Early Defibrillation Restarts a Heart

Early defibrillation is the only definitive treatment that will save a victim of Sudden Cardiac Arrest (SCA). It is relatively simple to perform, and must be administered immediately onsite upon recognition of SCA, coupled with proper CPR techniques. Rapid defibrillation is proven to save lives and is the ONLY effective treatment in an out of hospital emergency that will prevent a victim from dying within a few minutes.

Resuscitation science tells us that CPR itself may double chances for survival when given by someone with CPR training, however, rapid defibrillation is still the only way to restore the heartbeat. Once the heart has entered a state of arrhythmia, typically in SCA either pulseless ventricular tachycardia or ventricular fibrillation, it will rarely ever return to a normal sinus rhythm on its own.  As long as it is in this state, the heart is not effectively pumping blood through the body and the brain and other vital organs rapidly die.

Essentials of the “Chain of Survival”

Most of us have heard of cardiopulmonary resuscitation, or “CPR”, a breakthrough in emergency medicine. Once cardiac arrest has occurred, sudden cardiac death draws closer with each passing moment. Learning how to do an effective chest compression, as well as gaining the ability to quickly recognize heart-caused emergencies such as SCA, heart attack, stroke, etc. is extremely important for first responders.

As indicated by the American Heart Association chain of survival (below), victims should receive early CPR to help sustain life when the heart stops pumping blood. Early recognition by the first responder leads to the reduced response times so crucial to increased survival rates.

However, chest compressions for circulating blood are only a short-term substitute for normal oxygen-rich blood flow. Sudden Cardiac Arrest victims need rapid defibrillation. After three minutes of cardiac arrest without successful defibrillation, the cardiac arrest survival rate begins to decrease by 10% per minute. Thus early defibrillation to allow the heart muscle to restart with a normal rhythm is essential to save lives; this is made possible through timely response with automated external defibrillators, or “AEDs”.

Just as soon as an AED is available and deployed, a first defibrillation attempt should be made even if very little CPR has been performed. The combination of cardio pulmonary resuscitation and electrical defibrillation should continue until emergency medical services personnel arrive to provide out of hospital advanced life support for cardiac arrest.

Sudden Cardiac Arrest

The heart beats in response to electrical impulses from the sinus node, your body’s natural pacemaker. It is an area of specialized cells in the upper right chamber of the heart which controls the heart’s beat, or rate of pumping oxygenated blood through the body. The sinus node creates a steady pace of electrical impulses which may change depending on your activity, emotions, rest and other factors.  

The rate, or pace, of your heart is referred to as the “sinus rhythm”.  A normal sinus rhythm means the electrical pulses from your sinus node are being properly transmitted throughout the heart muscle, producing a healthy heart rate. However, the heart may begin to beat abnormally fast or slow, or in an uncoordinated fashion, in some cases resulting in Sudden Cardiac Arrest. If this occurs with no intervention, the victim will almost certainly and quickly die.

What is an AED?

Simply stated, an AED is a device that analyses heart function, then delivers an electrical shock as needed to stop it momentarily, allowing it to start again with its own normal sinus rhythm. By interrupting the misfiring electrical impulses which occur in Sudden Cardiac Arrest, the machine allows even inexperienced first responders to give effective first aid in out of hospital settings. You can learn more about what an AED is or what AED stands for in this article.

Photo from: https://www.communityheartbeat.org.uk/sites/default/files/1947_defib_prototype.jpg

First portable electric defibrillator

First Defibrillators

While the first portable defibrillators were simple in that they operated on the principle of delivering a single shock to a fibrillating heart, they still demanded a considerable amount of expertise in actual deployment. Only certain conditions indicate use of rapid defibrillation, and successfully shocking and restarting the heart in cardiac arrest relies on proper placement of electrodes through electrode pads, control of the amount of electrical current, correct timing, etc.

Nevertheless, rapid defibrillation came to be understood as the only treatment that can restart the heart in simple and timely fashion (without opening the chest or injecting a heart stimulant). It was clear to be seen that portable AED use markedly reduces the time to first defibrillation; since death comes so quickly to the untreated SCA victim, there was natural stimulus in the medical community for the development of a sophisticated machine for use in the field to facilitate early defibrillation.

ZOLL AED Plus with Real CPR Help

Modern Defibrillators

The desire to further improve survival rates, coupled with growth in medical and electronics technology, has led to rapid development of portable AEDs. Use of today’s modern automated external defibrillator by an untrained bystander to give first aid is now made possible. Computer technology provides an easy-to-use interface, guiding the rescuer and controlling the shock-giving capability of the machine. Most anyone, even a child, can now operate an AED, giving crucial first aid in case of an SCA emergency–making the difference between life and death.

Additionally, our most up-to-date AEDs now incorporate real-time CPR guidance and feedback with the delivery of any shock(s) needed for defibrillation. This is a leap forward in improving the survival rate of SCA victims, since response times are so important to the resuscitation success rate. As noted above, the  American Heart Association considers both CPR and rapid defibrillation important, placing them at the core of the “Chain of Survival”.

Early Defibrillation Programs

Thus today’s AED is not simply a defibrillator, but rather a sophisticated medical unit for use in rapid rescue of victims who have collapsed with a heart crisis. The goal of early defibrillation coupled with “high-quality CPR” (See Resuscitation, p 391, European Resuscitation Council) has been reached with the refinement of the portable public-access AED!

Many states are taking a strong lead in making AEDs universally available and encouraging public awareness and training to handle SCA emergencies. 

Photo from https://dhss.delaware.gov/dhss/dph/ems/aed.html

One such program is the Delaware Early Defibrillation Program. It is managed by the Delaware Department of Health and Social Services; the program, begun in 1993 with deployment of some of the first portable AEDs available, “…continues to combat death and disability by sudden cardiac arrest. Funding for the program is used to purchase AEDs and provide initial CPR/AED training to agencies applying for an AED through the program.”

Defibrillator FAQ

What are the signs of Sudden Cardiac Arrest?

The Signs of sudden cardiac arrest are immediate, drastic and include:

• Sudden collapse
• No pulse
• No breathing
• Loss of consciousness

What is “Pulseless Electrical Activity”?

PEA is a heart rhythm with no apparent pulse in spite of the presence of electrical activity. Unlike ventricular fibrillation or tachycardia, it typically doesn’t respond to shock with an AED, but can be treated by other means, including cardiopulmonary resuscitation and injection.

When Should an AED be used?

An AED should be used when a person has collapsed and is not breathing. Find the American Red Cross steps to use an AED here, or review our guidelines on how to use an AED. Today’s AEDs analyze the function of the heart via pads which you will attach to the victim, according to instructions given by the machine. It will not shock the victim (or instruct you to push the shock button) unless it is needed. Certain conditions, such as agonal breathing, can confuse a first aider. The greater the familiarity with signs of SCA, the more confidently a first responder can proceed.

Sudden Cardiac Arrest can happen in people who have no known heart disease. However, a life-threatening arrhythmia usually develops in a person with a preexisting, possibly undiagnosed heart condition. According to the Mayo Clinic these conditions include:

• Coronary artery disease. Most cases of sudden cardiac arrest occur in people who have coronary artery disease, in which the arteries become clogged with cholesterol and other deposits, reducing blood flow to the heart.
• Heart attack. If a heart attack occurs, often as a result of severe coronary artery disease, it can trigger ventricular fibrillation and sudden cardiac arrest. Also, a heart attack can leave scar tissue in your heart. Electrical short circuits around the scar tissue can lead to abnormalities in your heart rhythm.
• Enlarged heart (cardiomyopathy). This occurs primarily when your heart’s muscular walls stretch and enlarge or thicken. Then your heart’s muscle is abnormal, a condition that often leads to arrhythmias.
• Valvular heart disease. Leaking or narrowing of your heart valves can lead to stretching or thickening of your heart muscle.
• Heart defect present at birth (congenital heart disease). When sudden cardiac arrest occurs in children or adolescents, it can be due to congenital heart disease.
• Electrical problems in the heart. In some people, the problem is in the heart’s electrical system itself instead of a problem with the heart muscle or valves.

