Heart Attack or Sudden Cardiac Arrest

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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. f the blocked artery is not reopened !uickly, the part of the heart normally nourished by that artery begins to die. "he longer a person goes without treatment, the greater the damage. #ymptoms of a heart attack may be immediate and intense. $ore often, though, symptoms start slowly and persist for hours, days or weeks before a heart attack. %nlike with sudden cardiac arrest, the heart usually does not stop beating during a heart attack. "he heart attack symptoms in women can be different than men. What is cardiac arrest? #udden cardiac arrest occurs suddenly and often without warning. t is triggered by an electrical malfunction in the heart that causes an irregular heartbeat &arrhythmia'. (ith its pumping action disrupted, the heart cannot pump blood to the brain, lungs and other organs. #econds later, a person loses consciousness and has no pulse. )eath occurs within minutes if the victim does not receive treatment.

What is the link? "hese two distinct heart conditions are linked. #udden cardiac arrest can occur after a heart attack, or during recovery. *eart attacks increase the risk for sudden cardiac arrest. $ost heart attacks do not lead to sudden cardiac arrest. +ut when sudden cardiac arrest occurs, heart attack is a common cause. ,ther heart conditions may also disrupt the heart-s rhythm and lead to sudden cardiac arrest. "hese include a thickened heart muscle &cardiomyopathy', heart failure, arrhythmias, particularly ventricular fibrillation, andlong .-" syndrome. Fast action can save lives. Find out what to do if someone e !eriences a heart attack or cardiac arrest. What to do: Heart Attack /ven if you0re not sure it0s a heart attack, don0t wait more than five minutes to call "#$#$ or your emergency response number. /very minute matters1 t-s best to call /$# to get to the emergency room right away. /mergency medical services staff can begin treatment when they arrive 2 up to an hour sooner than if someone gets to the hospital by car. /$# 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 3ardiac arrest is reversible in most victims if it0s treated within a few minutes. 4irst, call "#$#$ for emergency medical services. "hen get an automated external defibrillator if one is available and use it as soon as it arrives. +egin 3P5 immediately and continue until professional emergency medical services arrive. f two people are available to help, one should begin 3P5 immediately while the other calls 6-7-7 and finds an A/).

Sudden cardiac arrest is a leadin% cause of death 8 nearly 9::,::: out-of-hospital cardiac arrests occur annually in the %nited #tates. +y performing *ands-,nly 3P5 to the beat of the classic disco song “#tayin- Alive,” you can double or even triple a victim-s chance of survival. ;earn the two easy steps to save a life at heart.org<handsonlycpr.
Si%ns of cardiac arrest: t strikes suddenly and without warning. • #udden loss of responsiveness =o response to tapping on shoulders )oes nothing when you ask if he is okay



=o normal breathing "he victim does not take a normal breath when you tilt the head up 3heck for at least five seconds

&f these si%ns of cardiac arrest are !resent:

• •

3all 6-7-7 for emergency medical services. >et an automated external defibrillator &A/)' f one is available +egin 3P5 immediately 3ontinue until professional emergency medical services arrive %se the A/) as soon as it arrives.





f two people are available to help, one should begin 3P5 immediately while the other calls 6-7-7 and finds an A/). Cardiac arrest is reversi'le in most victims if it(s treated within a few minutes. "his first became clear in the early 76?:s with the development of coronary care units. /lectrical devices that shocked the heart were discovered to turn an abnormally rapid rhythm into a normal one. +efore then, heart attack victims had a @: percent chance of dying if they got to the hospital aliveA B: percent of these deaths were due to cardiac arrest. n-hospital survival after cardiac arrest in heart attack patients improved dramatically when the )3 defibrillator and bedside monitoring were developed. ;ater, it also became clear that cardiac arrest could be reversed outside a hospital by properly staffed emergency rescue teams trained to give 3P5 and defibrillate. &mmediate treatment is essential to survival of cardiac arrest. "he problem isn0t whether cardiac arrest can be reversed but reaching the victim in time to do so. "he American *eart Association supports implementing a Cchain of survivalC to rescue people who suffer cardiac arrest. "he chain consists ofD

• • • •

/arly recognition of the emergency and activation of the emergency medical services &/$#'. /arly defibrillation when indicated.

/arly bystander 3P5 &cardiopulmonary resuscitation'.

/arly advanced life support followed by postresuscitation care delivered by healthcare providers

Care for Children =ot as much is known about care for children who experience cardiac arrest, but critical elements include managing temperature, glucose, blood pressure, ventilation and cardiac output. #urvival is higher in hospitals with specialiEed pediatric staff.

