CARDIAC ARREST AND SUDDEN CARDIAC DEATH Cardiac arrest Cardiac arrest describes the sudden and complete

e loss of cardiac output due to asystole, ventricular tachycardia or fibrillation, or loss of mechanical cardiac contraction. Sudden cardiac death (SCD) Natural death due to cardiac causes heralded by abrupt loss of consciousness within 1 hour of onset of acute symptoms Person may have known of preexisting heart disease, but time and mode of death are unexpected Aetiology of cardiac arrest 1) entricular fibrillation and pulseless ventricular tachycardia !ost common cause entricular fibrillation produces rapid, ineffective, uncoordinated movement of the ventricles, which therefore produce no pulse entricular tachycardia can cause cardiac arrest if the ventricular rate is so rapid that effective mechanical contraction and relaxation cannot occur, or if it occurs in the presence of severe left ventricular impairment 2) Asystole "his occurs when there is no electrical activity within the ventricles and is usually due to failure of the conducting tissue or massive ventricular damage complicating myocardial infarction 3) Pulseless electrical activity "his occurs when there is no effective cardiac output despite the presence of organised electrical activity Caused by reversible conditions such as hypovolaemia, cardiac tamponade or tension pneumothorax Causes of sudden cardiac death a) Coronary artery disease# most common cause b) $tructural heart disease %ortic stenosis &ypertrophic cardiomyopathy 'ilated cardiomyopathy c) No structural heart disease (ong )" syndrome *rugada syndrome +olff#Parkinson#+hite syndrome Management of cardiac arrest a) The Chain of Survival "his term refers to the se,uence of events that are necessary to maximise the chances of a cardiac arrest victim surviving. % victim of cardiac arrest is most likely to survive if all links in the chain are strong

b) asic life su!!ort ( "S) *($ encompasses manoeuvres that attempt to maintain a low level of circulation until more definitive treatment with advanced life support can be given !anagement of the collapsed patient re,uires prompt assessment and restoration of the airway, maintenance of breathing using rescue breathing -.mouth#to#mouth. breathing) and maintenance of the circulation using chest compressions

c) Advanced life su!!ort (A"S) %($ aims to restore normal cardiac rhythm by defibrillation when the cause of cardiac arrest is due to a tachyarrhythmia, or to restore cardiac output by correcting other reversible causes of cardiac arrest %($ can also involve administration of intravenous drugs to support the circulation, and endotracheal intubation to ventilate the lungs. a precordial thump may sometimes convert ventricular fibrillation or tachycardia to normal rhythm. "he priority is to assess the patient.s cardiac rhythm by attaching a defibrillator/monitor. entricular fibrillation - 0) or pulseless ventricular tachycardia - ") is treated with immediate defibrillation 'efibrillators have been developed that produce a biphasic shock, i.e. the polarity of the shock is reversed midway through the delivery.

 'efibrillation is firstly with a biphasic shock of 111 2oules or 311 2oules monophasic. 4f normal rhythm is not restored, a further shock of 111 2oules is given. 4f these three shocks are unsuccessful, 1 mg of adrenaline -epinephrine) intravenously and a further 1 minute of cardiopulmonary resuscitation should be given before trying a further se,uence of up to three biphasic shocks, each at 151 2oules 6eversible causes like hypoxia, hypotension, hyper and hypokalemia etc should be treated. Pulseless electrical activity is treated by maintaining cardiopulmonary resuscitation -CP6) whilst seeking such causes $urvivors of " or 0 arrest in whom no reversible cause can be identified may be at risk of another episode and should be considered for anti#arrhythmic therapy or implantation of an implantable cardiac defibrillator