Does my state have an AED program?

Virtually all states have laws and legislation regarding AED provision and use within that state.  You can find a map with information regarding your state.

The post Why is Defibrillation Important? appeared first on AED Superstore Resource Center.

(Updated 7/31/18 with data from the American Heart Association’s 2018 update on Heart & Stroke Statistics)

Sudden cardiac arrest (SCA) is a serious and often lethal medical condition, but its exact definition, the statistics behind its occurrence, and recorded survival rates are not always in consensus. In order to better understand why SCA has these discrepancies in data, this article will further explore its range of definitions, challenges in reporting and data gathering, and the differences between in-hospital and out-of-hospital occurrence outcomes.

Many of the statistics set forth in this compilation are derived from the American Heart Association’s 2018 update on Heart & Stroke Statistics. Even within this authoritative and lengthy document, the sources of the statistics gathered vary widely, and one set of data may be from as recently as 2016, while others reach back as far as 2009. What is important to remember is most of this information are estimates with varying margins of error.

Definitions of SCA

The general definition of sudden cardiac arrest appears to be fairly consistent, with most sources agreeing that SCA is the stopping of the heart due to a disruption of the heart’s electrical impulses, which results in inadequate oxygenated blood flow to the brain and vital organs, which causes the victim to lose consciousness.

The causes of SCA can be difficult to determine. To further complicate the matter, there are both cardiac and non-cardiac causes, which may not be readily evident when the incident occurs. Cardiac causes are attributed to the structure or function of the heart directly; non-cardiac causes are attributed to outside factors such as a blow to the chest, choking, or electrocution.

Another term which tends to cloud the results is sudden cardiac death, as opposed to sudden cardiac arrest. Make no mistake, someone in sudden cardiac arrest is technically dead. Some argue whether or not survivors of SCA are included within the broader category of SCD. SCD generally requires victims to have died from sudden cardiac issues, but despite its name, death does not seem to be a requirement for classification as an SCD in every case.

Let’s review some of the definitions from various authorities on this topic.

Sudden Cardiac Arrest:

American Heart Association

In the American Heart Association’s (AHA) 2018 report, cardiac arrest is defined as “the cessation of cardiac mechanical activity, as confirmed by the absence of signs of circulation.”

National Institutes of Health SCA Definition

The National Institutes of Health’s National Heart, Lung, and Blood Institute (NHLBI) defines sudden cardiac arrest as “a condition in which the heart suddenly and unexpectedly stops beating. If this happens, blood stops flowing to the brain and other vital organs. SCA usually causes death if it’s not treated within minutes.”

Sudden Cardiac Death:

American Heart Association

In the same report as above, the AHA defines sudden cardiac death (SCD) as “unexpected death without an obvious non-cardiac cause which occurs within one hour of symptom onset (witnessed) or within 24 hours of last being observed in normal health (unwitnessed).” With this in mind, the AHA is also quick to point out that the definitions of “sudden” and “unexpected” death are difficult to define medically, and that this definition of SCD is difficult to use in realistic settings.

Putting SCA and SCD in context

Drs. Deo and Albert in AHA Journal

In their report on Sudden Cardiac Death (SCD) published in the AHA Journal Circulation, Dr. Deo and Dr. Albert define SCD as “an unexpected death from a cardiovascular cause in a person with or without pre-existing heart disease.” They further elaborate that the definition may depend upon whether the event was witnessed or not, but generally, studies include witnessed collapses, death within one hour of acute changes in clinical status, or unexpected deaths occurring within a previous 24- hour period.

The doctors define SCA as a subset of SCD cases in which resuscitation was recorded or as nullified SCD cases for instances in which the victim survived the SCA. Please notice the use of the words “may” and “generally”. This is the crux of definition difficulties leading to statistical anomalies.

Discrepancies Identified in Comparing SCA and SCD Studies

In Dr. Kong et al.’s 2011 article “Systematic Review of the Incidence of Sudden Cardiac Death in the United States,” the doctors used six different studies carried out in time spans ranging from 1980 to 2007, which reported estimates for the number of SCA and SCD cases in the U.S. They found criteria for arriving at the statistics varied enough to influence numbers significantly.

• Three of the six studies included time restrictions within their definition of SCD.
• Four of the six studies used location of the event as part of the definition.
• Two of the studies limited SCD to deaths caused by ischemic or coronary heart disease, while the other four studies used a wider definition including deaths from cardiac or cardiovascular etiologies.
• One study included survivors of SCA in their definition of SCD.
• The final study focused on out-of-hospital cardiac arrest and included both survivors and deaths.

SCA Event and Survival Data

As the most consistent gatherer of information on sudden cardiac arrest numbers, the American Heart Association is the recognized expert when it comes to knowing the numbers. With regard to sudden cardiac arrest, the AHA relies on three sources for their data:

• ROC – Resuscitation Outcomes Consortium datum were gathered between June 1, 2014 and May 31, 2015 and includes EMS-assessed and EMS-treated out-of-hospital cardiac arrest (OHCA) from multiple regions of the US. According to the ROC:
  • Approximately 356,461 people in the US experienced an out-of-hospital cardiac arrest (347,922 adults, 7,037 children under age 18)
  • 22,520 of those 356,461 were witnessed by bystanders
  • 12.4% survived to hospital discharge
  • Of the EMS patients who experienced non-traumatic cardiac arrest outside a hospital, and did not have bystander intervention, 10.8% survived until hospital discharge
• CARES – Cardiac Arrest Registry to Enhance Survival’s estimates are of EMS-treated, out-of-hospital cardiac arrest of people of any age throughout the US. The CARES “program has expanded nationally to include state-wide registries in 24 states with community sites in 18 additional states, 1,400 EMS agencies and over 1,800 hospitals, representing a catchment area of more than 106 million people.” Its most recent report from 2017 states:
  • Of the 76,161 cases of OHCA reported by EMS, 10.4% survived to hospital discharge.  
  • 30.3% of the total were defibrillated in the field, 5.2% by bystanders, 19% by first responders (personnel who respond to the medical emergency in an official capacity as part of an organized medical response team, but are not the designated transporter of the patient to the hospital), and 75.8% by EMS personnel.
    • Of the 5% where bystanders used an AED on a patient, 49% of them survived to hospital discharge.
    • Patients who received their first shock from first responders had a 28% survival to hospital discharge rate.
    • Patients who received their first shock from EMS personnel had a 27% survival to hospital discharge rate.
    • The statistics show the importance of early defibrillation in the event of a sudden cardiac arrest.
• GWTG – Get with the Guidelines – Resuscitation – is an AHA program which “facilitates the efficient capture, analysis and reporting of data that empowers and supports the implementation of current guidelines, creation and dissemination of new knowledge, and development of next generation, evidence-based practice in resuscitation science.” According to GWTG:
  • When you apply gathered GWTG data to the total number of hospitalized patients in the US, it can be assumed approximately 209,000 patients are treated for in-hospital cardiac arrests every year
  • 22,960 adult in-hospital cardiac arrests were included in GWTG’s data survey of 300 hospitals and, of those, 25.8% survived to discharge

As you can see, data is reported and recorded separately for in-hospital versus out-of-hospital cardiac arrests, and for cardiac arrests in children versus adults. These variances within the data sets can make it difficult to view cardiac arrests as a whole. To add to the difficulty of obtaining reliable statistics, there are also no current national standards for tracking and monitoring the rate and outcomes of cardiac arrest.

Interpreting Out-of-Hospital SCA Statistics

Cardiac arrests which are assessed or treated by EMS personnel may be subject to regional or cultural differences related to emergency care access and treatment decisions. The causes of these variations have been attributed to varying definitions of cardiac arrest, different methods of collecting cardiac arrest data, and even variations in patient treatment after the start of cardiac arrest.

For example, while one EMS department may employ hypothermia techniques to assist in a patient’s recovery, another may not; or where one ambulance is able to reach the patient within three minutes, it may take another much longer in a larger city with more traffic.

Where the statistics speak loudest is the difference in survival rates when a bystander steps in and takes the initiative to step in and start CPR and/or find a defibrillator versus those who call 911 and simply wait for EMS to arrive.

