What is cardiac arrest?

Cardiac arrest is a medical condition where the heart stops functioning leading to a loss of breathing and consciousness. A cardiac arrest happens when the heart stops pumping blood leading to no flow of blood in the body, particularly the brain and resulting in death. 

Generally, the heart makes the blood in the upper chamber or atrium and then supplies the blood to the other organs in the body through a network of heart valves. However, in cardiac arrest, the upper chambers of the heart crash and stop functioning and thus, there is no supply of blood to the body. Alternatively, the bottom chambers, known as ventricles, stop beating and become identical to thick gooey masses that do no produce a heartbeat or supply oxygen and blood to the other organs of the body. 

This sudden crash of the system causes a complete loss o heartbeat, consciousness and can lead to an untimely death, if not resurrected timely. As per research, 95% of people who experience a cardiac arrest succumb to death. Also, each year in India, more than 10% of the total deaths occur because of cardiac arrest. It is also the most common cause of death in the entire world.

Symptoms of cardiac arrest

Mostly, a cardiac arrest is very sudden and hence, does not produce any significant signs and symptoms. However, some of the common symptoms of cardiac arrest include:

  • Abruptly racing heartbeat
  • Extreme anxiety
  • Dizziness
  • Dangerous heart rhythm
  • Fluttering ventricles
  • Frozen body temperature and numbness 
  • Sudden collapse
  • Painful and difficult breathing
  • Loss of pulse

That said, most of these signs appear very close to a cardiac arrest. However, some of the other symptoms that could indicate the upcoming dysfunctionality include:

  • Chest pain or discomfort
  • Shortness of breath
  • Fatigue 
  • Weakness
  • Palpitations

Apart from these, even if a person does not have these symptoms but experiences any irregularities in heart functioning, a doctor should be contacted immediately. Some of the irregularities include:

  • Chest pain or discomfort
  • Rapid or irregular heartbeats
  • Continuous unexplained wheezing
  • Shortness of breath
  • Extreme heart palpitations
  • Loss of consciousness
  • Dizziness and blurriness of sight

Mostly the symptoms of a cardiac arrest are very short-lived and hence, there is not much time to act before the heart stops functioning. Therefore, it is very important to get immediate medical treatment upon experiencing any of the above signs. Moreover, avoiding all cardiac arrest causes and staying clear of factors that can trigger a cardiac arrest, is the best way to prevent this problem.

Heart conditions that can cause a cardiac arrest

A few heart issues that could potentially cause a cardiac arrest include:

Coronary artery disease: This causes the coronary arteries of the heart to become narrowed or clogged due to build-up of cholesterol and fatty items called plaque. 

Heart attack: A heart attack in many cases occurs because of severe coronary artery disease and can cause ventricular fibrillation leading to a cardiac arrest. A heart attack can also cause scar tissue, which can cause abnormalities in the functioning of the heart.

Enlarged heart: An enlarged heart can also cause cardiac arrest. An enlarged heart is indicative of weak heart muscles, coronary heart disease, or a valve problem. 

Congenital heart disease: Congenital heart disorders, including Brugada syndrome (BrS) and long-QT Syndrome (LQTS), can potentially lead to abnormal heartbeats and rhythms. These birth defects can cause intense complications for adolescents and children. Also, people who have a history of congenital heart disease surgery are at high risk of cardiac arrest.

Valvular heart problem: A valvular heart problem occurs when there is a damage or defect in any of the four valves of the heart. A leakage or narrowing of the valve hampers the normal functioning of the heart, causing the heart muscles to stretch and thicken obstructing the blood flow. Further, this issue causes stress on the enlarged or weakened heart chambers, thereby, causing irregularity of heartbeat and rhythm.

