HEALTH: Cardiac arrest is not heart attack

If a doctor tells you about CV, he isn’t asking for your curriculum vitae but rather he is referring to cardiovascular or relating to the heart and blood vessels.

“For the longest time, cardiovascular causes remain the leading cause of death in our country and many parts of the world,” says Dr. Rafael D. Castillo, one of the country’s noted cardiologists and former president of the Philippine Heart Association (PHA).

“One out of three deaths are due to a CV cause which include coronary artery disease, heart failure, fatal arrhythmias, as well as strokes and other vascular causes,” points out Dr. Castillo, who writes a regular health column for Philippine Daily Inquirer.

Let’s take a closer look at heart diseases alone. The statistics are quite alarming: one out of five deaths are due to heart causes, based on figures released by the Department of Health (DOH). Health experts estimate that around eight to 11 Filipinos are suffering from cardiac arrest every hour.

But the big question among lesser mortals: is cardiac arrest the same as heart attack?

“The term ‘heart attack’ is often mistakenly used to describe cardiac arrest,” the American Heart Association (AHA) explains. “While a heart attack may cause cardiac arrest and sudden death, the terms don’t mean the same thing. A heart attack (or myocardial infarction) refers to death of heart muscle tissue due to the loss of blood supply, not necessarily resulting in the death of the heart attack victim.”

Cardiac arrest, on the other hand, is caused when the heart’s electrical system doesn’t work properly. If not treated within minutes, it usually leads to sudden death. “Death results when the heart suddenly stops working properly,” AHA says. This may be caused by abnormal, or irregular, heart rhythms (called in medical parlance as arrhythmias).

Cardiac arrest, in other words, is not a heart attack. “Unlike cardiac arrest, your heart doesn’t usually stop during a heart attack,” explains webMD.com. “Rather, blood flow is blocked in a heart attack, so your heart doesn’t get enough oxygen. That can kill some of the heart muscle.”

But cardiac arrest and heart attack are linked: The scar tissue that grows as the person recovers from a heart attack can mess with the heart’s electrical signals and could put the person at risk. And a heart attack itself can sometimes trigger cardiac arrest.

Cardiac arrest is not a heart failure, either. “Cardiac arrest strikes suddenly,” webMD.com says. “It’s an instant crisis. Heart failure is different. It’s a condition where the heart gets weaker over time until it can’t send enough blood and oxygen around the body. When the cells don’t get enough of these nutrients, the body doesn’t work as well. The person may find it hard to catch his breath when he does simple things like carrying groceries, climbs stairs, or even walks.”

Aside from the life-threatening arrhythmias, other causes of cardiac arrest, according to AHA, are as follows:

Scarring from a prior heart attack or other causes: A heart that’s scarred or enlarged from any cause is prone to develop life-threatening ventricular arrhythmias. The first six months after a heart attack is a particularly high-risk period for sudden cardiac arrest in patients with atherosclerotic heart disease.

A thickened heart muscle (cardiomyopathy) from any cause (typically high blood pressure or valvular heart disease) – especially if you also have heart failure – can make you more prone to sudden cardiac arrest.

Heart medications: Under certain conditions, various heart medications can set the stage for arrhythmias that cause sudden cardiac arrest. Paradoxically, antiarrhythmic drugs used to treat arrhythmias can sometimes produce lethal ventricular arrhythmias even at normally prescribed doses. Medical science called this as a “proarrhythmic” effect.

Regardless of whether there’s organic heart disease, significant changes in blood levels of potassium and magnesium – from using diuretics, for example – can also cause life-threatening arrhythmias and cardiac arrest.

Electrical abnormalities: Certain electrical abnormalities such as Wolff-Parkinson-White syndrome and Long QT syndrome may cause sudden cardiac arrest in children and young people.

Blood vessel abnormalities: Less often, inborn blood vessel abnormalities, particularly in the coronary arteries and aorta, may be present in young sudden death victims. Adrenaline released during intense physical or athletic activity often acts as a trigger for sudden cardiac arrest when these abnormalities are present.

Recreational drug use: In people without organic heart disease, recreational drug use is a cause of sudden cardiac arrest. Recreational drugs are chemical substances taken for enjoyment, or leisure purposes, rather than for medical reasons.