Out-of-Hospital Youth SCA Statistics

According to the AHA, approximately 7,000 children, age 18 or younger, experience an out-of-hospital cardiac arrest every year. The majority of sudden deaths in young athletes are caused by hypertrophic cardiomyopathy. A young athlete dies every 72 hours from SCA. According to a chart in the AHA’s 2018 report (Chart 16-4, Pg. 313):

In children ages 0-2: the causes of sudden cardiac arrest are overwhelmingly congenital at 84%

Children ages 3-13 who suffer sudden cardiac arrest have a close range of causes:

• Congenital defects at 21%
• Hypertrophic cardiomyopathy at 18%
• “Other” (any cause other than those listed) at 18%
• Long QT at 14%
• Myocarditis and Primary Arrhythmia both at 11%
• Mitral Valve prolapse at 7%.

For youth and young adults ages 14-24, the causes are once again varied:

• “Other” causes at 26%
• Congenital defects and primary arrhythmia both coming in at 23%
• Dilated cardiomyopathy at 14%
• Long QT at 8%
• Myocarditis at 4%
• Hypertrophic cardiomyopathy at 2%

Further Breakdown of Out-of-Hospital SCA Data

The AHA estimates over 350,000 people experience an out-of-hospital cardiac arrest every year.

• Approximately 52% are treated by EMS responders.
• 25% of individuals experiencing an out-of-hospital cardiac arrest had no previous symptoms.
• Around 19.8% of those individuals initially have ventricular fibrillation (VF) or ventricular tachycardia (VT), either of which can both be shocked by an automated external defibrillator.
• For out-of-hospital cases, cardiac arrest is witnessed by bystanders 37% of the time
• 12% of the time, cardiac arrest is witnessed by EMS providers.
• 51% of the time, the cardiac arrest is unwitnessed.
• 10.8% of EMS-treated cardiac arrest for patients of any age survive and 9% of them leave the hospital with good neurological function.
• 62.8% of patients die in the hospital after the out-of-hospital treatment of a cardiac arrest, according to the CARES Registry 2016.

Out-of-Hospital Regional Differences

Further studies have been conducted on the potential for regional differences in out-of-hospital cardiac arrests. In April of 2016, a study was published which included 132 counties across the US and included 96,662 patients. Of these cases:

• Only 9.6% of patients survived to hospital discharge, and of those, 7.4% retained neurological functional.
• At a county level, there was marked variation in rates of survival to discharge. (3.4% to 22.0%) and survival with functional recovery (0.8% to 21.0%).
• County-level rates of bystander CPR and AED use were positively correlated with both outcomes.
• Patient demographic and cardiac arrest characteristics explained 4.8% and 27.7% of the county-level variation in survival, respectively.
• Additional adjustment of bystander CPR and AED explained 41% of the survival variation, and this increased to 50.4% after adjustment for county-level socio-demographic factors. Similar findings were noted in analyses of survival with functional recovery.

Conclusions: Although out-of-hospital cardiac arrest survival varies significantly across U.S. counties, a substantial proportion of the variation is due to differences in bystander response across communities.

In-Hospital SCA

Finding consistent data for in-hospital sudden cardiac arrest is challenging since there are regional and cultural differences in the access to healthcare, the treatment methods used, and definitions of conditions and treatments may vary.

According to the GWTG 2016 report, out of a sample size of 495 children in 69 hospitals, there was asystole (no heartbeat at all) in 26.9% of children identified as having suffered SCA, and ventricular fibrillation and shockable ventricular tachycardia in 10.7% of hospitalized children experiencing an initial cardiac arrest. The survival rate for children is much higher than adults who suffer in-hospital cardiac arrest with 49.5% of them surviving to discharge, compared to only 26.4% of adults.

The AHA estimates that there are approximately 209,000 in-hospital cardiac arrests every year based on the reported statistics and the total number of hospitalized patients within the United States. The report goes on to say that adults who experienced a cardiac arrest in-hospital had a 25.8% survival to discharge rate and of those, 84.6% had good neurological function.

Conclusions

No matter what statistical source you look at, the reality is the majority of people who experience a sudden cardiac arrest (SCA) will not survive. Since these deaths usually occur without warning, and their survival rates drastically decrease if treatment isn’t received within minutes of the onset of the cardiac arrest, the likelihood of an SCA victim leaving the hospital with all neurological function intact is slim.

An automated external defibrillator (AED) is critical in saving victims of SCA. AEDs are often located in public places to increase their accessibility. Bystander use of an AED in conjunction with quality CPR has statistically shown an increase in survival rate over patients who must wait for EMS help to arrive. Those who receive immediate help are generally reported as having a survival rate up to three times higher.

The increasing availability of AEDs would lead the average person to guess there would be a substantial increase in SCA survival rates overall. So why aren’t we seeing these drastic changes? According to the 2016 Cardiac Arrest Registry to Enhance Survival (CARES) National Summary Report, 68.5% of SCA cases happen when people are either alone in their home, or witnesses do not have access to an AED. Only 21% occur in a public setting where there may or may not be an AED.

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Heart Attack and Sudden Cardiac Arrest

Heart attack and sudden cardiac arrest are two related but separate conditions of the same muscle of the body often mistakenly used interchangeably. Even though they are both cardiac related, prevention and treatment for each is different. Understanding the differences between the two most common and deadly heart conditions, and knowing how to recognize the signs and symptoms of each could mean the difference between life and death for the victim.

Physiology of a Heart Attack

A heart attack, also known as a myocardial infarction, is a sudden and complete blockage of one or more arteries which supply oxygen-rich blood to the heart. This kind of blockage is common in many forms of heart disease. One example is a condition known as atherosclerosis, which is clinically defined as “hardening of the arteries”. When arteries harden, “plaque” forms on the walls of the artery and ultimately blocks the artery completely. It can be thought of as a “plumbing problem”.

As more arteries become clogged completely, the circulatory system is unable to supply the heart with enough oxygen and the muscles within the heart begin to die. This condition, when it reaches its end-stage form, will generally result in a patient suffering a heart attack.   

Physiology of Sudden Cardiac Arrest

Conversely, sudden cardiac arrest (SCA), can be described as an “electrical problem.” It is a direct result of a lethal cardiac arrhythmia, generally ventricular fibrillation, which can occur in any person, at any time, regardless of health condition. Ventricular fibrillation is a rhythm defect in the heart, caused by an interruption of the natural electrical impulses produced by the sinoatrial node. The sinoatrial node acts as the heart’s natural pacemaker.

The lower chambers of the heart, known as ventricles, begin to beat in an irregular and often rapid pattern, which prevents the heart from pushing blood throughout the body. Without oxygenated blood flowing to the brain, heart and other vital organs, immediate clinical death occurs.

It is crucial to understand sudden cardiac arrest is not a condition which can be prevented entirely by lifestyle changes.  While exercise and a healthy diet help curb artery blockages, other causes of SCA include:

• An undiagnosed genetic condition such as Wolff Parkinson White Syndrome or Brugada Syndrome
• Choking
• Drowning
• Electrocution
• Excessive physical activity.

Symptoms of a Heart Attack

A heart attack has classic signs and symptoms a bystander can easily learn to recognize. Generally, someone in the midst of a heart attack will be alert, awake and able to tell you about these symptoms:

• Chest pain which can feel like intense burning or tightness (“clenched fist” feeling). This pain may radiate to the neck, between the shoulder blades, jaw, left arm, or the upper abdominal area.
• Occasionally nausea, clammy skin, fatigue, cold sweats, lightheadedness, and dizziness are present.
• Shortness of breath.
• Other symptoms, such as anxiety and a sense of impending doom, have been reported.
• Women sometimes report a stiff or painful jaw; this does not seem to be as prevalent in men.

