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| Cardiac arrest |
The Specialist:
An associate professor of medicine and cardiology at Mount Sinai, Dr.
Marie-Noelle Langan specializes in treating electrical malfunctions of
the heart. October is Sudden Cardiac Arrest Awareness Month.
Who’s at risk:
The single most common cause of death in people over age 40 is sudden cardiac arrest (SCA) — and it’s often preventable.
“Sudden cardiac arrest is when the heart stops pumping as the result of
an electrical disturbance,” Langan says. “Because there’s no blood flow
to the brain and other vital organs, people also stop breathing and
lose consciousness. So it’s necessary to restart the heart within four
to six minutes to save the patient’s life.”
About 362,000 Americans die each year as the result of SCA.
Many situations that people talk about as heart attacks are actually
sudden cardiac arrest. “Everybody confuses a heart attack with SCA,”
says Dr. Marie-Noelle Langan of Mount Sinai. “A heart attack is when
blood isn’t getting to the heart and the muscle of the heart is dying.
In contrast, SCA is when the heartbeat stops due to an electrical
malfunction that is like a short circuit in the cells of the heart.”
What does it look like when someone experiences SCA?
“This event is the typical thing you see on TV. People suddenly fall to
the ground and stop moving and breathing, or perhaps they start
seizing,” Langan says. “It can look like a prolonged faint and that’s
when you have to start CPR, call 911 and get a defibrillator on that
person as soon as possible.”
In most cases when a student athlete suddenly drops dead, it’s actually
an SCA — and that’s exactly the kind of case where doing CPR and using a
defibrillator can save someone’s life.
What begins as a heart attack can trigger SCA. “Every cell in the heart
makes electricity, but if the electricity starts going too fast, the
heart can’t handle it and stops beating,” says Langan. “You’re more
prone to this type of electrical malfunction if you’ve had previous
heart attacks or heart failure or if you have a congenital heart
problem, including abnormal channels in the heart that cause it to
mishandle the electrical charges.”
Sudden cardiac arrest affects hundreds of thousands of people a year in
this country alone, but some groups are more affected than others.
“By far the most common risk factor for SCA is coronary disease and
anybody who has previously had heart failure is at higher risk,” Langan
says. “Men have more coronary disease when they are younger, but women
are more predisposed to some of the electrical abnormalities that can
cause SCA. And the older you get, the more likely you are to have an SCA
event.”
Signs and symptoms:
One of the reasons that SCA is so deadly is that it can strike without
warning. “SCA is by definition without many symptoms — because it’s
sudden,” Langan says. “However, some people do have some warning signs
beforehand, like fainting or palpitations.”
Traditional treatment:
When someone suffers sudden cardiac arrest, the key is to restart the heart as soon as possible.
“The idea behind CPR is to replace the heart’s ability to squeeze with
your action on the chest. By pressing on the chest, you’re trying to
make the circulation move again,” Langan says. The pressure of your
hands creates a compression that pushes the blood, the body recoils, and
when you let go, the body suctions the blood back.”
The goal of performing CPR is to keep the person alive until a
defibrillator can be used to restart the heart. “Ideally, one person
starts CPR and someone else runs for the defibrillator — and always call
for 911, immediately,” says Langan. “Big places that handle crowds,
like stadiums and airports, will have defibrillators, and paramedics
will bring one with them.” About one-third of patients receive CPR when
they have sudden cardiac arrest, and only 2% have a defibrillator used
on them.
Automatic defibrillators are designed so that everyone can use them easily.
“It’s very user-friendly. All you have to do is follow the instructions
on top of the machine, which give you a diagram,” Langan says.
“Basically, you put the stickies where the picture tells you to, press
the on-button, and then walk back a few steps. You don’t want to be
touching the patient while the shock is delivered.”
It’s not actually possible to hurt someone using a defibrillator. “The
machine reads the person’s body and diagnoses it. So if they aren’t
actually in cardiac arrest, it won’t deliver an electrical charge,” says
Langan. “The crucial things to know are that you’re not going to hurt
yourself and you’re not going to hurt the person you’re attaching the
defibrillator to.”
What does the defibrillator actually do? “It’s kind of like rebooting
your computer: it sends a shock of electricity that clears out any short
circuit in the heart, so the heart can restart,” Langan says. “After
you give a shock, feel for the pulse, because you may need to continue
doing CPR.”
All patients are taken to the hospital after an SCA to determine what caused it.
“Sometimes the underlying cause was a heart attack, and we need to fix
an artery,” Langan says. “Sometimes, it’s a purely electrical
disturbance and the patient gets a defibrillator implanted under the
skin before they leave the hospital.”
The recovery depends on how quickly the heart is restarted and the
underlying cause of the event. “Depending on how long the brain was
without blood, it can take longer to wake back up,” Langan says. “But
some people who get care quickly can have an implantable defibrillator
put in and go home the next day.”
Research breakthroughs:
Doctors are racing to find betters ways to prevent SCA events from occurring in the first place.
“We’re working hard to discover who’s at higher risk and identify
people ahead of time so we can take preventive steps,” Langan says.
“Electrical or muscle abnormalities in the heart can be hard to pick up
on. But the improved technology of MRIs and echocardiograms is
increasingly allowing us to find these people. In the next 10 years, I
think everyone will get echocardiograms as universal screening.”
Questions for your doctor:
If you have a family history of sudden death, ask upfront, “Am I at
high risk of sudden cardiac arrest?” Similarly, if you ever faint out of
the blue, ask, “What could be causing this?”
Langan says, “Most of the time, fainting doesn’t mean anything, but it
gives you a chance to be screened for something more serious.”
If you’ve had a heart attack, ask “Do I have scarring in my heart? How big is it?”
Another good thing to ask is, “What is my ejection fraction?” The
ejection fraction meausres the amount of blood pumped out with each
heartbeat. The lower your ejection fraction, the more at risk you are.
Another good thing to ask is, “What is my ejection fraction?” The lower your ejection fraction, the more at risk you are.
“Sudden cardiac arrest can be devastating, but it’s also completely
preventable if you’re well-screened,” Langan says. “This is something
that we need to do something about and can avoid — so think
preventively.”
What you can do:
Get informed.
Instead of a random Google, do a targeted search. Start with the
American Heart Association (heart.org), the Heart Rhythm Society
(hrsonline.org/) and Mount Sinai
(mountsinai.org/patient-care/health-library/diseases-and-conditions/cardiac-arrest).
Pay attention to fainting and your family history. These are the two
red flags of SCA. If you have either a personal history of fainting or
family history of sudden death, talk to you doctor about having your
risk of SCA evaluated.
Check out your meds.
Some medicines can worsen the risk of electrical malfunctions in the
heart. “It never hurts to ask the pharmacist if this medication can
affect the rhythm of your heart,” Langan says.
Don’t be afraid to use a defibrillator. The picture instructions are
even simpler than the subway guides on how to pop out a window. You
could save a life.
Know nearby defibrillators. Ask if your school or workplace has one,
and if they don’t, advocate to get one. “They are getting cheaper, and
they save lives,” Langan says.
By the numbers:
— Sudden cardiac arrest (SCA) is the number one cause of death in Americans over 40
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