When your heart stops

Source: Malaysian Mirror by Ummi Nadiah Rosli

KUALA LUMPUR -The crowd went wild as the Portuguese Liga match reached its peak in Guimaraes, with Lisbon’s football club Benfica leading 1-0 against Vitoria S.C.

Broadcasted live on television on Jan 25, 2004, Benfica’s player, Miklos Feher received a yellow card in the injury time.

The cameras followed the Hungarian on the pitch as he suddenly bent forward, face contorted in pain, and then fell backwards to the ground.

The match was put to a stop as Feher’s teammates rushed to his aid and medical personnel soon swarmed over the striker performing CPR.

His teammates were in disbelief over their friend’s sudden collapse. It was later announced that Feher, at the age of 24, died from cardiac arrhythmia, also known as sudden cardiac arrest (SCA).

The tragic death of Feher, who appeared to be the picture of health is not an isolated case.

SCA occurs when the heart abruptly stops working, and is one of the most common causes of death in developed countries.

It is a condition that causes 350,000 deaths a year in Europe and affects more than 400,000 people in the United States, and accounts for 63 percent of all cardiac related deaths in the U.S.

And according to Dr Razali Omar – Director of Electrophysiology & Pacing Unit, National Heart Institute (IJN) Kuala Lumpur, SCA is a real national threat.

Not a heart attack

Contrary to popular belief, Dr Omar highlighted the important differences of SCA and other cardiovascular diseases.

“SCA is NOT a heart attack, where blockage in blood vessel prevents blood flow to the heart. Lack of blood causes damage to the heart muscle and scar tissue.

“SCA on the other hand happens when the heart’s electrical system malfunctions. The heart has a built-in electrical system, and if the heart is not electrically shocked within minutes, death occurs, and only 10 to 20 percent of those who had SCA survive,” he said.

He added that in a healthy heart, our very own ‘pace-maker’ triggers the heartbeat, then electrical impulses run along pathways in the heart causing it to contract in regular in a rhythmic way. When the heart contracts, blood is pumped.

Arrhythmia occurs when the electrical signals that control the heartbeat is delayed or blocked.

Out of rhythm

Heart failure is usually due to damaged or stretched heart muscle, which often impairs the electrical system that controls the normal timing of the heartbeat.

When the body realises that the heart is failing to pump normal amounts of blood, the heart will try to speed up to compensate.

Damaged heart muscle can make the heartbeat become too slow (bradycaria) or too fast (tachycardia) or just irregular. Thus, it is quite common to see heart failure patients have arrhythmia.

Furthermore, the most common cause of cardiac arrests is a form of arrhythmia, known as ventricular fibrillation (VF).

In VF, electrical signals that control the pumping of the heart suddenly become rapid and chaotic. As a result, the lower chambers of the heart, the ventricles, begin to tremble (fibrillate) instead of contracting.

Thus the blood is no longer pumping from the heart to the rest of the body, cutting off supply of oxygen to the brain and the person involved loses consciousness. Unless an emergency shock is delivered to restore its regular rhythm (using a machine known as a defibrillator), death can occur within minutes.

The silent killer

Unlike many heart problems that can be identified by symptoms, SCA is considered to be a silent killer.

Physical or athletic screenings do not usually signal conditions that can cause SCA, thus it can afflict outwardly healthy, active individuals with no known heart disease or other health complications.

But Dr Omar explained that SCA is not a random occurrence and most victims do have complications relating to their health or heart, although they may not know it.

He stated that any heart complications that damage the heart’s electrical system can cause arrhythmia. This includes smoking, heavy alcohol intake, use of certain drugs and even emotional stress.

“Those who are at risk of being affected with SCA comprise of 80 per cent of patients with coronary artery disease (condition in which the arteries that supply blood to the heart are narrowed or blocked), 15 percent heart muscle disease and 5 per cent disease of the heart cells. 75 percent of the people who die of SCA show signs of a previous heart attack.”

And with no warning signals, 95 percent of all SCA victims will die on the scene, and in the U.S, more than 70 percent of VF victims die before reaching the hospital.

Shocks to survive

In the absence of symptoms, prevention is of utmost priority to reduce the statistics for SCA deaths.

There are several options, Dr Omar said, among them is medication and the automatic external defibrillator (AED) which is a portable electronic device that stops cardiac arrhythmia by shocking the heart. Some countries provide AED for public use, especially in public places such as parks, schools and sport centres.

The implantable cardioverter defibrillators (ICD), are also very successful in preventing SCD in certain high-risk patients.

Implanted under the skin, the ICD monitors the heart to detect any abnormal rhythms and delivers an electric shock to restore the heart’s normal rhythm.
It can also function as a pacemaker if the heart beats too slowly.