Symptoms of Sudden Cardiac Arrest (SCA)

A person experiencing sudden cardiac arrest will not exhibit most of the symptoms present in a heart attack. SCA events truly are sudden, as the name implies. While heart attack symptoms can be gradual, sometimes occurring over days or even weeks, SCA occurs instantly when the heart goes into fibrillation and can no longer effectively pump blood. The signs and symptoms of sudden cardiac arrest include the following:

• Sudden loss of any and all responsiveness, which is defined as “no response to tapping on the shoulders or responding when asked if he/she is okay.”
• No pulse
• Not breathing (chest rising and falling). A victim may exhibit what is referred to as ‘agonal’ breathing – described as desperate gasping.  
• Some patients have reported a very brief sensation of nausea, irregular heartbeat, or rapid heartbeat prior to unconsciousness. The length of time between the patient feeling these sensations and becoming unconscious is so brief, it is immeasurable.

Treatment Options

Identifying which condition is occurring dictates which treatment needs to be administered.

Responding to a Heart Attack

Bystander Treatment of a Heart Attack

If you’re a bystander and you see someone experiencing heart attack symptoms, do the following:

• Call 911! It is not recommended you drive the person to the emergency room as this could actually delay treatment while you fill out forms and wait to get the person in to be seen.
• Stay close.  It is important to keep an eye on the person in case the heart attack turns to sudden cardiac arrest.  
• If the person has been prescribed nitroglycerin in the past, and it is close at hand, administer a dose.  
• If they have not been prescribed nitroglycerin, and you know for a fact they have no allergies or are taking medications which may interact badly with it, you can give regular aspirin.
  • Why: Since the arteries may be blocked, but not be completely closed, a blood thinner like aspirin can help blood continue to flow. The longer the heart is deprived of oxygen, the more damage is done. Thinning the blood as soon as possible will allow the heart to regain oxygenation much sooner than a patient who does not receive treatment until EMS arrives.
• Keep the patient comfortable and calm until EMS arrives.

Professional Treatment of a Heart Attack

• When professional responders arrive on the scene they will generally start an intravenous line to administer another blood thinner, such as heparin, which works via a different mechanism. They will also assess the patient and transport to the hospital if necessary.
• In the hospital, the patient will be assessed and will most likely undergo angioplasty to find and open any blocked arteries. Clot-busting drugs may also be given if the patient arrives at the hospital soon enough.
• Out-of-hospital, long-term treatments may include:
  • Medicines such as ACE inhibitors, anti-clotting, anticoagulants, beta blockers and statin drugs  
  • Additional medical procedures such as bypass surgeries to prevent further heart attacks
  • Lifestyle change recommendations including diet, safe exercise, stress management, limiting alcohol intake and quitting smoking (if relevant)
  • Cardiac rehabilitation, including education on heart disease, counseling, and training of the patient and loved ones on possible future signs and symptoms of possible future heart attacks.  
    

Responding to Sudden Cardiac Arrest

Bystander Treatment of Sudden Cardiac Arrest

If you’re a bystander and observe someone experiencing SCA symptoms, immediately begin the Chain of Survival:

• Call 911 or have another bystander call 911
• Get an AED or send another bystander to get the AED
• Begin CPR
• Turn on the AED when it arrives and follow its directions
• For every minute defibrillation is delayed, the patient’s chances of survival decrease by 10%.
• Continual CPR and defibrillation should be continued until EMS transport arrives at the scene, or until the patient regains consciousness.
• The AED should be left attached to the patient until EMS arrives for use as a monitoring tool.

It is important to remember a patient in SCA is clinically dead. There is nothing you can do treatment-wise with an AED or with chest compressions which will result in any further damage to this individual. In fact, only positive outcomes can be achieved from this form of treatment. Use of an AED and CPR should be initiated in 100% of cases, as quickly as possible.

Professional Treatment of Sudden Cardiac Arrest

• In Hospital: post-arrest care usually includes most of the treatments above for heart attack
• In-Hospital Care: may also include additional tests to determine the cause of the SCA if it is not apparent at the time of the arrest.
  
• Long-term Treatment: may include the permanent placement of an implantable cardioverter-defibrillator. This device is connected to the heart via electrical leads and implanted just under the first couple of layers of the skin. Implanted defibrillators deliver the same type of shock as an AED directly to the heart anytime an arrhythmia is detected. 

Conclusion

When comparing a heart attack to sudden cardiac arrest, the information provided here demonstrates the signs and symptoms are not only different but markedly different. Starting the correct treatments outlined above quickly is key to increasing the chances of survival for both.

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There is a shortage of firefighter and other EMS workers across the nation, especially when it comes to volunteers. Might emergency services be for you, either as a career professional or as a volunteer? In this interview, we talk with Mike, training center coordinator at AED Superstore, the world’s largest distributor of automated external defibrillators, and discuss his career in EMS.

DISPATCH: “BEEPBEEPBEEPBEEPBEEPBEEPBEEP”—

MIKE: HOLD ON!

DISPATCH: …LAKE TOM FIRE, YOU’VE GOT A ONE VEHICLE ACCIDENT WITH INJURY AT 7488 RIVER ROAD…

MIKE: I GOTTA CUT YOU SHORT—THAT’S ACTUALLY JUST DOWN THE ROAD FROM ME…

…So ended my interview with an emergency medical services (EMS) worker named Mike regarding what life is like for firefighters, EMT’s, paramedics, etc. He is now the training center coordinator at AED Superstore, the world’s largest distributor of automated external defibrillators (AEDs), as well as his community’s assistant fire chief. Mike’s current positions in firefighting and first aid, CPR, and AED training are a natural result of his lifelong work in all things emergency.

Getting a call from dispatch was a fitting end to my hour-long conversation with Mike. He has had a varied career in emergency services and I felt I had hit the jackpot as I interviewed him to get a picture of what life is like working in the EMS field. Taken from a wider view, Mike’s EMS career started in childhood as he began rescuing imaginary victims. He imagined people were trapped in snow caves dug into the side of mounds created by snowplows passing in front of his childhood home, then spent his playtime energy getting them out alive.

This natural passion which emerged when he was a 5-or 6-year-old kid (“I wanna be a firefighter”) spurred entrance into his high school Firefighting Recruit Academy his junior year. Completing the academy equipped him with a technical diploma and sufficient knowledge to take state firefighter certification tests which led to a fulfilling EMS career. As I discovered talking to Mike, at the core of his life experience in EMS are impassioned values of helping people, working as a skilled team member, acting bravely, and thinking cool-headedly in situations where most people instinctively run the other way.

Here is what Mike had to say as I talked with him about his career in EMS:

ABOUT MIKE

STEVE: “Tell me about your current position. What is your job title now and how does it fit in the EMS field?”

MIKE: “Currently I am the training center coordinator at AED Superstore and my position is to run our American Heart Association CPR training center. We offer CPR and AED training for the lay rescuer and healthcare providers across the entire country. I started at AED superstore in customer service and moved into this position. I’ve been a CPR instructor since ’99 and my background as a paramedic and a firefighter suited me for this position. Having a good working knowledge of cardiac arrest put me into a position where I can move our training centers into a big nationwide model which supports our mission to train as many people in CPR and AED use as we can. Our goal is to reduce the number of people who die each year from sudden cardiac arrest. Right now the American Heart Association estimates that number to be around 300-350 thousand.”

BECOMING A FIREFIGHTER/EMS PROVIDER

STEVE: “Sounds like you have had a wealth of experience and have a real sense of purpose in what you’re doing. I want to dig more into the process you went through in getting to this point. Were you first a paramedic?”

MIKE: “I actually started in public safety as a junior firefighter while still in high school, at a small fire department in Door County, Wisconsin and, once I turned 18, I was able to become a full member. I went through State of Wisconsin level 1 and level 2 firefighter training, completed both of those courses and also became an EMT Basic. I was offered the opportunity, through a private EMS company I worked for, to go through EMT/IV (intravenous) technician training, an advanced level that trains EMT’s to start IV’s and deliver some life-saving but relatively safe medications. Being able to do this reduces the number of people who require transport to an emergency room. A good example is diabetics who can be treated on scene, preventing them from having to spend 4-5 hours in an emergency room.

