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Sudden Cardiac Death

Sudden cardiac death is a sudden, unexpected death caused by loss of heart function. It is the largest cause of natural death in the U.S., causing about 250,000 adult deaths each year. Sudden Cardiac Death (SCD) occurs most frequently in adults in their mid-30s to mid-40s, and affects men twice as often as it does women. SCD is rare in children, affecting only 1 or 2 for every 100,000 children each year.

Is Sudden Cardiac Death a Heart Attack?

No. Sudden cardiac death is not a heart attack. Heart attacks occur when there is a problem with the "plumbing" of the heart; for example, a blockage in one or more of the arteries to the heart, preventing the heart from receiving enough blood. If the oxygen in the blood cannot reach the heart muscle, the heart becomes damaged.

 
In contrast, during sudden cardiac death, the electrical system to the heart suddenly becomes irregular. The ventricles may flutter or quiver (ventricular fibrillation), and blood is not delivered to the body. Of greatest concern in the first few minutes after an episode ensues is that blood flow to the brain will be reduced so drastically, a person will lose consciousness. Death follows unless emergency treatment is begun immediately.

Emergency treatment includes cardiopulmonary resuscitation (CPR) and, if possible, defibrillation. CPR is a manual technique using repetitive pressing to the chest and breathing into the person's airways that keeps enough oxygen and blood flowing to the brain until the normal heart rhythm is restored with an electric shock to the chest, a procedure called defibrillation. Emergency squads use portable defibrillators and frequently there are public access defibrillators (AEDs, ambulatory external defibrillators) in public locations that are intended to be available for use by citizens who observe cardiac arrest.

What Causes Sudden Cardiac Death?

Most sudden cardiac deaths are caused by abnormal heart rhythms called arrhythmias . The most common life-threatening arrhythmia is ventricular fibrillation, which is an erratic, disorganized firing of impulses from the ventricles. When this occurs, the heart is unable to pump blood and death will occur within minutes, if left untreated.

There are many factors that can place a person at risk of sudden cardiac death, including:

  • Coronary artery disease (80% of SCD is linked with this disease).
  • Smoking, family history of coronary disease, high cholesterol, and an enlarged heart.
  • Ventricular tachycardia (abnormally rapid heart rhythm) or fibrillation (abnormal contractions in the heart's lower chamber) after a heart attack.
  • History of heart defects
  • History of fainting
  • Heart failure
  • Dilated cardiomyopathy (an abnormally enlarged heart and the cause of SCD in about 10% of people).
  • The first 6 to 18 months after a heart attack.
  • Hypertrophic cardiomyopathy (an increased growth in thickness of the wall of the left ventricle).
  • History of certain abnormal heart rhythms , including long QT syndrome, extremely low heart rates or heart block.
  • Obesity
  • Diabetes

Can Sudden Cardiac Death Be Prevented?

If you have any of the above listed risk factors for SCD, it is important that you speak with your doctor about possible steps to reduce your risk. Some steps involve making lifestyle changes, while other risk factors require medical advice or intervention.

  • Medications. To help reduce the risk of sudden cardiac death from occurring, doctors may prescribe medications to people who have had heart attacks, heart failure or who have arrhythmias such as irregular heart rhythms. If your doctor prescribes medication, he or she will tell you more about why you are taking it. It is important that you know the names of your medications and any directions that you need to follow when taking them. If you have any questions be sure to ask your doctor or pharmacist.
  • Risk factor modification. There are certain lifestyle changes that can be made to reduce high blood pressure and cholesterol levels, and thus your risk of sudden cardiac death. These include: quitting smoking , losing weight, exercising regularly , eating a healthy diet . If you have any questions or are unsure how to make these changes, ask your doctor for advice.
  • Implantable cardioverter-defibrillator (ICD) . For people whose risk factors put them at great risk for sudden cardiac death, an ICD may be inserted as a preventive treatment. An ICD is a small machine similar to an AED that is designed to correct abnormal heartbeats by detecting and then correcting fast or slow heart rates. The ICD constantly monitors the heart rhythm. When it detects a very fast or slow heart rhythm, it delivers energy to the heart muscle to cause the heart to beat in a normal rhythm again. The ICD also records the data of each abnormal heartbeat, which can be viewed by the doctor through a third part of the system kept at the hospital. The ICD can be used in people who have survived sudden cardiac death and require constant heart rhythm monitoring.
  • Interventional procedures or coronary artery bypass surgery. For people with coronary artery disease, a procedure such as angioplasty or bypass surgery to open up clogged arteries may be needed to improve blood flow to the heart muscle and reduce the risk of having sudden cardiac death.
Can Sudden Cardiac Death Be Treated?

Yes, SCD can be treated and reversed, but emergency action must take place immediately. Survival can be as high as 90% if treatment is initiated within the first minutes after SCD. The rate decreases by about 10% each minute longer it takes to initiate therapy. Those who survive do well in the long-term.

What Do I Do if I Witness Sudden Cardiac Death?

If you witness someone experiencing sudden cardiac death, dial 911 or your local emergency personnel immediately and initiate CPR . If done properly, CPR can save a person's life, as the procedure keeps blood and oxygen circulating through the body until help arrives.

If there is an AED available, the best chance of rescuing the person includes defibrillation with that device. The shorter the time until defibrillation, the greater the chance the person will survive. It is CPR plus defibrillation that saves a person.

After successful defibrillation, most people require hospital care to treat and prevent future cardiac problems.

http://www.medicinenet.com/sudden_cardiac_death/article.htm