Doctors looking at predicting cardiac arrests, to make them more survivable

Research presented by the American Heart Association is focusing on how to determine if a patient may experience cardiac arrest in the near future.

Cardiac arrest is when the heart stops. There is no coherent electrical activity to cause the heart to beat. It can be from a number of causes like chest trauma, following a heart attack, or other reasons.

Cardiac arrest is not identical to a heart attack. But it can occur during or after a heart attack.

A heart attack, or myocardial infarction (MI) usually is caused by a blockage, often from a blood clot, in a coronary artery. Coronary arteries are the vessels that supply blood to the heart. This loss of blood supply causes death of, or damage to, heart muscle cells. It can lead to permanent problems with the heart (heart failure, arrhythmias, etc.) or even death. If the blood supply can be returned quickly by clot-buster drugs or placing a stent in the blocked artery, damage may be minimized. Time to treatment should be minimized. The longer the heart tissue is without blood, the greater the damage.

Most research has focused on what is happening at, and shortly before, the cardiac arrest takes place. This study looked at a period of time before an arrest occurred to see if patients reported any warning symptoms that might be used to predict the arrest.

Heart via Shutterstock

Heart via Shutterstock

Out-of-hospital cardiac arrest is fatal in about 90% of cases

Out-of-hospital cardiac arrest is fatal in about 90% of cases. The major reason is that resuscitation, in the form of CPR and definitive therapy, needs to be started immediately.

In cardiac arrests that happen at home, in shopping malls, on the sidewalk and other non-medical areas, CPR may not be done at all or may be started minutes too late. Often, by the time paramedics arrive, the window in which resuscitation might have been successful, has closed and the resuscitation fails.

If people could be warned about possible symptoms that indicate the possibility of an arrest, they might have a chance at preventing it, or at least getting to medical help in time to resuscitate them.

The newest technique for CPR is “hands only,” not breathing

Until more people are trained, and more importantly, willing to start CPR immediately, out-of-hospital survival will remain poor. Some people seem to not want to do CPR because of mouth-to-mouth contact (really). The new guidelines for CPR talk about “Hands Only” i.e., not doing mouth-to-mouth breathing. Hands only has been shown to be as effective as mouth-to-mouth CPR when done correctly by bystanders. Perhaps, as this information spreads, more people will be willing to initiate CPR.

Symptoms preceding a possible cardiac arrest

The study is based on a group of middle-aged men in the Portland, Oregon area. (NOTE: A similar study is underway looking at warning symptoms of cardiac arrest in women.) These men were in the age range of 35-65 years old. Cardiac arrest occurs more frequently in older people, but it certainly isn’t unheard of in 35 year olds, or even people of younger ages. Researchers reviewed data from men who experienced out-of-hospital cardiac arrest between the years 2002 and 2012. They reviewed the medical records of patients who had cardiac arrests to see if there were any warning signs that would serve to be useful predictors of an imminent arrest.

In the 500+ men who had a cardiac arrest during this period, 53% had some kind of warning symptom(s) prior to the cardiac arrest. Of those:

  • 56% had chest pain
  • 13% had shortness of breath
  • 4% had dizziness, fainting or palpitations (feeling that the heartbeat is irregular (rapid, skipping beats), forceful, pounding beats, or a feeling that the heart is fluttering.)
  • 80% of these patients experienced one or more of these symptoms from one hour to one month before cardiac arrest occurred.

Most of these men had some underlying coronary artery disease, but only about half of them had been tested for heart disease when their arrests occurred.

Chest pain, palpitations, shortness of breath

Dr. Sumeet Chugh, MD, cardiologist, who was an author of the study says that if you experience chest pain for the first time, or palpitations, of if you become more short of breath than you normally are when doing an activity, seek medical care soon. When you get to the doctor or ER, make sure to let them know that you’re concerned about having a cardiac arrest or heart attack, because of the symptom(s) you’re having.

He says that certain subsets of people are more at risk for cardiovascular disease and cardiac arrest. Those people include, people who smoke, ones who don’t exercise, those with high blood pressure, those with elevated lipid levels, and people who are overweight, among others.  Some risk factors are ones that can’t be changed, like genetics. Others can be changed or modifies through lifestyle modifications, medicines and the like.

“The lesson is, if you have these kinds of symptoms (palpitations, chest pain, shortness of breath, dizziness, etc.), please don’t blow them off,” said Dr. Chugh, who is the senior author and associate director for genomic cardiology at the Cedars-Sinai Heart Institute.

“Go see your healthcare provider. Don’t waste time.”

Let me echo that last, “Don’t waste time!” Very good advice.

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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