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Sudden Cardiac Arrest

(Also Called 'Cardiac Arrest (Sudden Cardiac Arrest)')
 
 
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What are sudden cardiac arrest and sudden cardiac death (SCD)?

Electrical system of the heart

Sudden cardiac death (SCD) is a sudden, unexpected death caused by loss of heart function (sudden cardiac arrest). SCD is the largest cause of natural death in the United States, causing about 325,000 adult deaths in the United States each year.

SCD is responsible for half of all heart disease deaths. Sudden death occurs most frequently in adults in their mid-30s to mid-40s, and affects men twice as often as it does women. SCD is rare in children, affecting only 1 to 2 per 100,000 children each year.

How is a cardiac sudden death different from a heart attack?

Sudden cardiac arrest is not a heart attack (myocardial infarction). Heart attacks occur when there is a blockage in one or more of the coronary arteries, preventing the heart from receiving enough oxygen-rich blood. If the oxygen in the blood cannot reach the heart muscle, the heart becomes damaged.

In contrast, sudden cardiac arrest occurs when the electrical system to the heart malfunctions and suddenly becomes very irregular. The heart beats dangerously fast. The ventricles may flutter or quiver (ventricular fibrillation), and blood is not delivered to the body. In 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. Death follows unless emergency treatment is begun immediately.

Emergency treatment includes cardiopulmonary resuscitation (CPR) and defibrillation. CPR keeps enough oxygen in the lungs and gets it to the brain until the normal heart rhythm is restored with an electric shock to the chest. Portable defibrillators used by emergency personnel, or public access defibrillators (AEDs) may help save the person’s life.

What are the symptoms of sudden cardiac arrest?

Some people may experience a racing heartbeat or they may feel dizzy or faint, alerting them that a potentially dangerous heart rhythm problem has started. In over half of the cases, however, sudden cardiac arrest occurs without prior symptoms.

What causes sudden cardiac death?

Most sudden deaths are caused by abnormal heart rhythms called arrhythmias. The most common life-threatening arrhythmia is ventricular fibrillation, which is an erratic, disorganized firing of impulses from the ventricles (the heart’s lower chambers). When this occurs, the heart is unable to pump blood and death will occur within minutes, if left untreated.

What are the risk factors of sudden cardiac arrest?

There are many factors that can increase a person's risk of sudden cardiac arrest and sudden death. The two leading risk factors include:

  • Previous heart attack (75 percent of SCD cases are linked to a previous heart attack) -- A person’s risk of SCD is higher during the first six months after a heart attack
  • Coronary artery disease (80 percent of SCD cases are linked with this disease) -- Risk factors for coronary artery disease include smoking, family history of cardiovascular disease, high cholesterol or an enlarged heart.

Other risk factors include:

  • Ejection fraction of less than 40 percent, combined with ventricular tachycardia
  • Prior episode of sudden cardiac arrest
  • Family history of sudden cardiac arrest or SCD
  • Personal or family history of certain abnormal heart rhythms including long QT syndrome, Wolff-Parkinson-White Syndrome, extremely low heart rates or heart block
  • Ventricular tachycardia or ventricular fibrillation after a heart attack
  • History of congenital heart defects or blood vessel abnormalities
  • History of syncope (fainting episodes of unknown cause)
  • Heart failure: a condition in which the heart’s pumping power is weaker than normal. Patients with heart failure are 6 to 9 times more likely than the general population to experience ventricular arrhythmias that can lead to sudden cardiac arrest.
  • Dilated cardiomyopathy (cause of SCD in about 10 percent of the cases): a decrease in the heart’s ability to pump blood due to an enlarged (dilated) and weakened left ventricle
  • Hypertrophic cardiomyopathy (a thickened heart muscle that especially affects the ventricles)
  • Significant changes in blood levels of potassium and magnesium (from using diuretics, for example), even if there is not organic heart disease
  • Obesity
  • Diabetes
  • Recreational drug abuse
  • Taking drugs that are “pro-arrhythmic” may increase the risk for life-threatening arrhythmias

Can sudden cardiac arrest be prevented?

