Download Sudden Cardiac Arrest (SCA)

Cardiopulmonary Resuscitation
(CPR) and Automated External
Defibrillator (AED) Education
Victoria L. Vetter, MD, MPH,
Youth Heart Watch Medical Director
Danielle Haley, MPH, Youth Heart
Watch Coordinator
Sudden Cardiac Arrest (SCA)

A condition in which the heartbeat stops
abruptly and unexpectedly.

The instantaneous loss of electrical heart
function.

Usually caused by ventricular fibrillation (VF)
− An abnormality in the heart's electrical system which
causes the heart to quiver and blood flow to the body
and brain to stop.
What Causes Sudden
Cardiac Arrest?



An abnormality in the heart, either in the
electrical system or in the heart’s structure
or function.
Over half to three quarters of the time, the
abnormality is not diagnosed prior to the
arrest and SCA is the first symptom.
Many of these conditions are inherited, so it
is important for family members to be
aware of their family history.
What Conditions Cause SCA?
The most common categories include
 Congenital Heart Disease
–Abnormal Heart Structure

Cardiomyopathies
–Abnormal Heart Function

Primary Electrical Disease
–Abnormal Heart Rhythm
What Conditions Cause SCA?


Coronary Artery Anomalies
Acquired Heart Disease
–Myocarditis (heart infection)
–Drugs
–Commotio Cordis (blow to chest)
Symptoms of
Sudden Cardiac Arrest

Warning signs and symptoms
– Fainting with exercise
– Rapid heart or irregular heart beats
(palpitations) with exercise
– Chest pain with exercise
– Shortness of breath with exercise (not
related to asthma)
– Extreme or unexpected fatigue
Risk Factors for
Sudden Cardiac Arrest



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Family history of known heart abnormalities or
sudden death before age 50 years
Family history of Long QT Syndrome, Brugada
Syndrome, Hypertrophic Cardiomyopathy,
Arrhythmogenic Right Ventricular Dysplasia or
other Congenital Heart Disease
Family members with unexplained fainting or
seizures
Use of drugs such as cocaine, inhalants,
“recreational” or club drugs
Lesions Associated with
Sudden Cardiac Arrest
Commotio
 Cardiomyopathy (CM)
Myocarditis
Cordis
 Hypertrophic (HCM)
5%
5%
 Dilated CM (DCM)
Cor Art
12%
 Right ventricular CM (ARVC)
ARVD/CM
 Primary Electrical Disease
5%
 Long and Short QT Syndromes
 Brugada syndrome
CHD
8%
 Ventricular tachycardia
LQT/Electrical
WPW
Marfan
Disease
2%
 Primary ventricular fibrillation
15%
5%
 Wolff-Parkinson-White (WPW)
Parent Heart Watch Database
 Congenital Heart Disease (CHD)
 Coronary Artery Anomalies
 Acquired Heart Disease
 Myocarditis
 Drugs
 Marfan Syndrome
 Commotio Cordis
HCM
43%
How Common Are The Conditions
That Cause SCA?
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
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Hypertrophic Cardiomyopathy
1/500
Other Cardiomyopathies/Myocarditis 1/1000
Long QT Syndrome
1/2000
Wolff-Parkinson-White (WPW)
1-3/1000
Brugada Syndrome
1-3/10,000
Other Primary Electrical Conditions
1/1000
Coronary Artery Anomalies
1-3/1000
Total
~ 4-6/1000
Hypertrophic Cardiomyopathy
Diagnosis
• Enlarged heart
• Thickened ventricular
septum on
echocardiogram or MRI
• Abnormal
electrocardiogram
Gene mutations
-MYH7, MYBPC3...
Long QT Syndrome
Characteristics
 Prolonged
QT Interval
 Synope/Fainting/Seizures
 Malignant
Ventricular Arrhythmias
– Torsades de Pointes
 Sudden
QTc = 580 ms
Death
Coronary Artery Abnormalities



Right or Left Coronary Artery
from wrong/opposite Coronary
Cusp.
Causes 10-20% of sudden death
in athletes.
During exercise, ventricular
fibrillation occurs.
Who Is At Risk for
Sudden Cardiac Arrest?