I was hired by the city I retired from and was immediately put through paramedics school, then spent just shy of 13 years as a paramedic. For the whole time I worked as a paramedic, I maintained my fire background. [Then] I let my paramedic license lapse. A lot of the reason for leaving the paramedic position was work burnout. We were a relatively busy department—we ran just shy of 2000 calls a year. Our department worked 24-hour shifts, and the burnout rate was pretty high in that scenario. I wanted to explore something that was a little bit different but still in a closely-related field.

Currently, apparently because I can’t stay out of the game, when I moved to Lake Tomahawk I was recruited by our local volunteer fire department and was just recently promoted to assistant chief.”

STEVE: “How would you say you got interested? What people or events got you going in this direction, even as a young guy in high school?”

MIKE: “There were quite a few different impacts…one of the first ones—I was always fascinated by fire trucks and people would ask me, ‘What do you want to be when you grow up?’ and I would always respond, ‘I wanna be a firefighter!’…I always had a passion for it even as a little kid. Not too long ago before my parents passed away I remember my Mom and I were talking and she asked me if I remembered this—she told me in the winter when I was little and there would be all of the big snow piles in the driveway, she goes ‘you put a little hole in there and pretended you were rescuing somebody out of there.’

Looking back it makes a lot of sense I did that, but it was that spark and that passion that was always inside of me…something I wanted to do. I started when I was 16 very early in my junior year of high school.I became a junior firefighter in a volunteer department that only ran 80-125 calls a year. The chiefs we had were all great teachers and really valued young people coming into the service because it provided an opportunity for them to show the young ones the ropes before they make a final career decision. One of our assistant chiefs, who unfortunately passed away in the line of duty, was a huge influence on me pursuing this as a career. One day he said ‘Hey, we were at a big chief’s conference and we heard about this school offering one of the best fire academies and they integrate EMS into it.” He was a big positive influence in my public safety career.

STEVE: “Did you end up going to one of those schools the assistant chief recommended?”

MIKE: “I did—myself and two other junior firefighters went through. We all rented an apartment together. Even though all three of us graduated from that location, only two of us actually pursued a career in fire and EMS.”

Note: As we talked, Mike outlined the various certifications one typically earns in the process of becoming an EMS provider. He pointed out that every state has its own requirements which are tied to National Registry minimum requirements. In addition, there are various training academies and college-level degrees that can be earned in fire science and emergency medical services. Below are listed those we discussed:

• Firefighter I
• Firefighter II
• Emergency Medical Responder
• EMT Basic
• EMT Intermediate
• PARAMEDIC (According to Mike, medically speaking, “Paramedic is top of the food chain with advanced knowledge, training, and certification in life-saving procedures. Paramedics are able to do out in the field generally the level of care that you’d receive in the first 30 minutes of arrival at an emergency room.”)

MIKE: “The crux of a lot of the training you receive at any one of the levels is critical thinking. It takes a lot of specialized training for an EMT, Paramedic, etc., to get their brain to function in a way that is difficult to explain to those who haven’t worked in the industry. You have to think almost abnormally, almost against what others would do in the same type of situation. We’re the ones going into a scene that people are trying to run away from. At the same time, we’re trying to maintain our safety and constantly monitoring our surroundings. The training at any level revolves around teaching the emergency responder how to think in a critical and very quick fashion, and to execute decisions that are kind of cookie cutter—see this-do this, see this-do this—but to also maintain the overall safety of the responders and the people who are involved in each incident.

There are medical procedures we refer to as “monkey skills.” A lot of things EMTs and paramedics do you could literally train a monkey to do; however, knowing when to do it and why to do it and what the possible side effects and outcomes could be is why we don’t have trained monkeys right now doing this. Basic life support is where it all starts. In the world of EMS, you need to be a good detective. For example, identifying if someone is breathing or not, if they’re conscious or not, then going from there to identify what the problem is, then knowing what you’re able to do and using your knowledge to fix that problem.”

EMS ROLES & RESPONSIBILITIES

STEVE: “What are the different people on scene doing in responding to an emergency, employing this kind of thinking or procedure?”

MIKE: “A really good way to highlight how all three levels of providers are responding and what their responsibilities are is to take a cardiac arrest patient. In the EMS world, the SCA patient is one of the most complicated calls you can ever go on—there are so many different moving parts in that. The first responders and even lay rescuers, their job is to get there quickly and to start CPR and to deploy an AED as quickly as they can. EMT basics are going to do CPR, place what is called a non-visualized airway (set up so someone can put it into the patient’s mouth, blow on some balloons on the end of that tube and that forces air directly into the trachea and down into the lungs.) The EMT intermediate and/or the Paramedic use the endotracheal tube. They are actually going to put a breathing tube down through the vocal cords and into the trachea. There is no margin for error in where the air is going to go.

Over the years we’ve found that good compressions, defibrillation, and medication is where we see success in returning someone essentially from dead to, well, not dead! The EMT Basic’s role stops after the airway is placed. Intermediates will start an IV and deliver some medications, but the Paramedic is definitely going to get IV access or even intraosseous access (actually putting a needle into the bone and delivering medications). The paramedic is going to use a lot of different medications to try to get the heart into a rhythm that electricity can fix.”

STEVE: “So the Paramedic is really doing some sophisticated ER doctor stuff at that point?”

MIKE: “Absolutely! If you look at cardiac arrest in an ER, cardiac arrest in the back of an ambulance or cardiac arrest in somebody’s house, the same procedures and the same level of care is happening. The biggest difference is the ER is a controlled setting. There’s good lighting, the scene is safe, you’re able to get the person up so you’re not kneeling down next to the person on the floor, doing chest compressions and starting IV’s and everything else. I can’t tell you how many times in my career we’d respond to an unconscious person and it ended up being a cardiac arrest and they’re wedged between a toilet and a wall; or they went into cardiac arrest on the bed and they’re a large person and it takes several of us to move that person down on the floor. They don’t face that kind of challenge in an ER, but the actual care being delivered is identical.”

STEVE: “So, these are life and death situations. How long did it take to become confident on the job?”

MIKE: “The ‘When did I stop [expletive]ing my pants?’ question? As an EMT it was a pretty quick transition from being brand new to being fairly comfortable and confident. When I became a Paramedic it was a good year of going on a lot of different calls. My first call as a Paramedic I was nervously confident because the program I went through was the University of Wisconsin’s and I can’t thank my instructors enough for the education they gave us. My first call was pretty serious— a gentleman at one of our clinics whose heart rate was weak and fast, and the medication that we used to correct that [condition] pauses their heart for a moment in time. I was getting ready to give the medication, and my instructor’s voice popped into my head and she told us that when we are giving the medication, that brief pause (and we’re talking a second or less usually) is going to feel like an eternity. You’re going to sit there and watch the cardiac monitor and you are going to want to see that change very quickly— but that brief pause is going to feel like an eternity.

But it was a good year before I was actually confident. It was the training and the phenomenal experience I had through my Paramedic program that gave me that confidence so quickly. I’ve known Paramedics that didn’t hit their comfort zone until they hit their two-year mark. It really depends on the individual and the training. When you have really good training officers and senior medics that you’re working with that are good teachers, that can really help shorten the time until you’re comfortable.”

LOOKING AT THE BOTTOM LINE

STEVE: “What is the EMS person’s typical schedule?”

Note: When I asked this question Mike launched into a lengthy description of various EMS work situations and some of their typical schedules. I have again arranged his responses in a bullet list in an effort to clarify the main points of his response:

• MUNICIPAL EMS PROVIDER—Union represented department, Usually 24-hr shifts:
  • “Modified California Shift”—1 day on / 1day off…1day on / 1 day off…1 day on / 4 days off (total 9-day rotation)…
  • Or—2 days on / 2 days off…
  • Or—1 day on / 2 days off…
  • Or –2 days on / 4 days off…

• PRIVATE SECTOR PROVIDER—Hospital or Stand-alone; schedules vary depending on services provided:
  • Emergency Response—24-hour shifts, varied days off
  • Or—12-hr shifts, varied days off
  • Or—On-call, especially for non-emergency transport (e.g., patient transfer from hospital to nursing home)

STEVE: “My impression is that most EMS persons are not in it for the money, but for the meaning and purpose that makes the work fulfilling. Is that generally true?”

