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Cardiac Arrest

Arrest Heart

Cardiac arrest is a medical term that refers to the mechanical cessation of the heart resulting to the absence of circulating blood in the system. The cessation of blood flow to the vital organs of the body results in death if left untreated. Sudden cardiac arrest refers to the abrupt cessation of cardiac function with minimal warning.


Presentation

Patients having a cardiac arrest will present with abrupt and drastic symptoms before the disease becomes eminent. In a number of cases, patients would suddenly collapse unconscious and may gain consciousness after a few minutes, or may never regain consciousness at all. It is also observable that breathing can arbitrarily stop during the cardiac event. Pulses may become faint or may not be appreciable at all especially during shock. In some cases of cardiac arrest, a number of signs may herald its onset like chest pain, fainting, dizziness, fatigue, shortness of breath, palpitation, vomiting, and weakness.

Hypothermia
  • Lundbye -- Hypothermia: How to Cool / Matthew W. Parker and Justin B.[worldcat.org]
  • Precision was not improved by transpulmonary thermodilution calibration during hypothermia.[ncbi.nlm.nih.gov]
  • Although reliable evidence has not been established, we recommend maintained mild therapeutic hypothermia using TTM, followed by slow rewarming in patients with post-CA hypothermia because of drowning, based on the observations in the current case and[ncbi.nlm.nih.gov]
  • KEYWORDS: Cardiac arrest, secondary; Hypothermia, induced; Meningitis, bacterial; Sevoflurane[ncbi.nlm.nih.gov]
  • We found no evidence to support one specific temperature over another during hypothermia.[ncbi.nlm.nih.gov]
Coronary Artery Disease
  • Risk factors Because sudden cardiac arrest is so often linked with coronary artery disease, the same factors that put you at risk of coronary artery disease can also put you at risk of sudden cardiac arrest.[mayoclinic.org]
  • More than half of the cases of cardiac arrest have an underlying diagnosed or undiagnosed coronary artery disease.[symptoma.com]
  • The absence of coronary artery disease was confirmed by 128-row multidetector computed tomography.[ncbi.nlm.nih.gov]
  • Coronary artery disease remains the predominant cause, but there is a diverse range of other potential cardiac and non-cardiac causes to be aware of.[ncbi.nlm.nih.gov]
  • KEYWORDS: Electrophysiologic considerations; cardioverter defibrillators (ICDs); coronary artery disease; mortality; sudden cardiac arrest; survival.[ncbi.nlm.nih.gov]
Falling
  • There were no signs or symptoms signifying that the person had been harmed in consequence of the fall. Only when brought into a supine position the patient suffered an immediate cardiac arrest.[ncbi.nlm.nih.gov]
  • The most common antecedents were hypotension and a fall in Glasgow Coma Scale.[ncbi.nlm.nih.gov]
  • Compared with traffic accidents, different injuries associated with survival to discharge were identified; the aOR (95% CI) was 1.89 (1.12-3.19) for poisoning, 1.63 (1.13-2.36) for falls, and 2.00 (1.36-2.92) for drowning/suffocation.This study has shown[ncbi.nlm.nih.gov]
  • Cardiac arrest falls under the umbrella of heart disease , which kills around 610,000 Americans every year, according to the U.S. Centers for Disease Control and Prevention.[health.com]
  • Recent Examples on the Web The world of football was left in mourning on Wednesday afternoon after news filtered through that Chelsea legend Ray Wilkins has passed away at the age of 61 following a recent cardiac arrest and fall at his home in Surrey.[merriam-webster.com]
Epilepsy
  • As a postdoctoral fellow, Auerbach studied the heart-brain connection in a severe genetic form of epilepsy, and found that cardiac arrhythmias were one cause of sudden unexplained death in people with epilepsy.[futurity.org]
  • Population-based study of the incidence of sudden unexplained death in epilepsy. Neurology . 1998 ; 51 :1270–1274. Crossref Medline Google Scholar 38 Lathers CM, Schraeder PL.[doi.org]
  • These tachyarrhythmia-associated SCA events must be distinguished from the well-recognized but poorly understood entity called sudden unexpected death in epilepsy. 26 , 27 In the latter, this primary neurologic event may cause a cardiac death, mediated[pediatrics.aappublications.org]
  • Differentiation of convulsive syncope and epilepsy with head-up tilt testing. Ann Intern Med . 115 : 1991 ; 871–6. Crossref Medline Google Scholar 152 Brignole M, Menozzi C, Gianfranchi L, Oddone D, Lolli G, Bertulla A.[circ.ahajournals.org]
Sudden Infant Death Syndrome
  • This statement is not intended to address sudden infant death syndrome or sudden unexplained death syndrome, nor will specific treatment of individual cardiac conditions be discussed.[pediatrics.aappublications.org]
Heart Disease
  • Read more about coronary heart disease risk factors .[web.archive.org]
  • You should still follow a heart-healthy lifestyle, even if you take medicines to treat your coronary heart disease.[web.archive.org]
  • However, there is no evidence of structural heart disease in approximately 5% of victims of sudden death, indicating that cardiac arrest in the absence of organic heart disease is more common than previously recognized.[ncbi.nlm.nih.gov]
  • Examples include coronary heart disease (CHD), also called coronary artery disease; severe physical stress; certain inherited disorders; and structural changes in the heart.[web.archive.org]
