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
NCM118
other signs and symptoms occur before SCA
 Chest discomfort
 Shortness of breath
 Weakness
 Fast-beating, fluttering or pounding heart
(palpitations)
But sudden cardiac arrest often occurs with no
warning.
Clinical Manifestations
 Consciousness, pulse, and blood pressure are
lost immediately.
 Ineffective respiratory gasping may occur.
 The pupils of the eyes begin dilating within 45
seconds.
 Seizures may or may not occur.
 The risk of irreversible brain damage and death
increases with every minute from the time that
circulation ceases.
Complications
 neurologic dysfunction
 brain injury
 disorders of consciousness
 neurocognitive deficits
Diagnosis
 Clinical evaluation
 Cardiac monitoring and electrocardiography
(ECG)
 Sometimes testing for cause (eg,
echocardiography, chest imaging [x-ray,
ultrasonography], electrolyte testing)
 Diagnosis of cardiac arrest is by clinical
findings of apnea, pulselessness, and
unconsciousness. Arterial pressure is not
measurable. Pupils dilate and become
unreactive to light after several minutes.
Sudden Cardiac Death Diagnosis
 Laboratory studies
 Cardiac enzymes (creatine kinase,
myoglobin, troponin)
 Electrolytes, calcium, and magnesium
 Quantitative drug levels (quinidine,
procainamide, tricyclic antidepressants,
digoxin): High or low drug levels may have
a proarrhythmic effect
 Toxicology screen: For drugs, such as
cocaine, that cause vasospasm-induced
ischemia
 Thyroid-stimulating hormone
 Brain natriuretic peptide (BNP)
Other tests to evaluate or predict risk of SCD in
certain cases
 Imaging studies: Chest radiography,
echocardiography, nuclear scintigraphy, and/or
cardiac MRI to detect the presence and extend
of cardiac structual abnormality
 Electrocardiography (ECG): Including, possibly,
signal-averaged ECG to detect certain ECG signs
of syndromes associated with SCD and to
detect arrhythmia
 Coronary angiography: To detect significant
coronary artery disease
 Electrophysiology study: To assess the electrical
properties of the heart and the inducibility of
ventricular arrhythmias; also to detect scar and
fibrosis by obtaining voltage map of the heart
Emergency Treatment of Cardiac Arrest
 Ensure scene safety.
 Check for response.
 Shout for help.
 Check for no breathing or only gasping. If
the person isn’t breathing or is only gasping,
begin CPR with compressions.
 Begin high quality CPR. Push down at least
two inches in the center of the chest at a
rate of 100 to 120 pushes a minute. Allow
the chest to come back up to its normal
position after each push.
 Use an AED.
 Continue CPR.
NCM118
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?