MIKE: “It’s a pretty accurate statement and pay varies everywhere. For those who want to make a career, their big goal is municipal employment. Full-time Paramedic/Firefighters are generally organized and represented so they have the ability to negotiate their salaries and benefits.

Private ambulances pay enough, but not in the same ballpark as municipal employment. With most of the 24-hour schedules, you have those chunks of 4 days off. A lot of guys and girls work second jobs and construction seems to be one of the most popular side jobs. But at 24-to-45,000 dollars a year in an entry-level position, no you’re not going to get rich working in this industry.”

STEVE: “Is most EMT pay hourly?”

MIKE: “Generally, yes. There’s some EMT Basics in a company or community role that make decent money, but for the most part, EMT Basic is viewed as an entry level position.”

STEVE: “Do you have any favorite stories like administering those meds on your first call?

MIKE: “One of my favorite stories is one that I share in every CPR class that I teach. It was a response to an athletic club for a cardiac arrest. We defibrillated the gentleman shortly after our arrival, and by the time we were loading him into the ambulance he was asking what happened. He made a full recovery and we found out later that he got to go see his oldest daughter graduate college and his youngest daughter get married just shortly after his cardiac arrest.

Those are the calls we like to talk about because it had a really positive outcome. Those are the ones you default to because there’s so many other calls we were on where we saw the gory gruesome stuff—not always blood and guts—sometimes it was child abuse and neglect, or elderly abuse and neglect. We had a saying on our shift, ‘When we show up it’s because you’re having a bad day. Now we’re involved and your day just went to hell in a hand-basket.’

Taking care of yourself mentally, dealing with those bad calls, you tend to look at the positive calls and the positive impact you made not only on the patient’s life but their family and friends and everybody that’s associated with them. Guys and gals that are in the business understand the stuff that we’ve seen, and we talk…there’s a healthy way to talk about this stuff so you don’t keep it internalized and let it eat at you. If you do that it can mentally and emotionally and physically destroy you.”

FINAL WORDS OF WISDOM

STEVE: “Anything else you would say to somebody that’s looking at the kind of career you’ve experienced?

MIKE: “If you have a passion for it, follow that passion and let your passion and your desire drive where you end up. I’ve known people that started out in fire and EMS and then went into law enforcement and they’re great cops. There’s never anything wrong with changing a career path right in the middle of beginning it. If you love what you do, it’s going to be easy and you’re going to be good at it. The best thing ever is good firefighters, good Paramedics, good law enforcement officers that love their job and are there for all the right reasons—to help other people when their day has just turned around on them and it’s not going so well.

The other thing is that as you get into this, asking questions is where you learn. One of the things I’ve always said, and I say this to my wife quite often, ‘The day I feel I’ve learned it all is the day that I completely retire from all of this.’ It’s an ever-evolving business, technology has made our life easier, has made the outcomes for the people who are suffering these emergencies better. There’s always something out there to learn, something new that somebody’s tried…it’s the experience you learn on that call from talking with another provider and you say ‘Oh, wow, I’ve never seen that!’ And now you’ve seen it and you have a knowledge base to work on that. The day that anybody who’s in this business feels they have learned it all is the day they should retire.

I would add that if you’re not a team player then this isn’t the business for you. When new people came in I would always ask, ‘Did you ever play organized sports, or do some kind of activity where it took teamwork to achieve a common goal, at any time as a kid?’ Those that did were great members of the team, they understood the team dynamic and how we all work together to achieve a goal. I coach youth hockey and I always tell the girls how valuable teamwork is in their everyday lives, but teamwork in public safety is paramount.”

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Sudden Cardiac Arrest (SCA) survivors understand the preciousness of life – that one moment you can feel perfectly fine and the next wake up in the ICU a few days (or weeks!) later with no idea you have been through SCA, cardiopulmonary resuscitation (CPR), and defibrillation, listening to the stories your loved ones and hospital staff tell you about your ordeal. And that is only if you are mentally cognizant. Some survivors suffer severe neurological damage as the result of a lack of oxygen to their brain during sudden cardiac arrest and face a long road of therapy to regain a “normal” life. It’s a frightening prospect. So what is a “normal” life for the majority of SCA survivors?

Implantable Cardioverter Defibrillator (ICD)

Many people who have been through SCA receive an implantable cardioverter defibrillator (ICD). An ICD is a device placed just under the skin in the chest with leads connected to a patient’s heart. It performs the same function as an AED (automated external defibrillator). ICDs monitor the heart’s rhythm constantly, act as a pacemaker when the heart goes out of normal rhythm, and automatically delivers a shock to the heart when it detects a shockable rhythm, Ventricular Fibrillation or Ventricular Tachycardia. An ICD delivers immediate treatment without delay.  

Post Traumatic Stress Disorder (PTSD)

PTSD is most often associated with soldiers returning from combat situations, but it can also be found in persons who have suffered profound dangerous experiences or trauma in other ways. Car accidents, domestic violence, and severe health issues such as sudden cardiac arrest are examples. In the case of PTSD associated with SCA, there is a debilitating fear of a recurrence which keeps patients from enjoying their everyday activities since they do not know when it might happen again.  

General Anxiety and Depression

Not as severe as PTSD, sometimes the patient will feel general anxiety. Those patients with ICDs report anxiety around the possibility of feeling the shock from the device, which would indicate they once again could have been in a sudden cardiac arrest situation, not to mention the discomfort associated with the shock. Depression is also sometimes present, although it is usually reported in the first 6-12 months after resuscitation, and largely as a result of the loss of memory and the frustrations from coping with the physical and neurological stresses of recovery to varying degrees.

Long-Term Treatment

Once it has been determined what caused a patient’s sudden cardiac arrest, there are several options for procedures and drug treatment.

Procedures may include:

Coronary angioplasty
Coronary bypass surgery
Radiofrequency catheter ablation

Corrective heart surgery – if your sudden cardiac arrest was brought on by a structural heart defect, your cardiologist may recommend specific surgeries to address your particular concerns with an eye toward preventing further complications.

Medications are almost always prescribed for long-term care.

Doctors use various anti-arrhythmic drugs for emergency or long-term treatment of arrhythmias or potential arrhythmia complications. A class of medications called beta blockers is commonly used in people at risk for sudden cardiac arrest. Other possible drugs include angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers or a drug called amiodarone (Cordarone, Pacerone).¹

Side effects will be discussed when you meet with your doctor to decide the best options based on the underlying condition which caused the sudden cardiac arrest to occur and to potentially prevent further incidences.

Life Expectancy

While exact statistics on life expectancy after SCA are difficult to find due to the sheer number of victims each year, it is estimated “More than 80 percent of SCA victims who are discharged home from the hospital live at least one year. More than half live another five years after resuscitation. Most people who survive SCA can return to their previous level of functioning.”²

Summary

Modern science and medical techniques have made it possible to survive cardiac arrest. As the public becomes more aware of the signs, symptoms, and treatments for SCA, early intervention with CPR and defibrillation should be able to save more lives and increase the likelihood of a viable life afterward. The sooner a victim of SCA receives CPR and defibrillation, the better their chances for neurological recovery. While the underlying problems which caused the SCA would still be present, at least patients would have a chance to address those problems and continue on.
One fine young man who went into sudden cardiac arrest on the ball field received early CPR and defibrillation, and has gone on to help his community place more AEDs at ballparks is Hunter, Read his story here.

Footnote1:

https://www.mayoclinic.org/diseases-conditions/sudden-cardiac-arrest/diagnosis-treatment/treatment/txc-20164901

Footnote2:

https://www.sca-aware.org/sudden-cardiac-arrest-faqs#faq23

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Cardiopulmonary resuscitation (CPR) is vital to the survival of a cardiac arrest victim. When someone goes into sudden cardiac arrest, their heart is no longer pumping oxygenated blood to the brain and vital organs. CPR circulates oxygenated blood remaining in the body to minimize neurological damage until defibrillation can be administered. Statistics for best survival rates usually mention “High-Quality CPR”, but what makes CPR high-quality?

