs with no warning.

When to see a doctor

See your doctor promptly if you have episodes of:

 Chest pain or discomfort

 Heart palpitations

 Rapid or irregular heartbeats

 Unexplained wheezing

 Shortness of breath

 Fainting or near fainting

 Lightheadedness or dizziness

If you're currently having these symptoms, call 911 or emergency medical help.

When the heart stops, the lack of oxygenated blood can cause death or permanent
brain damage in minutes. Time is critical when you're helping an unconscious person
who isn't breathing.

If you see someone who's unconscious and not breathing normally, do the following:

 Call 911 or the emergency number in your area. If you have immediate access to a
telephone, call before beginning CPR.

 Perform CPR. Quickly check the breathing. If the person 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 workers arrive.

 Use a portable defibrillator, if one is available. It will give you step-by-step voice
instructions. Continue chest compressions while the defibrillator is charging.
Deliver one shock if advised by the device and then immediately resume 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 give another shock. Repeat this cycle until the person recovers
consciousness or emergency workers take over.

Portable automated external defibrillators (AEDs) are available in many places,

including airports, casinos and shopping malls. You can also purchase one for your
home. AEDs come with built-in instructions for their use. They're programmed to allow a
shock only when appropriate.
Causes
A problem in your heart rhythm (arrhythmia) — the result of a problem with your heart's
electrical system — is the usual cause of sudden cardiac arrest.

The heart's electrical system controls the rate and rhythm of your heartbeat. If
something goes wrong, your heart can beat too fast, too slowly or irregularly
(arrhythmia). Often these arrhythmias are brief and harmless, but some types can lead
to sudden cardiac arrest.

The most common heart rhythm at the time of cardiac arrest is an arrhythmia in a lower
chamber of your heart (ventricle). Rapid, erratic electrical impulses cause your
ventricles to quiver uselessly instead of pumping blood (ventricle fibrillation).
Heart conditions that can lead to sudden cardiac arrest

Sudden cardiac arrest can happen in people who have no known heart diease.
However, a life-threatening arrhythmia usually develops in a person with a pre-existing,
possibly undiagnosed heart condition. Conditions include:

 Coronary artery disease. Most cases of sudden cardiac arrest occur in people who have
coronary artery disease, in which your arteries become clogged with cholesterol and other
deposits, reducing blood flow to your heart.
 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. Also, a heart attack can
leave scar tissue in your heart. 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. Then your heart's muscle is abnormal, a condition
that often leads to arrhythmias.

 Valvular heart disease. Leaking or narrowing of your heart valves can lead to stretching
or thickening of your heart muscle. 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 can be due to a heart defect that was present at birth (congenital heart disease). 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.
 Risk factors


 Chambers of the heart

Because sudden cardiac arrest is so often linked with coronary artery disease, the same
factors that put you at risk of coronary artery disease can 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

Other factors that might 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

 Using illegal drugs, such as cocaine or amphetamines

 Nutritional imbalance, such as low potassium or magnesium levels

 Obstructive sleep apnea

 Chronic kidney disease

Complications
When sudden cardiac arrest occurs, reduced blood flow to your brain causes
unconsciousness. If your heart rhythm doesn't rapidly return to normal, brain damage
occurs and death results. Survivors of cardiac arrest might show signs of brain damage.
Prevention
Reduce your risk of sudden cardiac arrest by getting regular checkups, being screened
for heart disease and living a heart-healthy lifestyle.