Sudden Cardiac Arrest - Is There Hope by anamaulida


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        <p>On June 25, 2009, Michael Jackson, well-known as the King of
Pop, died of cardiac arrest.</p><p>Cardiovascular disease (CVD) is the
leading cause of mortality in the U.S. and the majority of CVD deaths are
attributable to Sudden Cardiac Arrest (SCA) which claims more than
250,000 lives each year. One person dies of SCA-related events every two
minutes. This is equivalent to more 650 deaths each day. Each year, more
people die from SCA than from breast cancer, lung cancer, stroke, or AIDS
combined. 95% of SCA cases are fatal and two-thirds of SCA events occur
in people without any previous indications of heart
disease.</p><p>According to the American Heart Association (AHA), SCA
occurs when electrical impulses in the heart become rapid or chaotic,
which causes the heart to suddenly stop beating. The blood supply to the
rest of the body ceases and without the blood supply, the oxygen supply
is also cut off, resulting in tissue damage and death. Because of its
suddenness, cardiac arrest is also called sudden death or sudden cardiac
arrest (SCA) or sudden cardiac death.</p><p>Cardiac arrest is not a heart
attack. It is a widespread misconception that SCA is synonymous to a
heart attack. In order to educate the public, the AHA and the Sudden
Cardiac Arrest Coalition (SCAC) are quick to point out the difference. A
heart attack or myocardial infarction occurs when the arterial supply or
coronary arteries are compromised or blocked, thus cutting off the blood
supply to the heart. And if allowed to continue will eventually lead to
infarction or injury to the heart muscles. "The term "massive heart
attack" is often wrongly used in the media to describe sudden death." The
SCAC has a beautiful analogy to explain to the general public: "If you
think of your heart as a house - SCA would be a problem with the
electricity; a heart attack would be a problem with the
plumbing."</p><p>Cardiac arrest is not heart failure. In cardiac arrest
the electrical failure of the heart is sudden and unexpected, whereas
heart failure is progressive but slow, thus allowing time for heart
failure patients to eventually be considered as possible heart transplant
candidates.</p><p>Some people are more at risk for SCA than
others.</p><p>(1) SCA deaths are more common among women aged 35 to 44
years old compared to men of the same age. Women have also a less chance
of recovering from SCA than men.</p><p>(2) African Americans have a much
higher risk to suffer from SCA-related events than whites and other
ethnic groups. They also have less than a 1% chance of surviving, much
lower compared to the 5% survival chance in the general
population.</p><p>(3) Some underlying conditions especially heart
problems make people more susceptible to SCA than others. Yet, even
healthy individuals without any health problems may suffer from
SCA.</p><p>There many things that can cause the heart to stop abruptly.
Most of the cardiac arrests that lead to sudden death occur when the
electrical impulses in the diseased heart become rapid (ventricular
tachycardia) or chaotic (ventricular fibrillation) or both. This
irregular heart rhythm (arrhythmia) causes the heart to suddenly stop
beating. Some cardiac arrests are due to extreme slowing (bradycardia) of
the heart.</p><p>So what causes the electrical system of the heart to
fail?</p><p>(1) Cardiovascular disease. According to the AHA, in 90% of
adult victims of sudden cardiac death, two or more major coronary
arteries are narrowed by fatty buildups. Scarring from a prior heart
attack is found in two-thirds of victims.</p><p>(2) Electric
shock/electrocution. A strong electric shock, e.g. electrocution and
lighting strikes can cause the heart to stop. Conversely, it also takes
an electric shock to restart the heart.</p><p>(3) Respiratory arrest.
When people cannot breathe during to choking, suffocation, drowning, or
injury, SCA can also occur.</p><p>(4) Strenuous physical activity. There
are cases of athletes suddenly collapsing during training or
competitions. This may be caused by underlying heart abnormalities.