Risk factors of cardiac arrest

A few factors that make a person more prone to experience a cardiac arrest include:

  • Age – Men above 45 and women beyond 55
  • Medical history of heart attacks
  • A family history of heart issues or cardiac arrest
  • High blood pressure
  • Smoking
  • Excessive consumption of alcohol
  • High blood cholesterol
  • Overweight and obesity
  • Diabetes
  • Physical inactivity 
  • Abuse of drugs
  • Deficiency potassium and magnesium
  • Fatal kidney diseases

Treating of cardiac arrest

Since cardiac arrests are sudden, only immediate medical help can ensure survival. It is important to take prompt action and have an immense presence of mind to adopt the right medical approach. The heart can be revived if the patient receives treatment within the first minutes of an arrest. But every minute that is lost, reduces the chances of survival by 10%.

Here are some treatment options for a cardiac arrest:

CPR: CPR – Cardio-Pulmonary Resuscitation, includes chest compressions and mouth-to-mouth rescue breathing support to restore blood circulation. A person should give CPR to the patient until medical help is received.

Defibrillation: Defibrillation involvesdelivering electrical shocks through the chest wall to the heart muscle to revive it. This process aims to temporary stop the heart and the irregular rhythm. Once the heart is revived, the heartbeat is regularised. The defibrillators are configured such that they only send out signals when it is appropriate.

Long-term treatment: Once the patient is stabilised, the doctor will discuss the long-term treatment options to secure the heart from future cardiac arrests. These will include:

  • Drugs 
  • Implantable cardioverter-defibrillator (ICD)
  • Coronary angioplasty
  • Coronary bypass surgery
  • Radiofrequency catheter ablation
  • Corrective heart surgery

However, there is no better way to avoid cardiac arrest than to maintain a healthy lifestyle. Irrespective of the age or gender, a healthy lifestyle is very useful to avoid a cardiac arrest. Some healthy lifestyle habits that can prevent cardiac arrest include:

  • Opting for healthy eating food choices and habits
  • Increasing physical activeness
  • Getting regular check-ups done
  • Avoiding smoking or even passive smoking
  • Reducing stress 
  • Maintaining a healthy weight
  • Limiting alcohol intake

It is important to make these healthy lifestyle modifications a part of life. A person should aim to be more active and always be alert to his/her overall health. Regular medical check-ups can go a long way in detecting several issues in advance to minimise complications.

Paediatric Cardiologists

A paediatric cardiologist is a doctor that specialises in the diagnosis and treatment of heart conditions in children under the age of 18 years, including infants. Heart issues in children can occur due to various reasons, including:

  • Genes
  • Birth defects
  • Unhealthy lifestyle
  • Improper growth in the mother’s womb
  • Smoking and consumption of alcohol by the mother during pregnancy
  • Lack of proper nutrition by the mother during pregnancy
  • Trauma, injury or stress faced by the mother during pregnancy

Most of the problems in children develop when they are in the uterus. However, some issues occur due to specific illnesses that occur during childhood. Cardiac issues in children need to medically treated by a paediatric cardiologist.

A paediatric cardiologist holistically treats heart problems in children of all ages. A paediatric cardiologist can provide care for patients through various stages including pregnancy, infancy, childhood, teenage, and later years. Paediatric cardiologists obtain specialised training since children require more effective and attentive care as compared to adults.

A paediatric cardiologist is also primarily trained in general cardiologist and then goes on to further get expertise in treating heart problems specifically in children. A paediatric cardiologist provides all-round care for the healthy growth and development of a child. Paediatric cardiology involves treating minor issues such as irregular heartbeat and rhythm, as well as complicated matters of the circulatory function issues. Moreover, paediatric cardiologists are trained specially to provide comprehensive care to the child in the best possible manner. Essentially, paediatric cardiology is a branch of general cardiology, which focuses on the diagnosis, prevention and treatment of heart problems and defects in children.

Symptoms of heart issues in children

Children are different from adults and hence, the symptoms in both differ. A child needs to be treated by a paediatric cardiologist if he/she displays any of the below symptoms:

  • Blue lips and skin
  • Difficulty in feeding (sweating, breathlessness, etc.)
  • Shortness of breath
  • Palpitations
  • Poor growth
  • Pale skin
  • Fatigue
  • Weak immunity
  • Heart murmur
  • Fainting
  • Lack of physical activeness
  • Chest pain

The above symptoms could indicate a potential heart issue in children and hence, should be given immediate medical attention. Paediatric cardiologists work closely with cardiothoracic surgeons, paediatricians focussed on other specialities, as well as specialised nurses and staff to provide superior, patient-centric and family-oriented care for children. 

