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Sudden Cardiac Arrest: Sudden and Deadly Ilene Raymond Rush More than 350,000 people die every year from sudden cardiac arrest (SCA )in North America, a major health problem that has received far less attention than the more familiar heart attack. Unlike heart attacks, which are caused when plaque ruptures to create coronary blockages, sudden cardiac arrest is an electrical problem where the ventricles of the heart fibrillate and don’t contract normally, making it impossible for the heart to pump blood or oxygen to the body. “The name of (SCA) is paradoxical,” says Igino Contrafatto, M.D., Director of the Cardiac Electrophysiology Program at Hesperia Hospital in Modena, Italy, and an Adjunct Professor at Temple University’s College of Science and Technology, “In cardiac ‘arrest’ the heart activity is too fast and disorganized, causing the heart to stop beating and pumping.” Despite significant advancements in resuscitation science, and improvement of emergency team networks in many urban areas, survival from cardiac arrest remains low. A prospective study performed in a local community (Multnomah County, Oregon; population 660,486), using multiple source surveillance, showed that the annual incidence is 53 in 100,000, accounting for 5.6% of overall mortality; and in those cases in which resuscitation was attempted (67%), survival was low (8%). “People who have had a prior heart attack tend to have a higher risk of having a sudden cardiac arrest,” says Dr. Contrafatto. “Among victims of cardiac arrest who received autopsies, 79 percent had blockages in heart arteries, with these blockages indicative of possible prior myocardial infarction.” One problem, he notes, is that only half of adult cardiac arrest cases have coronary disease that had been identified. While patients who have had earlier heart attacks that have caused significant damage to their heart are at a higher risk, predicting SCA remains difficult. One measure used by cardiologists is the Ejection Fraction (EF), the percentage of blood pumped out of the heart during each beat. Research has shown that people with low EF, less than thirty-five percent, are at risk for developing sudden cardiac arrest. An echocardiogram is a commonly used test to determine EF. SCA often occurs without any warning. However, says Contrafatto, says symptoms can include “sudden collapse, loss of consciousness, abnormal breathing, and inability to find a pulse and loss of blood pressure.” Without immediate treatment of sudden cardiac arrest, there is little chance of survival. Options for immediate treatment include cardiopulmonary resuscitation (CPR), to help keep the heart and blood pumping, or the use of an automated external defibrillator to shock the heart and restore it to a normal rhythm. People who recover from sudden cardiac arrest, or who have the potential for a first episode of SCA, may receive an implantable cardioverter defibrillator, also called an ICD. An ICD is a small, programmable internal defibrillator, which can be implanted in patients who have had a prior episode, or those with a depressed cardiac pump function who are at high risk for SCA. More than 35,000 ICD’s are implanted every year. However, notes Dr. Contrafatto, these small and sophisticated devices need close and regular monitoring, since they can sometimes ‘overreact’ to cardiac rhythms, leading to inappropriate shock therapy treatments. At present, this occurs in 10 to 20 percent of patients. “The challenge is to improve our capability to identify patients who will really develop SCA,” says Dr. Contrafatto. “By targeting ICDs to patients at the highest risk for SCA, we will lower the risks of possible overreactions and inappropriate treatments.” For more see: Sudden Cardiac Arrest Association |
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