  • People who have heart disease are at higher risk for SCA. However, SCA can happen in people who appear healthy and have no known heart disease or other risk factors for SCA. Outlook Most people who have SCA die from it—often within minutes.[web.archive.org]
Heart Failure
  • Some studies show that blacks—particularly those with underlying conditions such as diabetes, high blood pressure, heart failure, and chronic kidney disease or certain cardiac findings on tests such as an electrocardiogram—have a higher risk for SCA.[web.archive.org]
  • MORE RELATED WORDS FOR CARDIAC ARREST coronary infarction noun heart attack cardiac arrest congestive heart failure heart failure myocardial infarction tachycardia heart attack noun heart failure acute myocardial infarction angina pectoris cardiac arrest[thesaurus.com]
  • As a consequence, the traumatic AV regurgitation can rapidly or progressively lead to congestive heart failure unless surgically corrected.[ncbi.nlm.nih.gov]
  • TIC has a wide range of clinical manifestations, from asymptomatic tachycardia to cardiomyopathy leading to end stage heart failure.[ncbi.nlm.nih.gov]
Hypotension
  • When the inferior vena cava was compressed, the PetCO2 level decreased abruptly from 30 to 10 mmHg, followed by a decrease in SpO2 and the development of hypotension.[ncbi.nlm.nih.gov]
  • It does not suppress the respiratory system significantly, but has adverse effects on the cardiovascular system, for example, bradycardia and hypotension.[ncbi.nlm.nih.gov]
  • The most common antecedents were hypotension and a fall in Glasgow Coma Scale.[ncbi.nlm.nih.gov]
  • A 62-year-old woman with renal cell carcinoma (RCC) experienced deteriorating hypotension and bradycardia during radical nephrectomy.[ncbi.nlm.nih.gov]
  • […] for cardiac arrhythmias -- Pacemakers and implantable cardioverter-defibrillators -- Specific arrhythmias : diagnosis and treatment -- Atrial fibrillation : clinical features, mechanisms, and management -- Cardiac arrest and sudden cardiac death -- Hypotension[worldcat.org]
Cyanosis
  • The diagnosis of truncus arteriosus is suspected in newborns with mild cyanosis, a cardiac murmur, and pulmonary overcirculation.[doi.org]
  • […] epinephrine in the field. 14 , 15 On the other hand, as EMS personnel in Japan are legally prohibited from terminating resuscitation in the field (except in specific situations such as decapitation, incineration, decomposition, rigor mortis, or dependent cyanosis[jaha.ahajournals.org]
  • […] appears obstructed or if PPV is required (Class IIb, LOE C).not reviewed in 20152010Assessment of Oxygen Need and Administration of OxygenIt is recommended that oximetry be used when resuscitation can be anticipated, when PPV is administered, when central cyanosis[doi.org]
Stroke
  • We compared stroke volume measured by minimally-invasive monitoring devices with or without thermodilution calibration, and transthoracic echocardiography (TTE), and hypothesised that thermodilution calibration would give stroke volume index (SVI) more[ncbi.nlm.nih.gov]
  • Your doctor also may discuss beginning statin treatment if you have an elevated risk for developing heart disease or having a stroke.[web.archive.org]
  • What’s a Stroke? A stroke is a “brain attack” that can happen to anyone at any time and occurs when blood flow to the brain is blocked by a clogged or burst blood vessel.[cardiopartners.com]
  • ., 2014), ischemic stroke (Bleck, 2005) and subarachnoid hemorrhage (Bleck, 2005).[ncbi.nlm.nih.gov]
  • (See also the American Heart Association's 2017 update and 2013 update of heart disease and stroke statistics and the statistical update for out-of-hospital and in-hospital cardiac arrest.)[merckmanuals.com]
Seizure
  • CASE PRESENTATION: A 65-year-old Caucasian man presented with multiple seizures, dysarthria and behavioral disturbance of unclear etiology, with associated asystolic cardiac arrest.[ncbi.nlm.nih.gov]
  • After admission to the intensive care unit the child was intubated for airway and seizure control. Further diagnostic work-up by angiography revealed agenesis of the left coronary artery.[ncbi.nlm.nih.gov]
  • The intermittent features were factor loaded with the features of seizures, periodic patterns, and interictal discharges. Factor scores were calculated for each EEG segment.[ncbi.nlm.nih.gov]
  • seizure-like activity, especially with or just after activity Dizziness or lightheadedness Racing heart rate, palpitations Excessive fatigue or unexplained shortness of breath with exercise Recent viral infection with chest pain or change in exercise[chop.edu]
  • Opioid overdose is a common cause of respiratory compromise, but there are other causes, including seizures, anaphylaxis, obstructive lung disease or overdose on other toxins.[ems1.com]
Intracranial Hemorrhage
  • Non-cardiac causes [ edit ] SCA due to non-cardiac causes accounts for the remaining 15 to 25%. [28] [30] The most common non-cardiac causes are trauma, bleeding (such as gastrointestinal bleeding, aortic rupture, or intracranial hemorrhage ), overdose[en.wikipedia.org]
  • Further study is warranted because cord milking may improve initial mean blood pressure, hematologic indices, and reduce intracranial hemorrhage, but thus far there is no evidence for improvement in long-term outcomes (Class IIb, LOE C-LD).new for 20152015Importance[doi.org]
Altered Mental Status
  • If the bradycardia is suspected to be the cause of acute altered mental status, ischemic chest discomfort, acute heart failure, hypotension, or other signs of shock, the patient should receive immediate treatment.[doi.org]