For congestive heart failure caused by complications with the heart muscle, cardiac resynchronization therapy are utilised. The therapy applies the use of a specialised pace-maker to re-coordinate action of the right and left ventricle in patients with heart failure.

Learning CPR a must

pic MM

Every second is a ticking bomb for SCA victims. With every minute that passes, the chances of survival from SCA decreases by 7 to 10 percent.

While more than 70 percent of all sudden cardiac arrest victims are saved by defibrillators, Dr Omar advised that everyone should learn CPR if there is no defibrillator nearby.

“Of course, CPR is definitely life-saving, and important to maintain brain integrity of SCA victims. It doesn’t matter whether you’re in school or an elderly, CPR should be learnt by all. SCA can happen anytime, anywhere.”

With patient demographics provided by the National Cardiovascular Disease Database point out that the minimum age for heart failure in the country is 18 years old and 100 years old being the oldest, it is best to take heed to that advise.

How Can Death Due to Sudden Cardiac Arrest Be Prevented?

Ways to prevent death due to sudden cardiac arrest (SCA) differ depending on whether:

  • You’ve already had SCA
  • You’ve never had SCA but are at high risk for the condition
  • You’ve never had SCA and have no known risk factors for the condition

For People Who Have Survived Sudden Cardiac Arrest

If you’ve already had SCA, you’re at high risk of having it again. Research shows that an implantable cardioverter defibrillator (ICD) reduces the chances of dying from a second SCA.

An ICD is surgically placed under the skin in your chest or abdomen. The device has wires with electrodes on the ends that connect to your heart’s chambers. The ICD monitors your heartbeat.

If the ICD detects a dangerous heart rhythm, it gives an electric shock to restore the heart’s normal rhythm. Your doctor may give you medicine to limit irregular heartbeats that can trigger the ICD.

Implantable Cardioverter Defibrillator

The illustration shows the location of an implantable cardioverter defibrillator in the upper chest. The electrodes are inserted into the heart through a vein.

The illustration shows the location of an implantable cardioverter defibrillator in the upper chest. The electrodes are inserted into the heart through a vein.

An ICD isn’t the same as a pacemaker. The devices are similar, but have some differences. Pacemakers only give off low-energy electrical pulses. They’re often used to treat less dangerous heart rhythms, such as those that occur in the upper chambers of the heart. Most new ICDs work as both pacemakers and ICDs.

For People at High Risk for a First Sudden Cardiac Arrest

If you have severe coronary artery disease (CAD), you’re at increased risk for SCA. This is especially true if you’ve recently had a heart attack.

Your doctor may prescribe a type of medicine called a beta blocker to help lower your risk for SCA. Other treatments for CAD, such as angioplasty or coronary artery bypass grafting, also may lower your risk for SCA.

Your doctor also may recommend an ICD if your risk for SCA is very high.

For People Who Have No Known Risk Factors for Sudden Cardiac Arrest

CAD seems to be the cause of most cases of SCA in adults. CAD also is a major risk factor for angina (chest pain or discomfort) and heart attack, and it contributes to other heart problems.

Following a healthy lifestyle can help you lower your risk for CAD, SCA, and other heart problems.

Healthy Diet and Physical Activity

A healthy diet is an important part of a heart healthy lifestyle. Choose a variety of fruits, vegetables, and grains; half of your grains should come from whole-grain products.

Choose foods that are low in saturated fat, trans fat, and cholesterol. Healthy choices include lean meats, poultry without skin, fish, beans, and fat-free or low-fat milk and milk products.

Choose and prepare foods with little sodium (salt). Too much salt can raise your risk for high blood pressure. Recent studies show that following the Dietary Approaches to Stop Hypertension (DASH) eating plan can lower blood pressure.

Choose foods and beverages that are low in added sugar. If you drink alcoholic beverages, do so in moderation.

Aim for a healthy weight by staying within your daily calorie needs. Balance the calories you take in with the calories you use while doing physical activity. Be as physically active as you can.

Some people should get medical advice before starting or increasing physical activity. For example, talk to your doctor if you have a chronic (ongoing) health problem, are on medicine, or have symptoms such as chest pain, shortness of breath, or dizziness. Your doctor can suggest types and amounts of physical activity that are safe for you.

For more information on following a healthy diet, see the National Heart, Lung, and Blood Institute’s (NHLBI’s) Aim for a Healthy Weight Web site, “Your Guide to a Healthy Heart,” and “Your Guide to Lowering Your Blood Pressure With DASH.” All of these resources provide general information about healthy eating.

For more information about physical activity, see NHLBI’s “Your Guide to Physical Activity and Your Heart.”

