Sudden cardiac arrest or a heart attack?

December 1, 2007
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You may read news stories about people who experience “a massive heart attack” and die suddenly. In many cases, the death is actually due to sudden cardiac arrest (SCA), which is different than a heart attack, although a heart attack can certainly lead to sudden cardiac arrest. It is important to know the difference between the two and how to respond if you encounter someone in your workplace who is experiencing either of these conditions, also known as Acute Coronary Syndromes (ACS).

What do they have in common? They are both life-threatening and, in both cases, it is important to act fast.

What is sudden cardiac arrest?
Sudden cardiac arrest (SCA) often strikes suddenly and without warning. It results from an “electrical problem” in the heart. The most common cause of SCA is an abnormal heart rhythm known as ventricular fibrillation (VF), in which the cells of the heart fire chaotically rather than working together. This causes the ventricles of the heart, responsible for pumping the blood to the body, to quiver chaotically rather than contract. This quivering motion of the ventricles makes the heart stop pumping altogether, no longer supplying the heart, brain and other vital organs with oxygen-rich blood.

A person in sudden cardiac arrest is truly vulnerable because, within seconds, he or she loses consciousness and has no pulse. Quick actions of others are critical to a victim’s survival because survival rates drop about ten percent every minute without fast and appropriate treatment.

Helping a victim of SCA
During sudden cardiac arrest, it is important to quickly initiate the Chain of Survival defined by the American Heart Association (AHA):
• Early activation of the emergency response system (call 9-1-1)
• Early cardiopulmonary resuscitation (CPR)
• Early defibrillation
• Early advanced emergency medical care.

CPR and defibrillation are critical to surviving SCA. CPR helps maintain blood flow and oxygen to the brain and other vital organs, and is crucial to survival, but it will not reverse the dangerous VF rhythm.

The single, most effective way to return a fibrillating heart back to a normal rhythm is defibrillation, and the sooner the better. For cardiac arrests occurring outside the hospital, the AHA recommends defibrillation within five minutes, preferably less. Since it takes EMS teams an average of six to 12 minutes to arrive, this means the best opportunity for defibrillation occurs when trained bystanders provide CPR and a defibrillation shock from an automated external defibrillator (AED).

An AED is lightweight and easy to use, and provides rescuers with voice and visual prompts throughout the resuscitation effort. A computer inside the device automatically analyzes the heart’s rhythm. The AED is designed to provide a shock only if it detects a shockable rhythm. Nationally certified CPR/AED training is available through a number of organizations, including the American Heart Association (AHA) and the American Red Cross.

What is a heart attack?
A heart attack occurs when there is a circulation problem in the heart and one or more of the arteries feeding blood to the heart are blocked. When oxygen in the blood cannot reach the heart muscle, the heart muscle can become damaged or die. Think of a heart attack as a “plumbing problem” in the heart. Most commonly, the blockage is caused by a buildup of plaque in the blood vessels, which is also known as atherosclerosis.

Although symptoms can vary widely, someone who is having a heart attack often experiences pain, pressure or discomfort in the chest. Other symptoms can include jaw pain or pain in the arm (one or both), the back, neck or stomach. Feelings that “something is not quite right,” or faintness, nausea, a cold sweat, or shortness of breath may also indicate a heart attack is occurring. Men typically have the more “classic” symptoms of heart attack. Women are more likely to experience the less commonly known aforementioned “other” symptoms.

Helping a heart attack sufferer
Time is also essential to surviving a heart attack and to protecting the heart muscle from damage. If someone experiences symptoms of a heart attack, call 9-1-1 immediately. Notify your facility’s medical personnel as well. If an AED is onsite, have it readily available. Do not drive the person to the hospital, but wait with him or her until the EMS team arrives — they have the capability to begin treatment right at the scene. Also, patients who are brought into the emergency room by ambulance are more likely to be given prompt attention than those who drive in. And when a heart attack occurs, time means heart muscle.

The 9-1-1 operator may ask you to give the person an aspirin unless the person’s medical history contraindicates it. If the operator does not assess for this, EMS personnel will decide if it is appropriate. Research shows that taking an aspirin early in the treatment of a heart attack, along with the care provided by emergency medical professionals, can significantly improve chances of survival.

When the EMS team arrives, they may do a 12-lead electrocardiogram (ECG) on the patient and transmit it to the emergency department or cardiologist for evaluation. Today, there is a strong emphasis on pre-hospital 12-lead ECGs because they enable hospital personnel to make treatment decisions and recommend where the patient should be transported for care, thereby reducing time to treatment.

Recent guidelines published by the American College of Cardiology and the American Heart Association recommend treatment in 90 minutes or less for a major type of heart attack called ST-elevation myocardial infarction (STEMI). Chances of survival are much greater when the patient bypasses the emergency room and is taken right to the cardiac catheterization lab, where he or she may receive balloon angioplasty or stent placement to open blocked arteries. This goal is often referred to as “reducing door to balloon times.”

Arm your employees
It is clear that companies can prepare employees to take quick action for someone experiencing an acute coronary syndrome in the workplace, including sudden cardiac arrest and heart attack. You can help improve chances of survival, as well as overall outcomes, by helping to preserve heart and brain function through effective CPR and timely defibrillation and treatment.

Everyone is affected when a serious incident occurs in the workplace. Knowing that employees were prepared to respond and that they acted quickly makes all the difference in helping them recover emotionally from such an event, whatever the outcome. For more information about sudden cardiac arrest and heart attack, visit the AHA’s Web site at www.americanheart.org.

SIDEBAR: Shock treatment

According to the American Heart Association, about 95 percent of people who experience SCA do not survive because treatment is not available soon enough. Having an automated external defibrillator (AED) program onsite, with employees who are trained in CPR and AED use, can significantly reduce time to defibrillation. This is critical since survival rates drop about ten percent every minute defibrillation is delayed. Although not everyone can survive sudden cardiac arrest, a study published in the New England Journal of Medicine (Valenzuela and others, 2000), showed survival rates as high as 74 percent can be achieved if a shock is provided within three minutes of collapse.

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