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www.heartpodcast.org
a new educational medium for physicians, by physicians and for patients, by patients.
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Who can be affected by SCA?
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Unfortunately, anyone can suffer sudden cardiac arrest. SCA is unpredictable and can happen to anyone, anytime, anywhere - even teenagers. Risk factors of SCA include a previous heart attack, previous SCA event, fast rhythm in the lower part of the heart, family history of SCA and heart failure. Although pre-existing heart disease is a common cause of cardiac arrest, many victims have never had a heart problem.
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Wolff-Parkinson-White syndrome (WPW)
This results from some ”extra wiring” connecting the upper (atria) and lower (ventricles) chambers of the heart. This additional circuit occasionally allows very fast and unstable rhythms to develop and this can lead to SCA. These rhythm disturbances most often become apparent in teenage years or the early twenties, but occasionally start earlier or later. The most common rhythm disturbance is SVT, involving both the normal and additional conduction circuits in the heart, but this can occasionally degenerate to VF. The diagnosis is usually obvious from an ECG, although sometimes the characteristic appearances are not evident all the time and may require additional testing to diagnose. Many patients with WPW, however, have little or no problem throughout their lives.
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Long Q-T syndrome
This is in fact a number of similar, inherited syndromes which make the patient prone to rapid rhythm disturbances (VT) which can quickly degenerate into VF. The cause lies in the heart muscle cells which take slightly longer to recover from a heart beat (only by about a tenth of a second) but are prone to chaotic rhythm disturbances as a result. In the presence of long Q-T syndrome, SCA may be precipitated by such things as certain types of exercise, loud noises, or other sudden stimuli. Events usually occur in children or young people, but can be very variable. The diagnosis is again apparent from the ECG and this should be examined in relatives of a patient shown to have long Q-T syndrome
Brugada Syndrome.
This is a rare inherited tendency to SCA which again relates to the functioning of the heart muscle cells; it most commonly presents in the thirties and has a tendency to cluster in certain countries. Like the long Q-T syndromes, it can usually be diagnosed from an ECG but may need additional tests. Affected people suffer sudden collapse (“syncope”) due to VF or a very rapid form of VT called Torsade de Pointes. This can lead rapidly to SCA unless treated with defibrillation.
Patients with previous heart attack or heart failure or other known heart problems
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SCA is usually caused by VT and/or VF starting in scars or damaged areas in the heart muscle or very occasionally due to the effects of other drugs that the patient may need to take.
Is sudden cardiac arrest the same as a heart attack?
Sudden cardiac arrest (SCA) is not the same thing as a heart attack, although a person suffering a heart attack has an increased risk of SCA.
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Is Sudden Cardiac Arrest a heart attack?
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Sudden cardiac arrest (SCA) is not the same thing as a heart attack, although a person suffering a heart attack has an increased risk of SCA.
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HEART ATTACK
Caused by a blockage in an artery that supplies blood to the heart. The affected heart muscle then begins to die due to lack of oxygen.
Symptoms including central ‘crushing’ chest pain, often radiating to arms and jaw. Patient usually remains awake and alert.
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SUDDEN CARDIAC ARREST
Caused by an abnormal heart rhythm, usually ventricular fibrillation.
There is rarely a warning and the patient always loses consciousness
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How is Sudden Cardiac Arrest Treated?
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When someone is in sudden cardiac arrest, defibrillation is the only way to reestablish a regular heartbeat.
Cardiopulmonary resuscitation (CPR) will not restart a heart in sudden cardiac arrest. CPR is just a temporary measure used to continue a minimal supply of oxygen to the brain and other organs.
CPR is otherwise known as Basic Life Support (BLS) and guidelines are available for out of hospital adult, paediatrics and newborn BLS. The “Resuscitation Guidelines 2005” are published in A4 booklet form by the Resuscitation Council (UK). The booklet contains detailed information about Emergency Life Support and can be obtained from the Resuscitation Council (UK) www.resus.org.uk.
