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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9 Responses to “Doctors looking at predicting cardiac arrests, to make them more survivable”

  1. docsterx says:

    Women sometimes tend to experience and/or report symptoms of a heart attack differently from men. For example, usually relatively severe chest pain is a fairly common symptom of a heart attack. Women sometimes describe this as a feeling of fullness or pressure in the chest. Sometimes they ascribe it to a stomach ulcer or gas or some kind of abdominal complaint. Also, women also more often report the pain as being somewhere else than in the middle or left chest. They may complain of arm, neck or jaw pain. Sometimes back pain. Men experience that, too, but often much less frequently. Most men who are having heart attacks don’t complain of tiredness or extreme fatigue, but some women do. They’ll say that they have no strength or energy or are exhausted.

    So imagine a woman in the ER or doctor’s office saying that she is really tired and is having some abdominal and neck pain. Heart attack probably wouldn’t be the first thing that the doctor might consider.

    I’m not trying to make excuses for any of the things that were reported below. I’m just trying to say that sometimes making a diagnosis of heart attack isn’t as easy as it might appear on the surface. It’s always much easier to look back and make the correct diagnosis in retrospect.

  2. Number Six says:

    Also (according to a cardiac nurse I know): women’s symptoms are sometimes different from men’s symptoms, and can include a pain in the lower back instead of a pain in the arm.

  3. Whitewitch says:

    Yeah – we are just big whinners who should stay in the kitchen and be quite (and if we must have a heart attack – please do it after you are done cooking).

    I don’t know why I have been so grumpy lately – seems like every thing focuses on men – UNLESS of course it is controlling our lady bits and pregnancy…then they are OOOHHHH so Smart about what is right.

  4. BeccaM says:

    Unfortunately, the studies I’ve seen over the years have indicated that women are less likely to receive timely cardiac intervention. Mainly because when we complain about chest pain or shortness of breath or nausea or any of the usual symptoms, our reports are given less credence than when they come from men.

  5. Whitewitch says:

    Very similar experience – women are ignored by the medical community …on so many levels. You know those womimman’s they are just having a girl thing.

  6. Whitewitch says:

    Why does the medical community ignore women – No studies ever involve women…we have cardiac arrest as well. Yet no stats on what symptoms women might experience.

  7. ArthurH says:

    My old family doctor had his own way of detecting if you were prone to cardiac arrest. If your lips developed a purple tint, he’d recommend a blood test that would determine the presence of blood clots. In the case of an uncle, a clot was discovered that was big enough should it have reached the heart would have shut him down immediately. He got the necessary treatment and is still alive at age 91.

  8. jad says:

    Thought I’d just add a clinical study my husband has been part of for 6 yrs. now. Not for everyone but those with a cardiac history and meeting the criteria might eventually find this device available.

  9. Terry Cooper says:

    I had a cardiac event when I was 45. I had all the same symptoms as the males who were studied. However, even in the ER, having severe chest pains, I was # asked about what drugs I had been using, the implication being that I have been using illegal drugs, #2 an ER doctor told me that women my age did not have heart attacks. It was not until an EKG tech ran a short tape and ran to the desk, wherein a code was called. I was in V-fib. Some years later, I had to have a double bypass, both bypasses failed and I had to go to the ER several times with chest pains. Again I was treated as if I was just being hysterical by the staff. I had to have two stents the first time, and the second time, I had a heart attack prior to being treated and had to have another stent. So, ladies, if you are having any symptoms, regardless of age, go to the ER immediately, and if they are indifferent toward you or worse, insulting, let them know that a failure to treat you immediately will result ii a lawsuit. Start taking names of the nurses and doctors who are there and being dismissive. Hopefully, you will have someone who cares about you with you, and they will do this for you. I did not.

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