When it comes to out-of-hospital bystander CPR, there is one factor which is always variable in each situation – bystander CPR is performed by humans, and humans come in different sizes, capabilities, knowledge, and responses. Even trained EMS professionals may perform tasks differently depending on their fatigue, training, and the particulars of a situation (environment, trauma level, on-lookers, etc.).

To define “High-Quality CPR” for teens and adults, there are certain courses of action identified by the American Heart Association’s 2015 CPR & ECC Guidelines to maximize the benefits of CPR, and they are simple:

Compressions at a rate of 100-120 per minute

Compressions at a depth of 2” – 2.4”

Full recoil of the chest after each compression

Minimal interruptions to compressions

In a nutshell: “Press the chest – fast and deep” until an Automated External Defibrillator (AED) is utilized (and again after, if necessary), EMS arrives, or the person shows signs of life.

Note rescue breaths are not included in this list. The AHA (American Heart Association) does recommend rescue breaths at a rate of 30 compressions to 2 breaths when the rescuer has been trained and is confident in the technique, so interruptions to the compressions are no more than 10 seconds (and still stresses the importance of breaths when performing CPR on children and infants). The AHA has recognized “hands-only” CPR is an effective alternative when the rescuer is not confident in their ability to provide ventilations or is untrained. Hands-only CPR also removes the potentially uncomfortable step of placing one’s mouth onto the mouth of a stranger if no CPR mask or shield is available.

Never hesitate to attempt CPR, regardless of experience or skill level. Someone in cardiac arrest is already clinically dead, and you cannot make them any more dead! Any CPR is better than no CPR, and if there is an AED handy, it should be retrieved and deployed as quickly as possible for the victim’s best chance for survival.  

Remember: “Press the chest – fast and deep!”

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Hypertrophic cardiomyopathy (HCM) is the leading cause of heart-related sudden death in people under the age of 40. According to the HCM Association website, publications from the 2000’s indicate that HCM is the most common of all genetic heart conditions affecting over 1 in 500 people in the general population. Based on these data we may estimate that between 700K and 725K people in the United States have HCM. Symptoms may be mild, and many times are dismissed as attributable to other conditions. An ECG (electrocardiogram) can identify this condition 90% of the time. Once detected, either through an ECG or a physical exam, an echocardiogram can confirm HCM.

Hypertrophic cardiomyopathy is a thickening of the heart muscle walls, making it more difficult to pump blood effectively.  While many people can have this condition but never experience symptoms and never even know they have it, for some, it is severely life-threatening. In HCM,  the cells which make up the heart are not aligned normally; this abnormality is called “myocardial disarray”. This disarray is usually not present in 100% of the heart muscle but affects it in patches.

It is theorized this patchy “disarray” is what interferes with the electrical impulses of the heart, causing abnormal heart rhythms (arrhythmia), which may lead to sudden cardiac arrest during times of physical exertion. This occurs most publicly among young male athletes, with basketball and soccer players leading the list. There are countless news stories about seemingly healthy individuals suddenly collapsing on the court or field. Around 14% of the time, autopsies reveal hypertrophic cardiomyopathy is the culprit – a condition which could have been identified with a routine ECG. In some cases, athletes are able to be revived through CPR and early defibrillation with an automated external defibrillator (AED), making the case not only for CPR training of anyone in a sports leadership position (athletic trainers, coaches, umpires, referees), but better access to AEDs, and more thorough prescreening procedures to identify those athletes at risk as well.

Hypertrophic cardiomyopathy does not have to be a death sentence. Knowing you have the condition is the best defense against an unexpected event. Most people with the condition live normal, active lives. It definitely does not mean you should not exercise at all. In fact, not exercising is detrimental to your overall health and may lead to obesity and other health concerns which could impact your heart such as high cholesterol and high blood pressure. However, high-impact and competitive sports are not recommended.

Treatments for HCM vary depending on the severity of the condition in individual patients. One of the most effective treatments for identified high-risk HCM patients is an implantable defibrillator which will administer a shock any time it senses the heart has gone into a shockable rhythm, ventricular fibrillation or ventricular tachycardia. Medications prescribed for HCM are designed to treat symptoms of the condition, rather than the condition itself for which there is no cure. Beta-blockers and calcium channel blockers help the heart contract and relax and may be prescribed to relieve pain in the chest and shortness of breath during exercise. Blood thinners are sometimes prescribed to reduce the risk of blood clots (if there is an arrhythmia present due to atrial fibrillation).   

Occasionally, circumstances or other conditions prevent patients from taking medications or receiving an implantable defibrillator.  In these instances, surgery may be an option. When blood flow out of the heart is severely blocked, symptoms can become severe. An operation called surgical myectomy may be done where a portion of the thickened heart muscle wall is removed to allow better blood flow. In other cases, patients may be given an injection of alcohol into the arteries which feed the thickened part of the heart (alcohol septal ablation). The bulging wall shrinks, allowing for better blood flow. People who have this procedure often show much improvement.

Since hypertrophic cardiomyopathy is genetic, it is recommended people with an immediate family (parents, siblings, children) history of sudden cardiac death be evaluated by their physician if they have exhibited any of the following symptoms (from the Cleveland Clinic website):

• Chest pain or pressure that usually occurs with exercise or physical activity, but also may occur with rest or after meals.
• Shortness of breath and fatigue, especially with exertion. These symptoms are more common in adults with hypertrophic cardiomyopathy and are most likely caused by a backup of pressure in the left atrium and lungs.
• Syncope (fainting or passing out) may affect HCM patients. Syncope with HCM may be caused by irregular heart rhythms, abnormal responses of the blood vessels during exercise, or no cause may be found.
• Palpitations (fluttering in the chest) due to abnormal heart rhythms (arrhythmias) such as atrial fibrillation or ventricular tachycardia. Atrial fibrillation occurs in about 25 percent of those with HCM and increases the risk for blood clots and heart failure.

There may be no cure for HCM, but understanding the implications of living with this condition are critical to survival for those who have it.

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Bypass heart surgery is exactly what it sounds like. If you think about a highway bypass, which offers an alternative route to congested city driving, you get the general idea. In this case, it is blood, which needs to be rerouted due to clogged coronary arteries which normally supply oxygen-rich blood to the heart muscles. Blockages are generally caused by a buildup of plaque on the walls of the blood vessel.  If the plaque ruptures, a blood clot will form around the plaque.  This can significantly block blood flow through the artery, and the heart muscle supplied by this artery begins to die due to lack of oxygen and nutrients. This is called a heart attack or myocardial infarction.

In order to reroute the blood around the blockage, a strong, healthy, clear vein must be grafted to the existing coronary arteries before and after the block. If there is more than one blocked artery, multiple grafts may be needed – hence the terms “bypass” (one), double bypass (two), triple bypass (three) and quadruple bypass (four). It is very rare for a quintuple bypass to be performed, but it does occasionally happen.

In traditional, open-chest bypass surgery, a vein is harvested from the patient’s leg or wrist for the graft (the more bypasses which need to be made, the longer the vein must be). The patient’s sternum is cut open with a saw and the ribs spread. Blood is re-routed through a heart/lung machine to keep oxygenated blood flowing to the patient’s brain and vital organs, and the heart is stopped. The surgeon goes to work sewing the re-routed vein to the arteries before and after the blockages, opening up the pathways for blood to flow freely again. Recovery for this kind of surgery averages around two months, depending on the general health of the patient.

A new kind of bypass surgery, called Totally Endoscopic Coronary Artery Bypass (TECAB) Surgery is now being performed at some hospitals. This breakthrough surgery utilizes the Da Vinci Surgical System robot which accesses the heart through five finger-tip sized slits in the chest. There is no need to saw through the sternum or spread the ribs. According to the University of Chicago hospital website, with the Da Vinci Surgical System, “The surgeon sits in a console equipped with controls that direct robotic arms to perform the surgery. The robotic arms are very agile and work as an extension of the surgeon’s hands. A tiny camera attached to the robotic arms gives the surgeon a very detailed, three-dimensional view of the operating space inside the chest.” Advantages to this type of surgery include a much shorter recovery time, (according to the same website, “Most patients are back to work and/or other activities within a week, compared to four to eight weeks with open-chest bypass.”), shorter hospital stay, less chance for infection, minimal blood loss, minimal scarring, and sometimes, it can be performed without stopping the heart.