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What is CPR?
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Often people feel that CPR is enough, but when you tell them that CPR has a 5% success rate compared with a 50% success rate with an AED they begin to realize the importance of needing a AED.
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What is an Automatic External Defibrillator?
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An AED is a small, portable device that analyzes the heart’s rhythm and prompts the user to deliver a defi brillation shock only if it is needed. Once turned on, the AED guides the user through each step of the defibrillation process by providing voice and/or visual prompts.
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Who can use an AED? …Anyone!…Minimal Training...No Medical Background!...
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Putting AEDs in the Community, Offices, Shops, Public Places, Home… can dramatically reduce the time from collapse to defibrillation and has shown to greatly improve survival rates.
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Using an AED is a simple as...
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AEDs are designed for use by anyone with minimal training and little or no experience.
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The Chain of Survival
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A chain of survival is in the worldwide guidelines for response to sudden cardiac arrest. Quick action by the first person on-scene can truly make a difference in saving a life.
The chain of survival concept represents the sequence of four events that must occur quickly to optimize a person’s chance of surviving a cardiac arrest. The four links of the chain:
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The Gary Humphries Story
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Its not until you save a life, or meet someone who has survived Sudden Cardiac Arrest that you realise the difference that an AED can make…
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‘I actually died on the squash court floor’, says Gary of Caerphilly, South Wales.
Fortunately for Gary, he and his squash partner were playing at the Hawthorn Leisure Centre in Rhonda Cynon Taff, where a new type of resuscitation device was available. The LIFEPAK defibrillator was put on his chest and moments later his heart was beating again.
Gary said ‘I felt nothing, no pain or anything. In fact, I remember very little about it. I was clinically dead for 2 minutes. I would not have pulled through but for the defibrillator and if we hadn’t gone to that particular Leisure Centre I’d be dead’.
7 out of 10 cardiac arrests such as that suffered by Gary happen outside the hospital and only a tiny fraction of victims survive, largely because of the lack of rapidly available resuscitation equipment.
Less than 5% of people in the UK survive cardiac arrests outside hospital whereas the rate in Seattle climbed to over 40% after defibrillators had been made available to the public.
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The Sir Ranulph Fiennes Story
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Sir Ranulph Fiennes, as described by the Guinness Book of Records, is the greatest living explorer. In 1993 he and Mike Stroud became the first men to walk unaided across the Antarctic continent, overcoming life-threatening situations in the process.
When you hear his name you think fitness & stamina but in June 2003 after boarding a flight to Edinburgh at Bristol airport he suffered a massive heart attack.
Fortunately airport fire-fighters were able to revive Sir Ranulph using an automatic external defibrillator, a device that shocks the heart. He later underwent a double heart bypass operation at Bristol Royal Infirmary.
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Sir Ranulph doesn’t remember anything 3 days previous to the attack as well as 3 days after the attack, so his thoughts on his heart stopping are all second hand. He says of the arrest “I know I am amazingly lucky to have had a heart attack at an airport that had a defibrillator in easy reach and had the expert assistance of the Blue Watch of the Bristol Airport Fire Station who were able to attend immediately”.
“I also feel very lucky to be alive, because the truth is most people who suffer a cardiac arrest are not in hospital surrounded by doctors, but at home or in public places. Many do not survive because life-saving treatment simply does not come quickly enough”.
“The surgeons and fire-fighters who worked on me all say the key item in surviving a sudden cardiac arrest is the availability of a defibrillator in 2 or 3 minutes. This means that defibrillators should be available in places where there are lots of people i.e supermarkets, shopping centers, airports etc”.
“In future all expeditions I embark on will have a defibrillator as standard kit along with morphine, first aid kit etc”.
“If you had a defibrillator – (which is a small comparatively inexpensive item) set up in these places it would make all the difference, I know I’m alive because there was one at an airport”.
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