Conditions treated by a paediatric cardiologist

A paediatric cardiologist can treat all conditions related to the heart of children. Some of the most common issues treated by paediatric cardiologists include:

  • Infancy cardiovascular collapse
  • Cardiac failure
  • Newborn cyanosis
  • Heart murmurs
  • Chest pain, palpitations
  • Fatigue and fainting
  • Congenital heart problem
  • Cardiovascular defects
  • Cardiac abnormalities
  • Heart transplant
  • Aortic valve stenosis
  • Arterial trunk
  • Atrial septal defect (ASD)

A paediatric cardiologist makes a general physical exam and then conducts various other medical tests including imaging tests (X-rays, ultrasound, MRI, CT scan, etc.), blood tests, and others. But the treatment of a particular issue depends on the type of problem, age of the child, medical history, family history, general health of the child and the severity of the condition. 

That said, in terms of treating a condition, the approach adopted by a paediatric cardiologist is similar to that of a general cardiologist. However, the former is more intensive and precise in handling the child. In general heart surgery, the paediatric cardiologist opens the chest cavity of the patient and divides the chest bone to access the heart. During this time, the heart of the patient is connected to a heart-lung bypass machine, which substitutes the functioning of the heart, allowing the cardiologist time to perform the surgery with utmost precision. Once the issue is treated, the cardiologist seals the chest incision with sternal wires. These wires are used to bind the separated chest wall and eventually dissolve on their own. The staples used are removed after 7-14 days and the glue wears off on its own. Overall, the recovery usually takes 6-8 weeks. This is an open-heart surgery, which is performed by a paediatric cardiologist to treat various conditions. However, the applicability of this procedure is only in extremely severe cases, when other non-invasive and minimally invasive forms of treatment fail to provide any result. 

The main difference between a general cardiologist and paediatric cardiologist are the types of problem, the intricacy of the surgery, and the approach or procedure of the surgery. That said, in many cases, minor heart issues in children tend to resolve on their own or with some minimum treatment administered by a qualified paediatric cardiologist. In case of slightly major issues, medications or minimally-invasive forms of treatment can be used by the paediatric cardiologist. However, for intense and critical cases, the paediatric cardiologist will perform invasive surgical procedures to treat the issue. But it is very important to take proper consultation and understand the issue of the child and the best treatment possible. It is very critical to select a qualified and attentive paediatric cardiologist that can provide superior care and treatment to the child.

Cardiac Arrest Causes

Cardiac arrest is the sudden loss of heart function, leading to shortness of breath and loss of consciousness. Cardiac arrest typically occurs because of a disturbance in the electrical system of the heart, which hampers the pumping action and thereby stops the normal flow of blood to the body. 

A cardiac arrest is different from a heart attack, where only a part of the heart muscle is devoid of blood. But a heart attack can often cause a cardiac arrest by hampering the electrical activity of the heart. 

A cardiac arrest is a very serious condition and if not treated timely and adequately, it can lead to death. However, with fast, responsive and immediate care such as CPR (Cardiopulmonary resuscitation), defibrillator or chest compressions, chances of survival can be improved until medical care is received. 

Causes of Cardiac Arrest

The most common cause of a cardiac arrest is the problem or an irregularity in the heart rhythm. This condition is medically known as arrhythmia and occurs because of disturbance in the electrical activity of the heart. 

Generally, in a human body, the heart’s electrical system is responsible for controlling the rate and rhythm of the heartbeat. In case there is a problem in the heart, the heartbeats too fast or too slow or irregularly. Most often such episodes are brief and do not cause much harm. However, in some cases, these irregularities can lead to a sudden cardiac arrest. 