Workup

The following diagnostic modalities and tests are done to patients suspected of having cardiac arrest:

  • Electrocardiogram (ECG): This test uses electrodes that are attached on the chest and limbs to detect the electrical activity of the heart [8]. Characteristic ECG tracing can reveal that cardiac arrest has recently occurred.
  • Cardiac enzymes: This type of blood test detects the enzymes that is leaked by the damaged heart. 
  • Electrolytes: Important electrolytes that helps propagate cardiac impulses like potassium, sodium, calcium, and magnesium can be quantitatively measured in the serum.
  • Drug test: The use of a drug assay from the serum can determine the possible agents that could have caused the arrhythmia and eventually cardiac arrest.
  • Thyroid hormones: The high levels of thyroid hormones may induce cardiac arrhythmias. 
  • Chest X-ray: This imaging technique will show the actual shape of the heart and determine the presence of heart failure.
  • Echocardiogram: This imaging modality will elucidate the part of the heart involved in ischemia and demonstrate any valvular abnormalities.
  • Coronary angiogram: Contrast dyes could be delivered through a cardiac catheter to show any functional blockage to the vessels of the heart. 
Pericardial Effusion
  • Emergency echocardiography to detect pericardial effusion in patients in PEA and near-PEA states . Resuscitation . 2003 ; 59 :315–318. Crossref Medline Google Scholar 228.[doi.org]
Left Anterior Fascicular Block
  • Preoperative electrocardiogram revealed sinus bradycardia (54 beats/min) and a left anterior fascicular block. Spinal anesthesia was performed with 11 mg of 0.5% heavy bupivacaine, and the upper level of sensory loss was at T6.[ncbi.nlm.nih.gov]
  • (Level of Evidence: B) 126 Permanent ventricular pacing is not indicated for transient AV block in the presence of isolated left anterior fascicular block.[circ.ahajournals.org]

Treatment

The following treatment modalities are used in patients who present with cardiac arrest:

  • CPR: Witnesses of an attack must ensue CPR right away as soon as the event happens to increase the survival chance [9]. CPR is focused on the restoration of airways, breathing and circulation before the patient is brought to the emergency room.
  • Defibrillation: This makes use of an electric shock that is directly delivered to the chest to reverse the fibrillation. 
  • Anti-arrhythmic drugs: In the emergency room, patients are given anti-arrhythmics to control the arrhythmia that caused the arrest. The more common anti-arrhythmic drugs used during cardiac arrest include angiotensin converting enzyme (ACE) inhibitors, calcium channel blockers, and amiodarone. 
  • Implantable cardioverter-defibrillator (ICD): As soon as the patient is stabilized, this battery operated implantable device may be installed to perpetually monitor the heart rhythm and automatically give out charged impulses to stabilize the heart rhythm when the need arises [10].
  • Coronary angioplasty: This is the surgical repair of the clogged vessels to restore the free flow of blood towards the heart muscles. 
  • Coronary bypass surgery: This makes use of vein to surgically bypass the clogged coronary artery and restore normal blood flow and circulation.
  • Corrective surgery: This procedure is done to repair congenital defects that predisposes to arrhythmias
  • Heart transplant: Patients with heart failure and have concurrently experienced cardiac arrest will greatly benefit from a heart transplantation surgery. 

Prognosis

The prognosis of cardiac arrest greatly depends on several signs during the CPR phase. Patients will have better outlook when they have an unsupported systolic pressure of 90 mmHg after the arrest. For those who became unconscious during the cardiac arrest, a spontaneous vascular circulation within less than 25 minutes offers a good chance of survival after the event. Patients who stay unconscious may have a good outlook if they show signs of neurological responsiveness upon stimulation [7].

Etiology

The most common condition that leads to cardiac arrest are cardiac arrhythmias [1]. There are a number of cardiac conditions that may lead to life-threatening cardiac arrhythmias:

  • Coronary artery disease: This refers to heart diseases characterized by the clogging of vessels due to cholesterol deposits. The most common cause of sudden cardiac arrest is coronary artery disease
  • Myocardial infarction: This cardiac condition is considered a severe and acute coronary disease that may trigger ventricular fibrillation and cardiac arrest. 
  • Cardiomyopathy: The progressive enlargement and thickening of the heart muscles may lead to abnormal cardiac function and abnormal electrical impulses generation.
  • Congenital heart diseases: The innate abnormalities seen in congenital heart diseases can trigger a cardiac arrest as well as the scars left in the myocardium after its corrective surgery among adults. 
  • Valvular heart diseases: The stenosis or the regurgitation seen in heart valves can advertently lead to chamber enlargements that increases the risk for an arrhythmia.
  • Electrical disorders of the heart: This refers to primary heart conditions that may lead to abnormal heart rhythms like long QT syndrome and Brugada syndrome [2].

Epidemiology

In the United States, cardiac arrests account for at least 350,000 deaths per year. The annual prevalence rate translates to 1 to 2 cases per 1000 adult population. More than half of the cases of cardiac arrest have an underlying diagnosed or undiagnosed coronary artery disease. Patient who survives a cardiac arrest event will have a higher chance of recurrence within the first 6 to 24 months from the initial attack. Internationally, mortalities associated with cardiac arrests number up to 7 million deaths per year [3].

Among the more than 300,000 cardiac arrest deaths in the United States, at least 40% of these occur unwitnessed. Mortality in cardiac arrest greatly depends on the competence of the by-stander to conduct an immediate cardiopulmonary resuscitation (CPR) to the victim, and the duration between the time of arrest and the conduction of the patient to the nearest hospital [4]. Deaths with cardiac arrest are seen to be higher among the black races compared to the white ones [5]. Men are more prone to cardiac arrest than women with prevalence ratio of 3:1. In the Framingham cardiac studies, the highest age incidence where cardiac arrest was observed were between the ages 45 to 54 years old [6].

Sex distribution
Age distribution

Pathophysiology

The abnormal electrophysiologic mechanisms involved in the development of arrhythmias that lead to cardiac arrest are diverse and multifactorial. Alteration in normal physiology that may affect the normal electroconductivity of the heart impulses emanates from the subcellular, cellular, tissue, and organ level. In the subcellular level, abnormalities in the sodium, potassium, and calcium channels increase the likelihood of ventricular tachyarrhythmias and ventricular fibrillation. A sick sinus at the cardiac tissue level that causes asystole and bradyarrhythmias accounts for 20% to 30% of cardiac arrest deaths. Organic defects with hypertrophic cardiomyopathy and dilated cardiomyopathy are associated with high risk for sudden cardiac arrest.