Athletes
General & Selected Child
and Adolescent Population
– Known congenital heart
disease
– Undiagnosed cardiac
conditions
– Exposure to drugs,
medications, toxins,
infectious agents
Infants or Neonates
How to Recognize and
Prevent SCA

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When SCA occurs, the heart stops beating
and doesn’t pump blood to the body.
The person suddenly passes out, and
appears lifeless—except for abnormal
“gasping” or seizure-like movements.
The SCA victim is unconscious and needs
immediate help.
If nothing is done, the victim will die within
minutes.
Problems with Identification of
Conditions that Cause SCA

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There is a relatively low frequency of these
conditions in the population.
The conditions that cause SCA may not be
apparent on routine physical exam.
Symptoms may not be present prior to the SCA.
ECG/ECHO Findings: It may be difficult to
distinguish true disease from athlete’s heart due
to training.
The Problem…
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20% of our population can be found on a
school campus on any given day.
420,000 Americans die each year from
SCA, including more than 2,000 children.
Every minute of delay following SCA
decreases the chance of survival by 10%.
…Why the Solution is CPR and
AED Education in Schools


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Broad deployment of AEDs and
increased bystander CPR could
prevent as many as 50,000 deaths
each year.
AEDs can be safely placed in schools.
The best chance of SCA survival is
prompt recognition, and a planned
emergency response.
Sudden Cardiac Arrest
Prevention

What is Primary Prevention for SCA?
– Any method to prevent sudden cardiac arrest from occurring
in order to reduce sudden cardiac death, usually by
identification of a predisposing condition and early
intervention.
o Optimize Screening
o Identify and Treat High-Risk Children
o Medication
o Lifestyle alterations
o Implantable Cardioverter Defibrillator (ICD)
Sudden Cardiac Arrest
Prevention

What is Secondary Prevention for SCA?
– Any methods to prevent sudden cardiac death
from occurring once someone has experienced
a sudden cardiac arrest.
o Cardiopulmonary Resuscitation (CPR)
o Automated External Defibrillator (AED)
o Implantable Cardioverter Defibrillator
(ICD)
Chain of Survival
The chain of survival refers to five events that must occur
quickly to optimize a person's chance of surviving a cardiac
arrest. The five links of the chain:
1. Immediate recognition of cardiac arrest and activation of
the emergency response system.
2. Early CPR with emphasis on chest compressions.
3. Rapid defibrillation to establish a normal heart rhythm to
a person suffering a cardiac arrest. It is most effective
when it is performed in the first few minutes of a cardiac
arrest.
4. Effective advanced life support.
5. Integrated post-cardiac arrest care.

How to Recognize and
Prevent SCA

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When SCA occurs, the heart stops beating and
doesn’t pump blood to the body.
The person suddenly passes out, and appears
lifeless—except for abnormal “gasping” or
seizure-like movements.
The SCA victim is unconscious and needs
immediate help.
If nothing is done, the victim will die within
minutes.
If the Victim is Unresponsive
 The
first responder should call 9-1-1 and start CPR
immediately.
 Someone else should get the AED. Don’t wait for a
responder to ask for it. If you see someone collapse
suddenly, make sure someone gets the AED, even if
you don’t know what has happened.
 Know that time is essential, and this requires a
rapid response from everyone involved. Seconds
count.
 One person should stay near the front door to
direct EMS responders to the scene.
How to Perform
Hands-Only CPR

If you see a person suddenly collapse,
just remember these two easy steps:
– Call 9-1-1
– Push hard and fast on the center of
the chest
How to use an Automated
External Defibrillator

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Verify the victim is unconscious or
without signs of circulation.
Turn on AED and attach electrodes.
The AED ANALYZES the heart rhythm.
Follow the voice prompts and screen
messages.
How You Can Save a Life

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Survival from SCA requires immediate
intervention, frequently by bystanders
like you.
Prompt treatment could save 40-80%
of those experiencing SCA.
An increase in the current survival rate
to only 20% would save 50,000 lives
each year.
For more information about
CPR/AED programs, education and
training, contact Youth Heart Watch
Phone: 267-426-7389
E-mail:
[email protected]