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Sudden Cardiac ArrestRecognition and Response OverviewSudden Cardiac Arrest (SCA) DefinedCauses of SCACardiac Chain of SurvivalSurvival RatesRealitiesPreparedness

Sudden Cardiac ArrestSuddenUnexpectedElectrical DisturbanceUsually Fatal

Sudden Cardiac ArrestSudden Cardiac Arrest . . . it's not a heart attack! Sudden cardiac arrest (SCA) is sometimes referred to as cardiac arrest or sudden death. Though it is not the same as a heart attack, it can often happen at the same time. Often confused, the two problems have different origins, causes and outcomes. Sudden cardiac arrest is a malfunction of the heart's electrical system. It happens when the heart abruptly, and without warning, starts beating very rapidly and erratically. It is a leading cause of death in the United States, responsible for half of all heart disease deaths.

3SCA vs. Heart Attack

Electrical Problem Pump Problem A heart attack occurs when a coronary artery becomes blocked interrupting the supply of blood (oxygen) to the heart muscleUsually related to CAD

Sudden cardiac arrest occurs when the hearts electrical rhythm suddenly becomes disorganized causing the heart to suddenly stop pumping bloodwhich leads to rapid loss of consciousness and death if not quickly corrected. May occur at ANY age but more common in individuals over 40A heart attack can lead to sudden cardiac arrest 4Ventricular Fibrillation

Defibrillation

Causes of Death

What Causes Sudden Cardiac Arrest?Other problems with the heart's electrical system also can cause SCA. For example, SCA can occur if the rate of the heart's electrical signals becomes very slow and stops. SCA also can occur if the heart muscle doesn't respond to the heart's electrical signals.Certain diseases and conditions can cause the electrical problems that lead to SCA. Examples includecoronary heart disease(CHD), also called coronary artery disease; severe physical stress; certain inherited disorders; and structural changes in the heart.Several research studies are under way to try to find the exact causes of SCA and how to prevent them.Coronary Heart DiseaseCHD is a disease in which a waxy substance called plaque (plak) builds up in the coronary arteries. These arteries supply oxygen-rich blood to your heart muscle.Plaque narrows the arteries and reduces blood flow to your heart muscle. Eventually, an area of plaque can rupture (break open). This may cause a blood clot to form on the plaque's surface.A blood clot can partly or fully block the flow of oxygen-rich blood to the portion of heart muscle fed by the artery. This causes aheart attack.During a heart attack, some heart muscle cells die and are replaced with scar tissue. The scar tissue damages the heart's electrical system. As a result, electrical signals may spread abnormally throughout the heart. These changes to the heart increase the risk of dangerous arrhythmias and SCA.CHD seems to cause most cases of SCA in adults. Many of these adults, however, have no signs or symptoms of CHD before having SCA.Physical StressCertain types of physical stress can cause your heart's electrical system to fail. Examples include:Intense physical activity. The hormone adrenaline is released during intense physical activity. This hormone can trigger SCA in people who have heart problems.Very low blood levels of potassium or magnesium. These minerals play an important role in your heart's electrical signaling.Major blood loss.Severe lack of oxygen.Inherited DisordersA tendency to have arrhythmias runs in some families. This tendency is inherited, which means it's passed from parents to children through the genes. Members of these families may be at higher risk for SCA.An example of an inherited disorder that makes you more likely to have arrhythmias islong QT syndrome(LQTS). LQTS is a disorder of the heart's electrical activity. Problems with tiny pores on the surface of heart muscle cells cause the disorder. LQTS can cause sudden, uncontrollable, dangerous heart rhythms.People who inherit structural heart problems also may be at higher risk for SCA. These types of problems often are the cause of SCA in children.Structural Changes in the HeartChanges in the heart's normal size or structure may affect its electrical system. Examples of such changes include an enlarged heart due tohigh blood pressureor advanced heart disease. Heart infections also may cause structural changes in the heart.7Causes of SCAUnexplained ~40%ToxinsElectrolyte ImbalanceHeart Disease ~13%Infection of Heart ~ 7%Enlarged Heart ~6%Miscellaneous ~14%valve diseasecongenital