Dr. Vincent Gaudiani, a cardiologist at the California Pacific Medical Center, in his 3-part video series showing a live open-chest bypass, described surgery as “controlled injury that has a therapeutic aim.” TECAB would appear to minimize this injury to a significant degree.

Angioplasty & Stents

Sometimes bypass surgery is not necessary, and balloon angioplasty to open blocked arteries can be performed. With this procedure, a catheter is threaded through the patient’s groin or wrist arteries, the end of which is capped with a tiny balloon. When the constricted area is reached, the balloon is inflated and deflated in succession, inflating a little more each time to increase the cleared area. Sometimes a stent is inserted at the same time to hold the artery walls open. To install the stent, it is placed over the deflated balloon prior to insertion and, when the balloon is in place and inflated, the inflated balloon expands the stent, which locks in place. The balloon is deflated and removed, but the stent remains within the artery, hopefully keeping the artery clear indefinitely. Some stents are even coated with medications to prevent further clotting.

The procedure is minimally invasive and usually only requires a night or two in the hospital. The majority of experienced pain will be at the insertion site, and recovery is relatively quick.

If you suspect you may have heart-related issues, please take the time to visit your doctor. There are many options available, from surgical and medicinal, to relatively simple lifestyle changes, which can treat life-threatening heart problems before they become fatal.

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October is Sudden Cardiac Arrest (SCA) Awareness Month! Although SCA awareness is always our objective, every year at this time AED Superstore tries our best to bring SCA awareness to the forefront of the general public. This year we decided to take a slightly different tack and conducted a survey (of more than 6000 people) to garner just what the average person knows about sudden cardiac arrest and how to help.

Sudden cardiac arrest strikes more than 300,000 people each year[1], and sadly, only one out of ten victims survive[2]. Those statistics are grim. Lifestyle, fitness level, and age are not determining factors for those at risk. It can happen to anyone, at any time, anywhere. The only way to improve survival rates is to improve the response by the general public.

Our study determined only 6% of respondents would know what to do if faced with a sudden cardiac arrest event. When people get involved, including calling for emergency services, starting CPR, and sending someone for an AED (automated external defibrillator), survival rates can increase from a nearly hopeless 10% to a much more encouraging 38% or better[3]. In fact, using an AED in the first few minutes of an event can increase SCA survival rates by up to 90%[4].

Our study confirms many potential responders hesitate to provide assistance – while 50% of those surveyed would call 911, only 26% would feel comfortable performing CPR and only 10% would use an AED. Some feel reticent to help believing they may cause further injury. The fact is, an SCA victim is technically deceased and will remain so unless steps are taken to keep blood flowing until a defibrillator can be applied. Some bystanders worry about culpability or litigation from the victim or their family. Good Samaritan laws offer legal protection when help is given in good faith[5], but only 34% of those responding were aware of these protections. If you haven’t had CPR training, you can still help by calling 911, sending someone for an AED, and pushing hard and fast in the center of the victim’s chest until help arrives.

We were shocked to find 62% of respondents were unaware AEDs have voice prompts to guide the rescuer and do not shock regular heart rhythms, and when they were asked if knowledge of these contingencies would increase the likelihood they may assist in such a situation, 64% believe they would be more willing to help.

Effective CPR and early defibrillation are keys to enhancing the chance of survival for every SCA victim. AEDs can be hard to find, but their numbers are increasing every day – in those surveyed, 64% believe AEDs should be available in their workplaces. There are also apps for smartphones (PulsePoint, AEDRegistry, Atrus’ AED Link, MyHeartMap) which can help locate an AED in the vicinity. EMS dispatchers may be able to help in locating nearby AEDs and may also be able to guide you in performing CPR.

Speaking of CPR, yes, it is a good idea to be trained! We found 61% of those responding to our survey had CPR training at some point in the past, but only 14% had active CPR certifications (training in the last two years). If you haven’t been trained, you can also just give it your best shot by pushing hard and fast in the center of the chest to the beat of the Bee Gees’ “Stayin’ Alive” or Queen’s “Another One Bites the Dust”. We can all make a difference in the outcome of this indiscriminate killer’s ominous statistics. Do the best you can, but more importantly, do something!

Footnote1:

1 https://www.heart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_470704.pdf

Footnote2:

2 https://www.heart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_470704.pdf

Footnote3:

3 https://www.ncbi.nlm.nih.gov/pubmed/20394876

Footnote4:

4 https://www.suddencardiacarrest.org/aws/SCAA/pt/sd/…

Footnote5:

5 https://en.wikipedia.org/wiki/Good_Samaritan_law

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Too often, people tend to lump major life-threatening physical conditions together. While heart attack and stroke both get a lot of press, they are completely different conditions with very different symptoms, treatments, and outcomes. They do have two things in common – they are both commonly caused by blockages of arteries, and they can both result in death.

Heart Attacks are caused by a blockage in the arteries of the heart (as the name would imply). Without a supply of oxygenated blood, the part of the heart supplied by the blocked artery begins to die. This muscle death can cause a range of symptoms such as a feeling of crushing pain in the chest, numbness of the left arm, shortness of breath, shoulder or back pain, sweating, and nausea. The victim is typically awake and able to describe their pain. They need to get to a hospital without delay. If someone complaining of heart attack symptoms suddenly collapses and is no longer responsive or breathing normally, the heart attack has escalated into sudden cardiac arrest. Call 911 and begin CPR immediately. Defibrillation with an AED may be necessary to reset the heart’s rhythm. If one is available it should be utilized as soon as possible – ideally within 3 to 5 minutes. If no AED is available, continue CPR until EMS help arrives.

Stroke is typically caused by either a blockage of a blood vessel in the brain or by a rupture of a blood vessel in the brain. This can result in symptoms including “sudden difficulty seeing, speaking, or walking, and feelings of weakness, numbness, dizziness, and confusion.” (https://newsinhealth.nih.gov/issue/aug2014/feature1) Numbness or paralyzation on one side of the body is also a notable outward sign of stroke and observers will be able to see it most obviously in the victim’s facial muscles. If you suspect someone is having a stroke, you should administer a simple 4-part test: 1. Ask them to smile. 2. Ask them to speak a simple sentence such as “It is a very nice day.” 3. Ask them to raise both arms. 4. Ask them to stick out their tongue. If they are only able to smile on one side, their speech is slurred or they can’t remember the sentence, they are only able to raise one arm, and/or if their tongue automatically goes to one side or the other, they may be having a stroke. Call 911 immediately and wait for EMS to arrive. They can begin to administer treatment on the way to the hospital. Every minute counts!

Treating a heart attack often includes anticoagulant drugs to thin the blood (liquids move through small openings quicker if they are thinner – the most common of these is simple aspirin) or other drug therapy, catheter procedures to open the arteries without opening the chest, or bypass surgery. Lifestyle changes are also often recommended as part of continuing treatment. Someone who suffers a heart attack can live a relatively “normal” life after leaving the hospital.

Since there are two different kinds of stroke – Ischemic (where the artery is blocked) and Hemorrhagic (where a blood vessel ruptures or leaks blood), there are two different treatments. For an ischemic stroke, treatment is similar to those of a heart attack – anti-clotting drugs or clot-busting drugs can be used to dissolve the clot, or a catheter procedure can be performed to physically open the blocked vessel. For a hemorrhagic stroke, the first thing the doctor will do is try to isolate the location of the bleed. Surgery may be needed. After leaving the hospital, recovery times can vary from days to years depending on the severity of the damage incurred during the stroke and may include both physical and speech therapy.

In cases of both heart attack and stroke, early intervention is the key to favorable outcomes. Heart attack symptoms can go on for hours, days or even weeks and can lead to sudden cardiac arrest if ignored. As strokes affect the brain, they can leave a victim with a road to recovery which involves relearning or improving how they move, think and speak. If there is any indication you are in the presence of someone experiencing a heart attack or a stroke, or if you think you may be having one yourself, the best advice is always to get medical help immediately!

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