NCM118
CARDIAC ARREST Heart attack or myocardial infarction
(seen in 30% of cases)
occurs when the heart ceases to produce an Cardiac anatomical abnormality
effective pulse and circulate blood.
Cardiac rhythm disturbance or
Cardiac arrest may follow respiratory arrest; arrhythmia. The most common fatal
it may also occur when electrical activity is abnormal heart rhythm is ventricular
present but there is ineffective cardiac fibrillation.
contraction or circulating volume, which is Cardiomyopathy
called pulseless electrical activity (PEA). Sepsis and major infection
Reversible causes (4H&4T’s): Drug overdose
Major injury and blood loss. Lung or heart
H: Hypoxia, hypovolemia, acidosis injury may also lead to cardiac arrest.
(hydrogen ion), hyperkalemia or Advanced cancer
hypokalemia, hypothermia Extremely high or low body temperature
T: Tablet or toxin ingestion, cardiac Extremely high or low blood level of
tamponade, tension pneumothorax, potassium
thrombosis (pulmonary or coronary) Severe oxygen deprivation
Two of the most common are ventricular and Pulmonary embolism
atrial fibrillation Risk factors
Atrial fibrillation, often called AFib or AF, is the Abnormal heart rhythms
most common type of treated heart Birth defects of the heart or blood vessels
arrhythmia. An arrhythmia is when the heart Previous Myocardial Infarction
beats too slowly, too fast, or in an irregular Family history of CAD
way. Smoking
Occurs when the upper chamber and lower High blood pressure
chambers are not coordinated, causing the Obesity
heart to beat slowly, too quickly, or irregularly. Diabetes
When a person has AFib, the normal beating in Inactive lifestyle
the upper chambers of the heart (the two atria) Previous episode of cardiac arrest
is irregular, and blood doesn’t flow as well as it Family history of other forms of heart disease
should from the atria to the lower chambers of (heart rhythm disorders, congenital heart
the heart (the two ventricles). AFib may happen defects, heart failure, cardiomyopathy_
in brief episodes, or it may be a permanent Older age
condition. Nutritional imbalance (low potassium or
Ventricular fibrillation (VF) is a life-threatening magnesium)
cardiac arrhythmia in which the coordinated Obstructive sleep apnea
contraction of the ventricular myocardium is Chronic kidney disease
replaced by high-frequency, disorganized
excitation, resulting in [the effective] failure of Symptoms
the heart to pump blood. Sudden collapse
Important causes of cardiac arrest include: No pulse
No breathing
Loss of consciousness
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other signs and symptoms occur before SCA Electrolytes, calcium, and magnesium
Quantitative drug levels (quinidine,
Chest discomfort
procainamide, tricyclic antidepressants,
Shortness of breath
digoxin): High or low drug levels may have
Weakness
a proarrhythmic effect
Fast-beating, fluttering or pounding heart
Toxicology screen: For drugs, such as
(palpitations)
cocaine, that cause vasospasm-induced
But sudden cardiac arrest often occurs with no ischemia
warning. Thyroid-stimulating hormone
Brain natriuretic peptide (BNP)
Clinical Manifestations
Other tests to evaluate or predict risk of SCD in
Consciousness, pulse, and blood pressure are
certain cases
lost immediately.
Ineffective respiratory gasping may occur. Imaging studies: Chest radiography,
The pupils of the eyes begin dilating within 45 echocardiography, nuclear scintigraphy, and/or
seconds. cardiac MRI to detect the presence and extend
Seizures may or may not occur. of cardiac structual abnormality
The risk of irreversible brain damage and death Electrocardiography (ECG): Including, possibly,
increases with every minute from the time that signal-averaged ECG to detect certain ECG signs
circulation ceases. of syndromes associated with SCD and to
detect arrhythmia
Complications
Coronary angiography: To detect significant
neurologic dysfunction coronary artery disease
brain injury Electrophysiology study: To assess the electrical
disorders of consciousness properties of the heart and the inducibility of
neurocognitive deficits ventricular arrhythmias; also to detect scar and
fibrosis by obtaining voltage map of the heart
Diagnosis
Emergency Treatment of Cardiac Arrest
Clinical evaluation
Cardiac monitoring and electrocardiography Ensure scene safety.
(ECG) Check for response.
Sometimes testing for cause (eg, Shout for help.
echocardiography, chest imaging [x-ray, Check for no breathing or only gasping. If
ultrasonography], electrolyte testing) the person isn’t breathing or is only gasping,
Diagnosis of cardiac arrest is by clinical begin CPR with compressions.
findings of apnea, pulselessness, and Begin high quality CPR. Push down at least
unconsciousness. Arterial pressure is not two inches in the center of the chest at a
measurable. Pupils dilate and become rate of 100 to 120 pushes a minute. Allow
unreactive to light after several minutes. the chest to come back up to its normal
position after each push.
Sudden Cardiac Death Diagnosis
Use an AED.
Laboratory studies Continue CPR.
Cardiac enzymes (creatine kinase,
myoglobin, troponin)
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Call 9-1-1 and shout for Call 9-1-1
a defibrillator
Medications
Start CPR Stop all activity. Sit or
lie down
Use a defibrillator as Take your nitroglycerin
soon as it arrives
Don't hesitate. This is a Chew ASA (Aspirin)
medical emergency (one 325 mg or two 81
that requires mg tablets).
immediate attention. Rest and wait.
Difference between cardiac arrest and a heart
attack
Cardiac arrest Heart attack
The heart has stopped The heart is not getting
pumping enough blood so it
starts to die
Caused by an abnormal Caused by a blockage
heart rhythm of blood flow to the
heart
The heart cannot pump The heart continues to
blood to the rest of the pump blood
body
It is a medical It is a medical
emergency emergency
Death occurs in Damage to the heart
minutes without increases with every
immediate action. minute of treatment
delay.
What does it look like?
Sudden collapse Person is generally
conscious.
Unresponsive to touch
or sound
Not breathing or Signs include: Chest or
making gasping upper body discomfort,
sounds. sweating nausea,
shortness of breath,
and light-headedness.
What to do?
