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Sudden cardiac death is the result of a sudden cardiac arrest (abbreviated as SCA), which means that the heart stops beating suddenly. The cessation of the mechanical activity of the heart causes ischemia and hypoxia of individual organs and tissues in the human body.
The organ most sensitive to ischemia is the central nervous system. Failure to take immediate action to maintain basic life functions after just a few minutes causes the death of cells in the nervous system, which may lead to clinical death.
Remember – do not hesitate to take CPR action!
The mechanisms responsible for cardiac arrest include: ventricular fibrillation, pulseless ventricular tachycardia, asystole, and pulse-free electrical activity. There are many causes that can lead to SCA. The most common of these is coronary artery disease (these are the vessels that supply blood to the heart). The manifestation of coronary artery disease may be myocardial infarction, the main cause of which is the occlusion of the coronary artery, which causes ischemia and then necrosis of the myocardium. Sudden cardiac arrest may result not only from diseases of the coronary vessels, but also from other elements of the heart, e.g. the heart valves (these are valve defects) or the heart muscle (these are cardiomyopathies) or disturbances in the electrical activity of the heart (these are heart rhythm disturbances). Among other reasons, cardiac arrest may also be caused by, inter alia, water and electrolyte disturbances, injuries (e.g. to the chest or central nervous system), various types of poisoning, allergic reactions, electric shock, asphyxiation or drowning.
The symptoms of SCA include loss of consciousness. Remember, however, that not every loss of consciousness is the result of SCA, as it may be the result of other conditions (e.g. poisoning or injuries) or diseases (e.g. epilepsy or stroke). Another symptom is respiratory arrest that occurs within several seconds of SCA. However, it should be remembered that it may be a complete lack of breathing (i.e. apnea) or single shallow breaths or intermittent loud sighs (so-called wheezes) – then we are talking about agonal breathing. The most important symptom of SCA, however, is the absence of a pulse in the large arteries – in the carotid artery (pulse in the neck) or in the femoral artery (pulse in the groin). There are also a number of other symptoms present in SCA, but they are not specific, e.g. lack of heart sounds (these are phenomena occurring during auscultation of the heart by a doctor), dilation of the pupils and lack of their reaction to light (properly under bright light, the pupils should be narrowing), bruising of the skin and mucous membranes or seizures. It is also possible to diagnose SCA on the basis of an electrocardiogram (so-called EKG) – most often in monitored patients during their hospital stay. You should also be aware of the symptoms of the most common diseases that may precede SCA. These include chest pain, shortness of breath, a feeling of rapid and / or irregular heartbeat, and fainting. They should never be taken lightly. Of course, SCA can also occur without any preceding symptoms.
Basic actions to maintain basic life functions (i.e. resuscitation) must be undertaken immediately after the diagnosis of SCA, because time is extremely important here. Rapid implementation of resuscitation measures increases the chances of survival of a person who has had SCA.
The rules of procedure in SCA are established by the Polish Resuscitation Council. Basic Life Support (BLS) must be implemented promptly by on-site bystanders. These are activities that are carried out without the use of any specialized tools. According to BLS rules, the condition of the person suspected of having cardiac arrest should be assessed first. The BLS uses a simple scheme that is abbreviated as ABC. The letter A (Airway) indicates the need to open the airways, the letter B (Breathing) – artificial respiration, and the letter C (Circulation) – restoration of blood circulation by means of external massage. Their purpose is to ensure at least a minimal flow of blood through the heart. BLS should continue until medical attention arrives to implement Advanced Life Support (ALS).
The sequence of steps that must be taken in a person with SCA is known as the “chain of survival”. The first link in the “chain of survival” is the early recognition of a life-threatening situation and calling for help, that is, notifying the emergency services (eg by phone to the Ambulance Service). The second link is the early commencement of resuscitation activities by the witnesses of the event (i.e. BLS activities). The third link is an early decision to defibrillate. The next link is the early initiation of ALS and post-resuscitation hospital care. Some highly specialized centers use hypothermia. The first three links in the chain of survival are the most important, because the sooner these activities are implemented, the greater the chances of survival for a person with SCA.
It should also be remembered that both in the world and in Poland, we have an increasing availability (including at airports, shopping centers) of automated external defibrillators (AED). These devices are used to restore normal heart rhythm in a patient with SCA. After sticking the electrodes, the device independently assesses the patient’s heart rhythm and decides about the need for defibrillation, so that the device can be operated by the witnesses of the incident without medical training.
In short, when it comes to NZK, every second counts. The sooner you start the rescue operation, the better the chances of the injured person’s prognosis.
Text: lek. Anna Szymanska
Chair and Department of Cardiology, Hypertension and Internal Diseases, Medical University of Warsaw
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