Adrenaline released during intense physical activity acts as a triggering
mechanism for arrhythmia and sudden death.</p><p>(5) Medications. Certain
drugs, prescription or illegal, can interfere with heart rhythms. When
taken in excessive amounts, certain medications can completely stop the
heart. Some of these drugs are: performance-enhancing drugs used in
sports, prescription drugs for heart problems, pain, and sleeping
disorders especially insomnia, and illegal or "recreation"
drugs.</p><p>(6) Trauma. A strong sudden blow to the heart during sports
competition for example, can cause a condition called Commotio cordis
that can trigger ventricular fibrillation and lead to SCA. An injury that
damages the heart can also lead to cardiac arrest.</p><p>(7) Unknown
causes. Unfortunately, a lot of cases of SCA are put down to unknown
causes, often in young, healthy people with no apparent heart disease or
other risk factors.</p><p>How can death from SCA be prevented? Not easy,
in fact, 95% of SCA cases are fatal. To have a chance of surviving,
victims of SCA must receive life-saving defibrillation within the first 4
to 6 minutes of an attack, when brain and organ damage start to
occur.</p><p>Following are ways to restart the heart during
SCA:</p><p>(1) Defibrillators. These are the so-called paddles applied to
the chest to deliver an electric shock to make the heart beat again.
Defibrillators are only available in emergency services and hospitals and
can only be operated by medical professionals.</p><p>(2) Automatic
External Defibrillators (AEDs) are battery-operated portable
defibrillators. Current AEDs are designed to be operable by almost
anybody, even without formal medical training. AEDs are now widely
available in public places where crowds tend to gather.</p><p>(3)
Implantable Cardioverter Defibrillators (ICDs) are implanted in patients
who have a high risk for cardiac arrest from recurrent, sustained
ventricular tachycardia or fibrillation. An ICD automatically reacts to
irregular rhythms of the heart and applies an electrical jolt to restore
normal heart rhythms. According to the SCAC, ICDs are 98% effective at
protecting those at risk for SCA, but only 35 percent of patients who
require this device have one. According to a New York Times article "in
the last two years the number of patients receiving defibrillators has
actually declined, as more doctors and patients decide the risks and
uncertainties the devices pose may outweigh their potential benefits."
More recently, the European Society of Cardiology (ESC) issued a
statement on driving restrictions for patients implanted with
ICDs.</p><p>(4) Cardiopulmonary resuscitation (CPR) works by attempting
to maintain the blood flow to the heart and the brain until more
effective defibrillation can be performed. About 80% of SCA cases happen
at home, just like in the case of Michael Jackson. Therefore, CPR needs
to be performed by bystanders, family members, and people, even without
medical training. Unfortunately, only a third of out-of-hospital SCA
victims receive bystander CPR and many die before the arrival of
emergency services. Immediate effective bystander CPR can double or even
triple a victim's dismal survival chances. A 2008 survey by the AHA
revealed that 80% of respondents said they were willing and able to do
something to help if they witnessed a medical emergency. However, only a
few (12%-20%) are confident that they would know when it is appropriate
to perform CPR or use an AED.</p><p>So, what could have caused Michael
Jackson's cardiac arrest? Some of the possible causes based on Jackson's
personal and medical history (Source: heartwire) include:</p><p>(1)
Overdose of prescription medications. Expectedly this is the most popular
theory but without a toxicology report, this remains speculative. It
seems that Jackson was on prescription painkillers and two that may
possibly be implicated in his death are Demerol (meperidine) and
Oxycontin (oxycodone). Dr Douglas Zipes of Indiana University Medical
School, Indianapolis tells heartwire: "It's really where I would go, but
it's all very speculative at this point. We know that depending on the
type of painkillers, they can depress respiration. The initial stories
are that he gradually slowed his respiratory rate and stopped breathing.
That can create hypoxia, which can produce ventricular fibrillation." The
use of Diprivan for his insomnia has also been implicated. Without an
official toxicology report, all these however, remain as
speculations.</p><p>(2) Complications from lupus. It is not a well-known
fact, but Jackson seemed to have been suffering from lupus, an
inflammatory disease that can also affect the heart and lead to a heart
block.</p><p>(3) Other heart diseases. A heart attack has also been
speculated but the singer did not have a history of heart disease and no
other heart conditions were detected during the most recent routine
physical exam.</p><p>(4) Stress. It cannot be denied that Jackson was
under too much stress. He was having major financial problems and he was
busy preparing for an international concert tour about to start in two
weeks.</p><p>It is without doubt that SCA is a major and deadly health
concern. Advocacy groups including the American Heart Association and the
Sudden Cardiac Arrest Coalition are actively involved in bringing this
issue to the forefront. There are even those who advocate the routine
placement of AEDs in the homes of patients who are at high
risk.</p><p>Yet SCA mortality remains high even in the setting of
bystander CPR and AEDs. WE have a long way to go!<br></p>         <!--

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