Sudden Cardiac Arrest

What It Is – and What It Isn’t

Sudden cardiac arrest (SCA) is a sudden, abrupt loss of heart function. Most sudden cardiac arrest episodes are caused by the rapid and/or chaotic activity of the heart. It’s a condition of the heart’s electrical conduction system that should not be confused with a heart attack, which is caused by a blocked blood vessel leading to loss of blood supply to a portion of the heart muscle. However, some people may experience SCA during a heart attack.

Incidence of Sudden Cardiac Arrest

Sudden cardiac arrest is a major health problem. According to the American Heart Association, SCA affects approximately 450,000 people each year in the United States.

  • SCA kills more Americans than lung cancer, breast cancer and AIDS combined.
  • Of the 450,000 Americans who suffer SCA each year, an estimated 95 percent die before reaching the hospital.
  • Rapid defibrillation is the only definitive treatment for SCA, and survival decreases 7-10 percent for every minute without it.
  • SCA victims range from young children to the elderly.
  • The average response time to an emergency call in a developed nation is six to 12 minutes or a country like India this can go upto few hours.

What Makes Someone Susceptible to Sudden Cardiac Arrest?

People with heart disease are at varying risks for dying suddenly, but there are ways to markedly decrease that risk. Anyone with heart disease should discuss the risk of sudden cardiac arrest with their physician and talk about whether or not a referral to a heart rhythm specialist is appropriate for them. SCA risk factors include

  • Survival of a previous SCA episode.
  • Previous heart attack.
  • Family history of SCA or other heart disease.
  • Heart failure
  • Fast rhythm in the lower chambers of the heart (ventricles)

Recognize the following signs of sudden cardiac arrest and take action in the event of one or more of the following:

  • The person is not moving, or is unresponsive, or appears to be unconscious.
  • The person is not breathing normally (has irregular breaths, gasping or gurgling, or is not breathing at all).
  • The person appears to be having a seizure or is experiencing convulsion-like activity. (Cardiac arrest victims commonly appear to be having convulsions).
  • Note: If the person received a blunt blow to the chest, this can cause cardiac arrest, a condition called commotio cordis. The person may have the signs of cardiac arrest described above and is treated the same.

Facilitate immediate access to professional medical help:

Start CPR:

  • Press hard and fast in center of chest. Goal is 100 compressions per minute. (Faster than once per second, but slower than twice per second.)
  • Use 2 hands: The heel of one hand and the other hand on top (or one hand for children under 8 years old), pushing to a depth of 2 inches (or 1/3rd the depth of the chest for children under 8 years old.

Use the nearest AED:

  • When the AED is brought to the patient’s side, press the power-on button, and attach the pads to the patient as shown in the diagram on the pads. Then follow the AED’s audio and visual instructions. If the person needs to be shocked to restore a normal heart rhythm, the AED will deliver one or more shocks.
  • Continue CPR until the patient is responsive or a professional responder arrives and takes over.

Dealing With Sudden Cardiac Arrest – Long term treatment Options

Cardiac arrest is reversible in most victims if it’s treated within minutes, but the only effective treatment is the delivery of an electrical shock. With the development of hospital coronary care units in the 1960s, it was found that electrical devices that shocked the heart could turn an abnormally rapid rhythm into a normal one. Later, it also became clear that cardiac arrest could be reversed outside the hospital if specially trained emergency rescue teams reached the person quickly Chances of survival are reduced by 7-10 percent with every passing minute. However, even after survival the prognosis continued to be dismal. The first-year recurrence rate was 20-40 percent.

In the mid-1980s, the implantable cardioverter-defibrillator (ICD) was designed and quickly called “an emergency room in the chest.” It monitored the heart’s electrical conduction system and administered electrical shocks directly to the heart to stop ventricular fibrillation. Today, ICDs do much more and have been proven to be 99 percent effective in treating ventricular arrhythmias.

A modern ICD is about the size of a small stopwatch and is implanted in the upper chest. It continuously monitors the electrical conduction system of the heart, watching for dangerous patterns and delivering electrical impulses when needed that may range from a tiny pulse like a cardiac pacemaker’s to a full, life-saving shock that can return the heart to normal rhythm. Dangerous patterns may indicate ventricular fibrillation, ventricular tachycardia or less problematic supraventricular tachycardias that arise in the upper chambers of the heart. ICDs now also collect information for the physician to use in diagnosis and programming the device to the exact needs of the patient. For patients with ICDs, the first-year recurrence rate of sudden cardiac arrest has been reduced to 1 to 2 percent.

External defibrillators are being more widely used by emergency medical technicians, firefighters and policemen. Thanks to new legislation, they also have become commonplace in many public buildings and airports, as well as at schools, shopping malls, stadiums, golf courses and other places where large groups of people congregate. External defibrillators for non-medical operators are called AEDs, or automated external defibrillators, and are extremely easy to use by trained laypersons, with voice-activated instructions.

A certain part of the population is at a higher risk of getting a sudden cardiac arrest based on following criteria.

  • Family history of heart attack or sudden cardiac arrest
  • Unexplained fainting or near fainting or palpitations (racing heart)
  • Chest pain, shortness of breath or fainting with exertion such as during sports
  • Heart attack or heart failure
  • Cardiac risk factors, such as high blood pressure, diabetes, obesity, or abnormal cholesterol
  • Weak heart muscle, or a cardiac “ejection fraction” of 35% or less

SCA can happen to a person of any age, race, or gender. In fact, it can even happen to young athletes who seem in excellent physical condition

About 95% of the at-risk population can be saved with proper healthcare assessment and treatment. It is a well-known fact that less than 5% of patients survive a cardiac arrest outside a hospital setup.

OPD details

    Dr. Vanita Arora is Director & Head for Cardiac Electrophysiology Lab and Arrhythmia Services at Max Hospital, Delhi. She has been a successful Cardiologist for the last 28 years. She is a DNB Cardiology, MD - Medicine, M.B.B.S . You can visit her at Max Super Speciality Hospital in Saket, Delhi. To book an appointment online with Dr. Vanita Arora, please contact us.



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