Prevention

The best way to prevent the occurrence of a cardiac arrest is to actively reduce its established risk factors. Patients with diagnosed cardiac diseases must abide religiously with their maintenance medications and visit their cardiologist regularly. A smoke free and a stress free lifestyle will prevent a number of cardiac events and would significantly lower the strain to the heart. A nutritious diet that is good for the heart should also be in place. An active lifestyle with regular cardio exercises will lower the likelihood of a sudden cardiac arrest.

Summary

Cardiac arrest is described to be the sudden and unexpected loss of cardiac function, consciousness, and breathing. Cardiac arrest usually ensues with an inciting electrical disturbance to the heart resulting in pump failure and the discontinuation of the blood flow in circulation. Cardiac arrest is considered a medical emergency, any delay in resuscitative efforts can result to sudden cardiac death and eventually the patient’s demise.

Patient Information

Definition

Cardiac arrest is a medical term that refers to the mechanical cessation of the heart resulting to the absence of circulating blood in the system resulting to a serious physiologic disturbance.

Cause

The great majority of cardiac arrest is caused by cardiac arrhythmias. There are a number of cardiac disorders that predisposes to arrhythmias like coronary artery disease, myocardial infarction, cardiomyopathy, and congenital heart diseases.

Symptoms

Patients in cardiac arrest will acutely be unconscious with eminent signs of shock. Dizziness, fainting, chest pain, and fatigue may sometimes herald the disease process.

Diagnosis

ECG is imperative in the face of a cardiac arrest. Ancillary tests like cardiac enzymes, electrolytes, echocardiography, chest X-ray, and coronary angiogram are also done when the patient is stabilized.

Treatment and follow-up

Patients who presents with cardiac arrest must be subjected to immediate cardiopulmonary resuscitation (CPR). Patients may also be given anti-arrhythmics and defibrillation while in the emergency room. Cardiac surgery may be done to repair clogged vessels or correct congenital cardiac defects that can cause arrhythmias.

References

Article

  1. Ezekowitz JA, Rowe BH, Dryden DM, et al. Systematic review: implantable cardioverter defibrillators for adults with left ventricular systolic dysfunction. Ann Intern Med. Aug 2007; 21; 147(4):251-62.
  2. Brugada J, Brugada R, Brugada P. Right bundle-branch block and ST-segment elevation in leads V1 through V3: a marker for sudden death in patients without demonstrable structural heart disease.Circulation. Feb 10 1998; 97(5):457-60.
  3. Mehra R. Global public health problem of sudden cardiac death. Journal of Electrocardiology. Nov-Dec 2007; 40(6 Suppl):S118-22.
  4. Neumar RW, Barnhart JM, Berg RA, et al. Implementation Strategies for Improving Survival After Out-of-Hospital Cardiac Arrest in the United States: Consensus Recommendations From the 2009 American Heart Association Cardiac Arrest Survival Summit. Circulation. Jun 21 2011; 123(24):2898-2910.
  5. Gillum RF. Sudden coronary death in the United States: 1980-1985. Circulation. Apr 1989; 79(4):756-65.
  6. Kannel WB, Cupples LA, D'Agostino RB. Sudden death risk in overt coronary heart disease: the Framingham Study. Am Heart J. Mar 1987; 113(3):799-804.
  7. Thompson RJ, McCullough PA, Kahn JK. Prediction of death and neurologic outcome in the emergency department in out-of-hospital cardiac arrest survivors. Am J Cardiol. Jan 1 1998; 81(1):17-21.
  8. Merchant FM, Ikeda T, Pedretti RF, Salerno-Uriarte JA, Chow T, Chan PS, et al. Clinical utility of microvolt T-wave alternans testing in identifying patients at high or low risk of sudden cardiac death. Heart Rhythm. Aug 2012; 9(8):1256-1264.e2.
  9. 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Circ. Nov 2 2010. 
  10. Moss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med. Dec 1996; 26; 335(26):1933-40.

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Last updated: 2018-06-22 10:27