Most often the cause of a cardiac arrest is an arrhythmia which occurs in the lower chambers of the heart, called ventricles. The lower chambers receive erratic signals, which causes useless quiver instead of the pumping action of blood.

That said, some heart conditions could also possibly lead to a cardiac arrest. Arrhythmia usually develops in people that have either of the below-mentioned heart disorders. However, it can occur even in people who have no known heart issues.

Some significant heart conditions that can cause cardiac arrest include:

Coronary artery disease: In this type of heart issue, the arteries of the person become clogged or narrow due to build-up of fat and fibrous substances, called plaque. This comprises of cholesterol and other harmful substances that tend to stick to the wall of the arteries and block the flow of blood to the heart muscle. Coronary artery disease can lead to cardiac arrest in many people. Some significant causes that tend to block the arteries include:

  • Bad cholesterol
  • Consuming trans and saturated fats
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Obesity and excessive weight
  • Smoking tobacco
  • Family history
  • Increasing age
  • Stress
  • Lack of physical exercise
  • Drug abuse

Heart attack: A heart attack occurs when a part of the heart muscle diesdue to loss of blood supply, which could be because of various reasons. The most common reason for a heart attack is when an artery supplying blood to a part of the heart is blocked due to a blood clot.Most often heart attacks lead to ventricular fibrillation, which can, in turn, cause a cardiac arrest. Moreover, a heart attack can also cause a scar tissue in the heart that disturb the electrical activity, leading to arrhythmia.

Enlarged heart: Also medically referred to ascardiomegaly,an enlarged heart implies that the heart is bigger than the normal. Typically, a heart becomes enlarged because the muscles work so hard that they thicken or the chambers widen than the normal size. Usually, an enlarged heart is not a disease but is an indication of an underlying disease such as cardiomyopathy, heart valve problems, or high blood pressure. These conditions make the heart work harder and hence, at a point in time, the heart is unable to pump blood into the body as efficiently as required. This can cause complications such as stroke, cardiac arrest or heart failure.

Valvular heart disease: Valvular heart disease occurs when there is a defect in one of the four valves of the heart – the mitral, aortic, tricuspid and pulmonary. A defect such as a leakage or narrowing of any of the heart valves can cause the heart muscle to stretch or thicken. Moreover, when the chambers of the heart become enlarged or weak due to excessive stress caused by a tight or a leaking valve, the electrical system of the heart can be disturbed and lead to arrhythmia. This can, in turn, cause a cardiac arrest.

Congenital heart disease: Congenital heart diseases are disorders of the heart that are present since birth. A few of these disorders such as blood vessel abnormalities can cause cardiac arrest. Blood vessel diseases, particularly of the coronary artery and the aorta, can trigger a sudden cardiac arrest. Due to congenital heart tissue of the blood vessel, adrenaline is released at the time of intense physical activity. This often triggers a disruption in the electrical functioning of the heart, leading to a cardiac arrest.

Electrical problems in the heart: Some people might have issues with the electrical system of the heart rather than the valves or the heart muscle. This is also known as primary heart rhythm abnormalities and is caused due to conditions such as Brugada’s syndrome and long QT syndrome.

Risk factors of cardiac arrest

Some people that are at a higher risk of experiencing a cardiac arrest include:

  • People with a family history of coronary artery disease
  • Smokers
  • People with issues such as high blood pressure, obesity, diabetes, etc.
  • People who are inactive and have a sedentary lifestyle

That said, a few other factors can also increase the chances of a cardiac arrest:

  • A previous history of cardiac arrest
  • A previous heart attack
  • Acute kidney disease
  • Male
  • Increasing age
  • Consumption of illegal drugs such as cocaine
  • Obstructive sleep apnea
  • Lack of essential nutrients such as potassium or magnesium
  • Congenital heart defects
  • Family history of heart issues, cardiomyopathy, heart rhythm disorders, etc.

Overall, a cardiac arrest can be avoided if a person follows a healthy lifestyle and leads an active life avoiding all triggers and risk factors. Regular medical check-ups can also keep a check on heart health.

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