Other Lifestyle Changes

Other lifestyle changes also can help lower your risk for SCA. Examples include:

  • Quitting smoking. Talk to your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.
  • Losing weight if you’re overweight or obese.
  • Treating other health problems, such as high blood pressure, high blood cholesterol, and diabetes.



sudden cardiac arrest key facts

Sudden Cardiac Arrest – Key Facts
Sudden Cardiac Arrest – Statistics

<!– Signs & Symptoms
Risk Factors
Sudden Cardiac Arrest Key Facts

  • Sudden Cardiac Arrest (SCA) is a leading cause of death in the United States, accounting for an estimated 325,000 deaths each year
  • In SCA, the heart abruptly and unexpectedly ceases to function (cardiac arrest). It is an “electrical problem” caused by a heart rhythm disorder called Ventricular Fibrillation (VF). In SCA, the heart is no longer able to pump blood to the rest of the body.
  • SCA is NOT a heart attack – a condition technically known as a myocardial infarction (MI). MI is a “plumbing problem” in which a blockage in a blood vessel interrupts the flow of blood to the heart causing an “infarct” – an area of dead heart muscle. SCA may, however, occur in association with a heart attack.
  • VF occurs when the electrical signals that control the pumping ability (contractions) of the lower chambers of the heart (ventricles) suddenly become rapid and chaotic. The ventricles begin to quiver and can not longer pump blood from the heart to the rest of the body.
  • SCA is NOT a random event. Although it may occur in outwardly healthy people, most victims DO have heart disease or other health problems, often without being aware of it.
  • Without emergency help, SCA leads to death within minutes.
  • Victims of cardiac arrest can be saved if a defibrillator device is immediately available to deliver an electric shock to restore the heart to its normal rhythm.
  • People who are at high risk for SCA may be treated with implantable cardioverter defibrillators (ICDs), devices that are implanted under the skin. ICDs monitor the heart’s rhythm and automatically deliver a short, high-energy shock when the individual develops an irregular heart rhythm that may lead to SCA.
  • Studies have shown that ICDs are the best way to prevent cardiac arrest in certain groups of patients who are at high risk.


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Sudden Cardiac Arrest Statistics

  • Sudden Cardiac Arrest (SCA) is a leading cause of death in the United States, claiming an estimated 325,000 lives each year.
  • SCA kills 1,000 people a day or one person every two minutes.
  • SCA most often occurs in patients with heart disease, especially those who have congestive heart failure and have had a heart attack.1
  • It is estimated that 95 percent of victims of cardiac arrest die before they reach a hospital or other source of emergency help.
  • As many as 75 percent of people who die of SCA show signs of a previous heart attack. Eighty percent have signs of coronary artery disease.
  • SCAs accounted for 10,460 (75.4 percent) of all 13,873 cardiac disease deaths in persons aged 35-44 years, and the proportion of cardiac arrests that occurred out-of-hospital increased with age, from 5.8 percent in persons aged 0-4 years to 61.0 percent in persons aged >85 years.2
  • SCAs accounted for 63.7 percent of all cardiac arrests among whites, 62.3 percent among African Americans, 59.8 percent among American Indians/Alaska Natives, 55.8 percent among Asians/Pacific Islanders, and 54.2 percent among Hispanics. Whites had the highest proportion of cardiac arrests out-of-hospital, and African Americans had the highest proportion of cardiac arrests in an Emergency Department or dead on arrival.3
  • According to the Centers for Disease Control and Prevention (CDC), deaths from sudden cardiac arrest increased 10 percent (from 2,719 in 1989 to 3,000 in 1996) in people between the ages of 15 and 34. In young women, the death rate from SCA increased 30 percent. African Americans are more likely to die from SCA than whites.
  • Wisconsin, Idaho, and Utah have the highest percentage of cardiac arrests.4

1AHRQ Research Activities, December 2002: Researchers examine the risk factors for sudden cardiac arrest and management of at-risk patients.
2MMWR Weekly February 15, 2002/51(06); 123-6: State-Specific Mortality from Sudden Cardiac Arrest — United States, 1999.
3MMWR Weekly February 15, 2002/51(06); 123-6: State-Specific Mortality from Sudden Cardiac Arrest — United States, 1999.
4MMWR Weekly February 15, 2002/51(06); 123-6: State-Specific Mortality from Sudden Cardiac Arrest — United States, 1999.

BERNAMA – Sudden Cardiac Arrest Can Occur During Heart Attack

9 Dec 2009 KUALA LUMPUR, Dec 9 (Bernama) — There is a likelihood that a sudden cardiac arrest (SCA) can occur during a heart attack.

3 Responses to “When your heart stops”

  1. kathy dann Says:

    I overdosed and my heart had to be electrically started. can you please tell me what the after symptoms are and what i should do . I am really weak. thank you

  2. marty rowan Says:

    i survived SCA and I think your site is excellent.
    I would be honored if you would consider putting a link to my blog on your site.,

  3. junctional rhythm Says:

    junctional rhythm…

    […]When your heart stops « Dr Ko Ko Gyi’s Blog[…]…

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