Last Updated: April 4, 2015
"The heart is a very resilient muscle," says Woody Allen in his
film Hannah and Her Sisters. And indeed it is. Charged with pumping
blood throughout the entire circulatory system, the heart is also a
muscle that reflects the treatment by its host more than any other
muscle in the human body. Treat the heart well with frequent
exercise, a good diet, and no smoking, and its potential to remain
healthy improves dramatically. Treat the heart poorly with a
cholesterol-laden, sedentary lifestyle and the chance of heart
Sudden cardiac arrest, often caused by a combination of the
above, is often confused with heart
attack. "It is important to clarify the differences between
these two conditions because people frequently lump them together,"
says Dr. Michael Chen, assistant professor of medicine at the
University of Washington in the division of cardiology.
Unlike a heart attack, which involves a blockage of the coronary
artery and can lead to damage to the heart itself, sudden cardiac
arrest is the result of a severely abnormal heart rhythm that stops
the flow of blood to the rest of the body. A heart attack can
actually cause sudden cardiac arrest when the arterial clot
triggers an irregular heart beat. But although sudden cardiac
arrest and heart attacks may occur together, it is possible to
experience sudden cardiac arrest without a blockage in the
"However," according to Chen, "determining the patterns of
sudden cardiac arrest can be a very complicated question, because
it can also come out of the blue with no symptoms whatsoever."
The most common symptoms of sudden cardiac arrest are sudden
collapse, lack of pulse, no breathing, and loss of consciousness.
Though sudden cardiac arrest can strike without warning, people
experiencing heart palpitations; rapid or irregular heart beats;
persistent chest pain; shortness of breath; blackouts, dizziness,
or fainting; fatigue; and/or vomiting should see a doctor
The first step in treating sudden cardiac arrest is usually
cardiopulmonary resuscitation (CPR), followed by a shock to the
heart (defibrillation), an attempt to establish a normal heart
rhythm. Advanced life support procedures (with EMT or in the
emergency room) should follow.
Every moment becomes critical when a victim goes into sudden
cardiac arrest. "The reason time is so important," Chen continues,
"is because when a person's heart stops there is a very small
window before the brain is lost. In fact, every minute that passes
without defibrillating the heart reduces the chance of survival by
20 percent. And even if the victim does survive, neurological
impairment often occurs."
According to Chen, several research studies at the University of
Washington are investigating the severity of cardiac arrest,
including a potential breakthrough that involves cooling the
patient to preserve the brain tissue and reduce stress while the
patient's body is under treatment. Chen also points out that
defibrillation is considered so important, most airlines carry
portable defibrillators. And because most cardiac arrests occur at
home, keeping a home unit makes sense for high-risk individuals.
However, if the high-risk individual lives alone, it may be time to
consider a change of living arrangement, such as a move to assisted living. A person experiencing
sudden cardiac arrest is simply unable to administer a
defibrillator on herself.
"Like with heart attacks, healthy living is one of the best ways
to lower the risk of sudden cardiac arrest. This includes eating a
well-rounded diet of fruits, vegetables, and fish, exercising
regularly, and reducing stress levels," Chen observes. "Of course,
not smoking is a given."
Risk factors are not unlike those of heart attack and other
- Advanced age
- Male gender
- Sedentary lifestyle
- Family history of early coronary artery disease
- People who have heart attacks when younger (Male less than 55,
female less than 65)
The doctor will consider a number of tests to analyze the
patient's likelihood of a sudden cardiac arrest. These may include
an electrocardiogram (ECG); blood tests such as a cardiac enzyme
test, an electrolyte test, a drug test, and a hormone test. Imaging
tests may also be performed, such as chest X-rays, nuclear scans,
and echocardiograms. Finally, electrophysiological testing and
mapping (to locate where in the heart an arrhythmia occurs),
ejection fraction testing (to measure heart pumping capacity), and
angiograms (to show narrowing or blockage of arteries) are also
used as diagnostics.
Defibrillation is the most important response to a sudden
cardiac arrest. In addition, doctors prescribe a variety of
medications to assist recovery, alleviate pain, or prevent
recurrence, including anti-arrhythmias drugs that slow the heart
rate. Doctors also prescribe beta blockers, ACE inhibitors, calcium
channel blockers, and amiodarone for high-risk patients.
The surgical implantation of animplantable
cardioverter-defibrillator(ICD) may be the most effective method of
preventing fatal arrhythmias in high-risk patients. This device
monitors the patient's heart rhythm and sends a shock to the heart
to reset its rhythm when it detects an abnormal pacing or rhythms.
Other surgical treatments may include:
- Coronary angioplastyand/orbypass surgery(these procedures are
described above in the heart attack section)
- Radiofrequency catheter ablation: An electrode designed to
create an electrical block is implanted, stopping the
- Corrective heart surgery: This procedure is designed to repair
congenital deformity, a faulty valve, or diseased heart
- Heart transplantation
The usual preventive measures that apply to all cardiovascular
diseases and conditions are equally important in preventing sudden
cardiac arrest, including a well-balanced diet, a smoke free
environment, and exercise. Frequent screening is advised after a
certain age (determined by your doctor), especially for those with
heart disease in the family.
The Emotional Toll
Sudden cardiac arrest forces its victims to reevaluate their
lifestyles and often their lives. This reflection often, but not
always, leads to anxiety and depression, as the survivor believes
his "time is almost up," or laments the missed opportunities thus
far in his life.
According to Chen, many survivors also suffer some degree of
neurological impairment, from short term memory loss to persistent
vegetative states (comas). The severity of the survivor's
impairment correlates with the swiftness of resuscitation,
specifically how quickly she received electrical defibrillation
But even the placement of the implanted defibrillator, a common
physical treatment after sudden cardiac arrest, can engender worry
in the survivor. The devices occasionally discharge in error,
shocking the user. Of course they are also a constant reminder to
the patient of his new physical vulnerability.
"[The patient's family] should also be closely monitored for
depression and guilt," Chen says. "They often feel they did not do
or know enough to help prevent the traumatic events of a sudden
cardiac arrest. Their loved one's impaired state serves as a
constant reminder of this inadequacy."
Heart attacks and sudden cardiac arrest starkly remind us of our
physical vulnerabilities, often a consequence of unhealthy
lifestyle choices. They are the heart's way of telling us in no
uncertain terms that we need to change our routines, if not our
entire way of life, if we want to continue living.
Over 25 percent of the deaths in 2003 were the result of heart
disease, by far the leading cause of death in the United States.
Someone dies from heart disease every forty-six seconds. The onset
of heart disease forces people to confront death, an experience
that makes most of us feel frightened and helpless. Yet we can make
daily decisions to fight heart disease when we choose to exercise,
to avoid smoking, and to eat a healthier diet high in fruits and
vegetables and low in saturated fats, and encourage those we love
to do the same. Modern medical advances, together with our
determination to change, can now give us and our loved ones a
second chance to fully live our lives for years, even decades, to