Heart Disease and Sudden Cardiac Death
#udden cardiac death &#3)' is a sudden, unexpected death caused by loss ofheart function &sudden cardiac arrest'. t is the largest cause of natural death in the %.#., causing about @FB,::: adult deaths in the %.#. each year. #3) is responsible for half of all heart disease deaths. How &s Sudden Cardiac Arrest Different from a Heart Attack? #udden cardiac arrest is not a heart attack &myocardial infarction' but can occur during a heart attack. *eart attacks occur when there is a blockage in one or more of the arteries to the heart, preventing the heart from receiving enough oxygen-rich blood. f the oxygen in the blood cannot reach the heart muscle, the heart becomes damaged. n contrast, sudden cardiac arrest occurs when the electrical system to the heart malfunctions and suddenly becomes very irregular. "he heart beats dangerously fast. "he ventricles may flutter or !uiver &ventricular fibrillation', and blood is not delivered to the body. n the first few minutes, the greatest concern is that blood flow to the brain will be reduced so drastically that a person will lose consciousness. )eath follows unless emergency treatment is begun immediately. /mergency treatment includes cardiopulmonary resuscitation &3P5' and defibrillation. 3P5 is a manual techni!ue using repetitive pressing to the chest and breathing into the person0s airways that keeps enough oxygen and blood flowing to the brain until the normal heart rhythm is restored with an electric shock to the chest, a procedure called defibrillation. /mergency s!uads use portable defibrillators and fre!uently there are public access defibrillators &A/)s, ambulatory external defibrillators' in public locations that are intended to be available for use by citiEens who observe cardiac arrest.

What Are the Sym!toms of Sudden Cardiac Arrest? #ome people may experience symptoms of sudden cardiac arrest, such as a racing heartbeat or they may feel diEEy, alerting them that a potentially dangerous heart rhythm problem has started. n over half of the cases, however, sudden cardiac arrest occurs without prior symptoms. What Causes Sudden Cardiac Death? $ost sudden cardiac deaths are caused by abnormal heart rhythms called arrhythmias. "he most common life-threatening arrhythmia is ventricular fibrillation, which is an erratic, disorganiEed firing of impulses from the ventricles &the heart0s lower chambers'. (hen this occurs, the heart is unable to pump blood and death will occur within minutes, if left untreated. What Are the )isk Factors of Sudden Cardiac Arrest? "here are many risk factors that can increase a person0s risk of sudden cardiac arrest and sudden cardiac death, including the followingD • • • • Previous heart attack with a large area of the heart damaged &GBH of #3) cases are linked to a previous heart attack'. A person0s risk of #3) is higher during the first ? months after a heart attack. 3oronary artery disease &I:H of #3) cases are linked with this disease'. 5isk factors for coronary artery disease include smoking, family history of heart disease, and high cholesterol.

What Are the )isk Factors of Sudden Cardiac Arrest? continued... ,ther risk factors of sudden cardiac arrest includeD • • • • • • • • /Jection fraction of less than 9:H, particularly in combination with ventricular tachycardia Prior episode of sudden cardiac arrest 4amily history of sudden cardiac arrest or #3) Personal or family history of certain abnormal heart rhythms, including long or short ." syndrome, (olff-Parkinson-(hite syndrome, extremely low heart rates, or heart block Kentricular tachycardia or ventricular fibrillation after a heart attack *istory of congenital heart defects or blood vessel abnormalities *istory of syncope &fainting episodes of unknown cause' *eart failureD a condition in which the heart0s pumping power is weaker than normal. Patients with heart failure are ? to 6 times more likely than the general population to experience ventricular arrhythmias that can lead to sudden cardiac arrest *ypertrophic cardiomyopathyD a thickened heart muscle that especially affects the ventricles #ignificant changes in blood levels of potassium and magnesium &from using diuretics, for example', even if there is not underlying heart disease ,besity )iabetes 5ecreational drug abuse "aking drugs that are Cpro-arrhythmicC may increase the risk for life-threatening arrhythmias

• • • • • •

Can Sudden Cardiac Death *e +revented? f you have any of the risk factors for sudden cardiac death &listed above', it is important that you speak with your doctor about possible steps to reduce your risk. Leeping regular follow-up appointments with your doctor, making certain lifestyle changes, taking medications as prescribed, and having interventional procedures or surgery &as recommended' are ways you can reduce your risk. Follow#,! Care With -our Doctor: Mour doctor will tell you how often you need to have follow-up visits. "o prevent future episodes of sudden cardiac arrest, your doctor will want to perform diagnostic tests to determine what caused the cardiac event. "ests may include electrocardiogram &/3> or /L>', ambulatory monitoring, echocardiogram, cardiac catheteriEation, and electrophysiology studies. ./ection Fraction 0.F1: /4 is a measurement of the percentage &fraction' of blood pumped &eJected' out of the heart with each beat. /4 can be measured in your doctor0s office during an echocardiogram &echo' or during other tests such as a $%>A &multiple gated ac!uisition' scan, cardiac catheteriEation, nuclear stress test, or magnetic resonance imaging &$5 ' scan of the heart. "he /4 of a healthy heart