If you have any of the risk factors listed above, it is important to speak with your doctor about how to reduce your risk.

Keeping 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-up Care with Your Doctor : Your doctor will tell you how often you need to have follow-up visits. During your follow-up appointments, your doctor will evaluate your overall health and your heart health.

To prevent future episodes of sudden cardiac arrest, your doctor will want to perform diagnostic tests to determine what caused the cardiac event. Tests may include ECG, ejection fraction, ambulatory monitoring, echocardiography, cardiac catheterization, and electrophysiology study.

  • Ejection Fraction (EF): EF is a measurement of the percentage of blood pumped out of the heart with each beat. EF can be measured in your doctor’s office during an echocardiogram (echo) or during other tests such as a MUGA (multiple gated acquisition) scan, cardiac catheterization, nuclear stress test or magnetic resonance imaging (MRI) scan of the heart.

    The EF of a healthy heart ranges from 55 to 65 percent. Your EF can go up and down, based on your heart condition and the effectiveness of the therapies that have been prescribed.

    If you have heart disease, it is important to have your EF measured initially, and then as needed, based on changes in your condition. Ask your doctor how often you should have your EF checked.

  • Reducing your risk factors: If you have coronary artery disease -- and even if you do not -- there are certain lifestyle changes you can make to reduce high blood pressure and cholesterol levels and manage your diabetes and weight - thereby reducing your risk of sudden cardiac arrest. These lifestyle changes include:
    • Quitting smoking
    • Losing weight
    • Exercising regularly
    • Following a low-fat diet
    • Managing diabetes
    • Managing other health conditions

    If you have questions or are unsure how make these changes, talk to your doctor. Click here for more information about prevention strategies.

    Patients and families should know the signs and symptoms of coronary artery disease and the steps to take if symptoms occur.

  • Medications: To help reduce the risk of sudden cardiac arrest, doctors may prescribe medications to patients who have had heart attacks, or who have heart failure or arrhythmias.

    These medications may include ACE inhibitors, beta blockers, calcium channel blockers and other antiarrhythmics. For patients with high cholesterol and coronary artery disease, statin medications may be prescribed.

    If medication is prescribed, your doctor will give you more specific instructions. Click here to learn more about your medications and taking medications safely.

  • Implantable cardioverter-defibrillator (ICD): For patients who have a great risk for SCD, an ICD may be inserted as a preventive treatment. An ICD is a small machine similar to a pacemaker that is designed to correct arrhythmias, detects and then corrects a fast heart rate.

    The ICD constantly monitors the heart rhythm. When it detects a very fast, abnormal 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. The ICD also records the data of each episode, which can be viewed by the doctor through a third part of the system that is kept at the hospital.

    The ICD may be used in patients who have survived sudden cardiac arrest and need their heart rhythms constantly monitored. It may also be combined with a pacemaker to treat other underlying irregular heart rhythms. Click here for more information about ICD.

  • Interventional procedures or surgery: For 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 SCD. For patients with other conditions, such as hypertrophic cardiomyopathy or congenital heart defects, an interventional procedure or surgery may be needed to correct the problem. Other procedures may be used to treat abnormal heart rhythms, including electrical cardioversion and catheter ablation.

    When a heart attack occurs in the left ventricle (left lower pumping chamber of the heart), a scar forms. The scarred tissue may increase the risk of ventricular tachycardia. The electrophysiologist (doctor specializing in electrical disorders of the heart) can determine the exact area causing the arrhythmia. The electrophysiologist, working with your surgeon, may combine ablation (the use of high-energy electrical energy to “disconnect” abnormal electrical pathways within the heart) with left ventricular reconstruction surgery ( surgical removal of the infarcted or dead area of heart tissue).