According to the US National Heart, Blood, and Lung Institute (NHBLI), the risk of cardiac arrest increases with age. A man is more likely to suffer from cardiac arrest compared to women.

Coronary heart disease is still the major risk factor for cardiac arrest. “Most people who have cardiac arrest have some degree of coronary heart disease; however, many people may not know that they have coronary heart disease until cardiac arrest occurs. Usually their coronary heart disease is ‘silent’ – that is, it has no signs or symptoms. Because of this, doctors and nurses have not detected it,” the NHBLI points out.

Other risk factors include: have had arrhythmias or cardiac arrest (or someone in the family), smoke or abuse drugs or alcohol, have had one or more heart attacks, have diabetes, hypertension or heart failure, and being obese.

“Sudden strong feelings, especially out-of-control anger, can prompt arrhythmias that trigger cardiac arrest,” webMD.com reminds. “Mental health conditions such as anxiety and depression may make you more likely to have it.”

The Mayo Clinic says cardiac arrest symptoms are immediate and drastic and include: sudden collapse, no pulse, no breathing, and loss of consciousness. “Sometimes other signs and symptoms precede sudden cardiac arrest,” it says. “These may include fatigue, fainting, blackouts, dizziness, chest pain, shortness of breath, weakness, palpitations or vomiting.”

Cardiac arrest is often likened to a thief as it occurs without warning. That’s why it’s a medical emergency; you need to see a doctor right away.

“If you have frequent episodes of chest pain or discomfort, heart palpitations, irregular or rapid heartbeats, unexplained wheezing or shortness of breath, fainting or near fainting, or you’re feeling lightheaded or dizzy, see your doctor promptly,” the Mayo Clinic advises. “If these symptoms are ongoing, you should seek emergency medical help.”

Cardiac arrest happens anytime, anywhere. Dr. Raul L. Lapitan, immediate past PHA president, claims about 70% of cardiac arrests happen out of the hospital and they occur mostly in public places. “Of those successfully brought to the hospital, only 4-6 percent come out alive with minimal mental and physical defects,” he lamented.

AHA says death occurs within minutes if the victim does not receive treatment. But cardiac arrest can be reversible in some victims if it’s treated within a few minutes. And the best chances of a person stricken with heart seizure starts with how long an emergency responds, according to Dr. Lapitan. That’s why he urges bystanders to conduct a hands-only cardiopulmonary resuscitation (CPR) to the victim.

CPR must start within the four to six minutes when the arrest started while advanced life support measures must begin within 8 minutes to avoid brain death.

“Every minute that a CPR is delayed reduces the chances of survival and recovery by 10 percent,” reminds Dr. Castillo. “If it’s delayed by five minutes, a 50% chance of recovery shall have gone down the drain. If it’s delayed by more than ten minutes, the prospect of recovery is nil.”

In a feature released by Philippine News Agency, Dr. Francis Lavapie, chairman of PHA Council on Cardiopulmonary Resuscitation, shares the following steps:

First, place the heel of one hand over the center of the person’s chest. Then, put your other hand on top of your hand. Keeping your elbows straight, position your shoulders directly above your hands before you do the push or compression.

Second, perform 100 to 120 compressions per minute. Make sure that each compression is two inches at the least.

“This must be done quickly because we’re trying to get back the heart beat rhythm,” Dr. Lavapie said. “To keep the rhythm, you can think of the ‘staying alive, staying alive, ha ha ha staying alive’ as you perform compressions on the person have cardiac arrest.”

Dr. Lavapie said that you continue doing the CPR until the patient or victim is brought back to life or until the rescue team arrives.

As there’s no sure way to know your risk of cardiac arrest, reducing the risk is your best strategy. Among the steps most doctors recommend which you can do include regular checkups, and screening for heart disease.

The Mayo Clinic also suggests to live a heart-healthy lifestyle with the following approaches: avoid smoking and drink alcohol in moderation (no more than one to two drinks a day). Eat a nutritious, balanced diet. Stay physically active. Get down to a healthy weight. Manage stress.

If you know you have heart disease or conditions that make you more vulnerable to an unhealthy heart, consult your doctor. He may recommend that you take appropriate steps to improve your health, such as taking medications for high cholesterol or carefully managing diabetes.

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