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Myocardial infarction and sudden cardiac arrest are two cardiac emergencies. Both are dangerous to health and life, but their mechanism is completely different. What are the different causes, symptoms and how to help the victim in each case, explains Dr. Szymon Budrejko from the Department of Cardiology and Heart Electrotherapy of the Medical University of Gdańsk, member of the Board of the Heart Rhythm Section of the Polish Society of Cardiology..
- A heart attack is a condition in which blood flow in the coronary vessels is partially or completely blocked. The symptom is sudden and severe chest pain, but this is not always associated with loss of consciousness
- On the other hand, sudden cardiac arrest is a condition in which the mechanical activity of the heart ceases
- SCA will be known primarily after the victim loses consciousness, the lack of a perceptible pulse and breath – says Dr. Szymon Budrejko
- It is a life-threatening condition that requires immediate intervention – adds the cardiologist
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Heart – mechanical and electrical work
– The function of the heart is to pump blood, which, along with oxygen, is delivered to all organs and tissues in the human body. In order for our “pump” to function properly, it needs a stimulus, a kind of starter. The right mode of heart work is no less important; maintaining the proper cycle of its contractions and diasters, that is, proper “steering” – says Dr. Szymon Budrejko.
In the heart, everything begins with an electrical signal – an impulse that “orders” the appropriate cells to contract and relax in the correct sequence. Without the correct rhythm of the heart, that is, the correct cycle of contraction and relaxation of the heart – stimulating first the atria and then the ventricles, there is no proper control. Following an appropriate control signal, the chambers of the heart contract, and they eject blood, pushing it through the heart and from there to the periphery. So there are two different mechanisms at work in the heart: electrical and mechanical. Both are extremely important for the proper functioning of the organ and the whole organism and are inextricably linked with each other.
Heart attack – a blockage in the coronary vessels
– Although in the media it happens that the term “heart attack” is seen, it is worth knowing that in Polish medical terminology such a term does not appear. It is a colloquial term and a tracing paper, the literal translation of the English expression heart attack. The correct Polish name for the condition defined by this term is myocardial infarction. It is worth knowing about it – says Dr. Szymon Budrejko.
A heart attack is a condition in which the blood flow in the coronary vessels is partially or completely blocked, resulting in ischemia and necrosis of the heart muscle. A heart attack occurs most often as a result of rupture and detachment of a fragment of atherosclerotic plaque, which suddenly blocks the coronary vessel. This leads to blood clotting and closure of the vessel lumen.
If the blood supply to a specific area of the heart is obstructed or even cut off, fragments of tissues deprived of nutrients and oxygen in the blood begin to die. This condition can occur, among others, as a result of severe stress, exercise or various inflammatory factors. It is an emergency and urgent intervention is required.
Heart attack – how to help?
A symptom of a heart attack is sudden and severe pain in the chest. A person may be conscious, breathing properly or breathing rapidly, his heart rate is palpable, and his pulse is often increased. Other symptoms of a heart attack may include weakness, paleness and sweating.
– In the event of a heart attack, first aid consists in immediately calling an ambulance, following the instructions of the dispatcher and ongoing monitoring of the victim. It is not necessary to undertake CPR. In this case, the goal is to transport the injured person to a center with specialist cardiological care as soon as possible and to restore the correct blood supply to the heart muscle as soon as possible. The situation changes when the victim develops a sudden cardiac arrest (SCA) as a result of a heart attack (it does not have to happen, but it is possible). SCA can be known primarily after the victim loses consciousness, and there is no perceptible pulse and breath. In such a case, there is a direct threat to life, and the correct procedure is completely different – says Dr. Szymon Budrejko.
Sudden cardiac arrest – a deadly arrhythmic problem
– Sudden cardiac arrest (SCA) is a condition in which the mechanical activity of the heart stops. It could be caused by a malfunction in the “control system” – for example, an arrhythmia that causes the electrical impulse in the heart to spread so quickly and / or chaotically that the heart contracts and relaxes asynchronously, causing the heart to disrupt its cycle. becomes so serious that our “pump” cannot do its job properly and distribute blood properly. The heart stops beating. It is a state of immediate threat to life, requiring immediate intervention – explains Dr. Szymon Budrejko.
As a specialist explains, sudden cardiac arrest can occur, among other things, as a result of “cut off” by the blood during a heart attack. Deterioration or cessation of blood supply to the heart muscle leads to a lack of energy for the “pump” and to mechanical failure of the heart, but can also affect the electrical “control” of the heart and lead to life-threatening arrhythmias. A heart attack may or may not lead to arrhythmias that may result in sudden cardiac arrest. At the same time, sudden cardiac arrest due to arrhythmia can occur not only in a heart attack.
Myocardial infarction is one of the possible causes of ventricular fibrillation or ventricular tachycardia, two life-threatening ventricular arrhythmias that can cause the heart to stop beating. These arrhythmias can also occur in patients whose heart is damaged due to chronic ischemia (i.e. long-term coronary heart disease), even if they have never had a heart attack or have had it a long time ago.
Sometimes SCAs occur as a result of other abnormalities or diseases. These include, for example, genetic heart diseases which, due to ionic disturbances, disrupt the electrical work of the heart and contribute to the onset of arrhythmias. It happens that the signs of this type of disease are diagnosed on a follow-up ECG, but this is not always the case. The history of various cardiac diseases in the patient’s immediate family can be helpful. If someone close to you was resuscitated or had an implanted cardioverter defibrillator (ICD), this is an important diagnostic clue.
Sudden cardiac arrest can also occur as a result of dilated cardiomyopathy-related heart failure. In this case, the heart is seriously damaged as a result of the disease and its work is impaired. However, it also happens that cardiac arrest occurs in an organically healthy heart – in young people, including athletes. Each case requires detailed diagnostics aimed at eliminating the cause of SCA occurrence and preventing possible future incidents.
Sudden cardiac arrest – how to help?
The most important symptom of cardiac arrest is loss of consciousness. In cardiac arrest, in contrast to brief syncope, the patient does not regain consciousness automatically after a while. The patient has undetectable heart rate and is not breathing properly.
In cardiac arrest, the only way to help the victim is to immediately call for help and take resuscitation. Experience and scientific research show that the sooner such action is taken (the main element of which is the so-called external heart massage, i.e. rhythmic compression of the sternum and chest), the greater the chances of survival of the injured persons (therefore it is important to train as many people as possible in this range whenever possible).
Additionally, defibrillation may be necessary, i.e. the delivery of an electrical impulse that will restore the patient’s normal heart rhythm. It is worth remembering that defibrillation can be performed by professional emergency services, but also by AED (Automated External Defibrillator) – an automatic external defibrillator. This device, available in an increasing number of public and non-public points, after connecting to the victim, will independently analyze his heart rhythm, instruct people providing help and perform defibrillation if necessary, thus securing the victim until the ambulance arrives.
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– The AED is so, first of all, it is worth knowing about this device. Then the natural reflex will be to look for it in the event of an event involving the injured person as a result of a sudden cardiac arrest. Second, stay calm, reach for the layout, and read the instructions. The device will guide us step by step; As we provide AED assistance, we learn what to do next. It is worth knowing that defibrillation will be performed by the system only when the device deems it necessary based on its analysis. Otherwise, it will tell you what to do next. Either way, the use of an AED for a cardiac arrest victim will certainly not hurt – remember that and do not be afraid to use this system. SCA is a state of immediate threat to life. Immediate defibrillation and restoration of the heart rate is often the only chance to survive and avoid disability, disability! – appeals Dr. Szymon Budrejko.