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Figure 1Causes of sudden cardiac death in 314 autopsied cases (adapted from Winkelet al., Fig. 3).1The miscellaneous category includes valvular heart disease (n= 8), dilated cardiomyopathy (n= 4), hypertrophic cardiomyopathy (n= 2), and other congenital heart diseases (n= 31).Arrhythmogenic right ventricular cardiomyopathy(ARVC)Arrhythmogenic right ventricular cardiomyopathy (ARVC)is an inherited heart muscle disorder where damaged heart muscle is gradually replaced by scar tissue and fat. A recognised cause of sudden death in the young, ARVC may cause abnormal electrical heart rhythms and weakening of the pumping action of the heart. ARVC is caused by a defect in the glue (desmosomes) that holds the muscle cells of the heart together. As the heart muscle is continuously stretching and contracting, the glue breaks down, the muscle cells separate and some die. The body then tries to repair this by replacing the normal heart muscle cells with scar and fat tissue. This process creates small islands of heart tissue that do not conduct electrical signals in the normal way and are not able to contract in the normal way. This allows abnormal short-circuits to develop, which cause the heart rhythm abnormalities that define the condition.

Study of 314 individuals who died from SCA 1-35 y/o

Take Home Message: Many Causes, not just cardiac, can happen at any age

In the meticulously performed study by Winkelet al.,1all deaths in persons age 135 years in Denmark, from 2000 to 2006, were carefully evaluated. In retrospective studies of the causes of sudden cardiac death, a major concern is the lack of a medical history of the patients and absence of uniformity in the quality of the autopsy findings due to lack of cardiac expertise of the pathologist. However, in this study, the investigators had access to the National Patient Registry containing information on all in- and outpatient activity in Danish Hospitals and emergency rooms. Death certificates were evaluated independently by two physicians to identify the causes of sudden unexpected deaths. The cause of death was reportedly revised based on autopsy findings. There was an exceptionally high autopsy rate of 75%. Autopsies were performed at three centralized departments of forensic pathology. The investigators found that, in a population of 2.38 million people aged 135 years, the incidence of sudden cardiac death was 2.8 per 100 000 person years (totaln= 625). There were 469 autopsy cases of sudden unexpected death of which 314 (or 67%) were attributed to sudden cardiac death.

Inherited DisordersA tendency to have arrhythmias runs in some families. This tendency is inherited, which means it's passed from parents to children through the genes. Members of these families may be at higher risk for SCA.An example of an inherited disorder that makes you more likely to have arrhythmias islong QT syndrome(LQTS). LQTS is a disorder of the heart's electrical activity. Problems with tiny pores on the surface of heart muscle cells cause the disorder. LQTS can cause sudden, uncontrollable, dangerous heart rhythms.People who inherit structural heart problems also may be at higher risk for SCA. These types of problems often are the cause of SCA in children.Structural Changes in the HeartChanges in the heart's normal size or structure may affect its electrical system. Examples of such changes include an enlarged heart due tohigh blood pressureor advanced heart disease. Heart infections also may cause structural changes in the heart.

8Cardiac Chain of Survival

Early Recognition

Sudden Loss of Conscious

Intense Sudden Chest Discomfort and/or Shortness of Breath followed by Loss of Consciousness

Early Warning Signs of SCA Risk: palpitations, light-headedness, or syncope

10Early CPR

11Early Defibrillation

Early Defibrillation

Early Advanced Care

Without Early Recognition, CPR and Defibrillation-No Amount of Advanced Care Will Make A Difference15Survival

Realities

Even under the best of circumstances.with the best of efforts. in an urban setting, there is still only a small chance of survival.

17Preparedness

Heartsaver CPR classes for Pogo workforce to be held throughout 201518PreventionEat HealthyGet Active See Your Doctor for an Annual PhysicalDrop Those PoundsReduce StressQuit SmokingTake Prescribed Medications

Eat Healthysmall changesportion controlemotional eatingGet Active start slowwalking works well

See Your Doctor for an Annual Physicalespecially if its been yearsearly detection1000s of people die every year from preventable conditions because they didnt want to go to the doctor or they felt healthy

Drop Those Poundscombination of healthy eating and increasing activitysimple equation; less calories in/more calories burned

Reduce Stressquality sleep exerciseEAP

Quit Smokingmost important modifiable risk factor

Take Prescribed Medicationscommon sensedont stop taking because you feel better adverse side effects can be managed by reducing doses or changing medication see you doctor

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