ranges from BBH to ?BH. Mour /4 can go up and down, based on your heart condition and the effectiveness of the therapies that have been prescribed. f you have heart disease, it is important to have your /4 measured initially, and then as needed, based on changes in your condition. Ask your doctor how often you should have your /4 checked. )educin% -our )isk Factors: f you have coronary artery disease -- and even if you do not -- there are certain lifestyle changes you can make to reduce your risk of sudden cardiac arrest. "hese lifestyle changes includeD • • • • • • .uitting smoking ;osing weight /xercising regularly 4ollowing a low-fat diet $anaging diabetes $anaging other health conditions including high blood pressure and cholesterol Can Sudden Cardiac Death *e +revented? continued... f you have !uestions or are unsure how make these changes, talk to your doctor. Patients and families should know the signs and symptoms of coronary artery disease and the steps to take if symptoms occur. 2edications: "o help reduce the risk of sudden cardiac arrest, doctors may prescribe medications to people who have had heart attacks or who have heart failure or arrhythmias such as irregular heart rhythms. "hese drugs may include A3/ inhibitors, beta-blockers, calcium-channel blockers, and other antiarrhythmics. 4or patients with high cholesterol and coronary artery disease, statin drugs may be prescribed. f medication is prescribed, your doctor will give you more specific instructions. t is important that you know the names of your medications and any directions that you need to follow when taking them. f you have any !uestions, be sure to ask your doctor or pharmacist. &m!lanta'le cardioverter#defi'rillator 0&CD1: 4or people whose risk factors put them at great risk for sudden cardiac death, an 3) may be inserted as a preventive treatment. An 3) is a small machine similar to a pacemaker that is designed to correct arrhythmias. t detects and then corrects a fast heart rate. "he 3) constantly monitors the heart rhythm. (hen it detects a very fast or slow heart rhythm, it delivers energy &a small, but powerful shock' to the heart muscle to cause the heart to beat in a normal rhythm again. "he 3) also records the data of each abnormal heartbeat, which can be viewed by the doctor using a special machine kept at the hospital. "he 3) may be used in patients who have survived sudden cardiac arrest and need their heart rhythms constantly monitored. t may also be combined with a pacemaker to treat other underlying irregular heart rhythms. &nterventional +rocedures or Sur%ery: 4or patients with coronary artery disease, an interventional procedure such as angioplasty &blood vessel repair' or bypass surgery may be needed to improve blood flow to the heart muscle and reduce the risk of #3). 4or patients with other conditions, such as hypertrophic cardiomyopathy or congenital heart defects, an interventional procedure or surgery may be needed to correct the problem. ,ther procedures may be used to treat abnormal heart rhythms, including electrical cardioversion and catheter ablation. (hen a heart attack occurs in the left ventricle &left lower pumping chamber of the heart', a scar forms. "he scarred tissue may increase the risk of ventricular tachycardia. "he electrophysiologist &doctor

specialiEing in electrical disorders of the heart' can determine the exact area causing the arrhythmia. "he electrophysiologist, working with your surgeon, may combine ablation &the use of high-energy electrical energy to CdisconnectC abnormal electrical pathways within the heart' with left ventricular reconstruction surgery &surgical removal of the infarcted or dead area of heart tissue'. .ducate -our Family 2em'ers: f you are at risk for #3), talk to your family members so they understand your condition and the importance of seeking immediate care in the event of an emergency. 4amily members and friends of those at risk for #3) should know how to perform 3P5. 3lasses to teach this are available in most communities. Can Sudden Cardiac Arrest *e Treated? Mes, sudden cardiac arrest can be treated and reversed, but emergency action must take place immediately. #urvival can be as high as 6:H if treatment is initiated within the first minutes after sudden cardiac arrest. "he rate decreases by about 7:H each minute longer it takes to initiate therapy. "hose who survive have a good long-term outlook. What Should & Do if & Witness Sudden Cardiac Arrest? f you witness someone experiencing sudden cardiac arrest, dial 677 or your local emergency personnel immediately and initiate 3P5. f done properly, 3P5 can save a person0s life, as the procedure keeps blood and oxygen circulating through the body until help arrives. f there is an A/) available, the best chance of rescuing the person includes defibrillation with that device. "he shorter the time until defibrillation, the greater the chance the person will survive. t is 3P5 plus defibrillation that saves a person. After successful defibrillation, most people re!uire hospital care to treat and prevent future cardiac problems. Sudden Cardiac Death and Athletes #3) occurs rarely in athletes, but when it does happen, it often affects us with shock and disbelief. Cause: $any cases of #3) are related to undetected heart disease. n the younger population, #3) is often caused by congenital heart defects, while in older athletes &@B years and older', the cause is more often related to coronary artery disease. +revalence: #3) in athletes is rare, but media coverage often makes it seem like it is more prevalent. n the younger population, most #3) occurs while playing team sports. t occurs in about one in 7::,::: to one in @::,::: athletes, and more often in males. n older athletes &@B years and older', #3) occurs more often whilerunning or Jogging. Screenin%: "he American *eart Association recommends cardiovascular screening for high school and collegiate athletes and should include a complete and careful evaluation of the athlete0s personal and family history and a physical exam. #creening should be repeated every two years, with a history obtained every year. $en aged 9: and older and women aged B: and older should also have a thorough examination and receive education about heart disease risk factors and symptoms. "hey may also need an exercise stress test based on their doctor-s evaluation. f heart problems are identified or suspected, the individual should be referred to a cardiologist for further evaluation and treatment guidelines before participating in sports.

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