  • Educate your family members: If you are at risk for SCD, talk to your family members so they understand your condition and the importance of seeking immediate care in the event of an emergency. Family members and friends of those at risk for SCD should know how to perform CPR.

What is the treatment for sudden cardiac death?

Sudden cardiac death can be treated and reversed, but emergency action must take place almost immediately. Survival can be as high as 90 percent if treatment is initiated within the first minutes after SCD. The rate decreases by about 10 percent each minute longer. Those who survive have a good long-term outlook.

If someone experiences sudden cardiac arrest:

  1. 9-1-1 should be dialed immediately
  2. Begin to perform CPR . If performed properly, CPR can help save a life, as the procedure keeps blood and oxygen circulating through the body until emergency medical help arrives.
  3. Early defibrillation. If a public access defibrillator -- also called an AED (Ambulatory External Defibrillator) -- is available, defibrillate. In adults, sudden cardiac death is usually related to ventricular fibrillation. Quick defibrillation (delivery of an electrical shock) is necessary to return the heart rhythm to a normal heartbeat. The shorter the time until defibrillation, the greater the chance the patient will survive. It is CPR plus defibrillation that rescues the person.
  4. Once emergency personnel arrive, more traditional defibrillation and initiation of medications can be provided. This type of defibrillation is done through an electric shock given to the heart through paddles placed on the chest.
  5. Advanced Care . After successful defibrillation, most patients require hospital care to treat and prevent future cardiac problems.

More about AEDs

Automatic external defibrillators (AEDs) are defibrillators with computers that are able to recognize ventricular fibrillation (VF), advise the operator that a shock is needed, and deliver the shock. AEDs are designed to be used by a wide range of personnel such as fire department personnel, police officers, lifeguards, flight attendants, security guards, teachers, and even family members of high-risk persons. The goal is to provide access defibrillation when needed as quickly as possible. CPR along with AEDs can dramatically increase survival rates for sudden cardiac death.

To learn CPR

Learning CPR is the largest gift you can give your family and friends. CPR is easy for most adults and teens to learn. It is a technique designed to temporarily circulate oxygenated blood through the body of a person whose heart has stopped. It involves:

  • Assessing the airway
  • Breathing for the person
  • Determining if the person is pulseless and applying pressure to the chest to circulate blood

To learn more about CPR:


CPR:

call 911

A - airway

B - breathing

C - circulation
(chest compressions)

A note about SCD and athletes

Although SCD occurs rarely in athletes, when it does happen, it often affects us with shock and disbelief.

  • Cause: Most cases of SCD are related to undetected cardiovascular disease. In the younger population, it is often due to congenital heart defects, while in older athletes (35 years and older), the cause is more often related to coronary artery disease.
  • Prevalence: SCD in athletes occurs rarely; however media coverage often makes it seem like it happens more often. In the younger population, most cases of SCD occur while playing team sports; in about one in 100,000 to one in 300,000 athletes, and more often in males. In older athletes, SCD occurs more often during running or jogging and in approximately one in 15,000 joggers and one in 50,000 marathon runners.
  • Screening: The American Heart Association recommends cardiovascular screening for high school and collegiate athletes and should include:
    • Complete and careful evaluation of the athlete's personal and family history
    • Physical exam
    • Screening should be repeated every two years with a history and physical obtained every year.
    • Men aged 40 years and older and women aged 50 years and older should also have an exercise stress test and receive education about cardiac risk factors and symptoms.

If heart problems are identified or suspected, the athlete should be referred to a cardiologist for further evaluation and treatment guidelines before participating in sports.

Resource: Cardiovascular Preparticipation Screening of Competitive Athletes*

For more information on SCD:

*a new browser window will open with this link. The inclusion of links to other web sites does not imply any endorsement of the material on the web sites or any association with their operators

© Copyright 2002- 2008 Cleveland Clinic.  All rights reserved, reviewed 10/06

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