Sudden cardiac arrest is the sudden, unexpected loss of heart function, breathing and consciousness. Sudden cardiac arrest usually results from an electrical disturbance in your heart that disrupts its pumping action, stopping blood flow to the rest of your body.
Sudden cardiac arrest is different from a heart attack, which occurs when blood flow to a portion of the heart is blocked. However, a heart attack can sometimes trigger an electrical disturbance that leads to sudden cardiac arrest.
Sudden cardiac arrest is a medical emergency. If not treated immediately, it causes sudden cardiac death. With fast, appropriate medical care, survival is possible. Administering cardiopulmonary resuscitation (CPR), treating with a defibrillator — or even just compressions to the chest — can improve the chances of survival until emergency personnel arrive.
Sudden cardiac arrest symptoms are immediate and drastic and include:
- Sudden collapse
- No pulse
- No breathing
- Loss of consciousness
Sometimes other signs and symptoms precede sudden cardiac arrest. These may include fatigue, fainting, blackouts, dizziness, chest pain, shortness of breath, weakness, palpitations or vomiting. But sudden cardiac arrest often occurs with no warning.
When to see a doctor
If you have frequent episodes of chest pain or discomfort, heart palpitations, irregular or rapid heartbeats, unexplained wheezing or shortness of breath, fainting or near fainting, or you're feeling lightheaded or dizzy, see your doctor promptly. If these symptoms are ongoing, you should call 911 or emergency medical help.
When the heart stops, the lack of oxygenated blood can cause brain damage in only a few minutes. Death or permanent brain damage can occur within four to six minutes. Time is critical when you're helping an unconscious person who isn't breathing. Take immediate action.
- Call 911, or the emergency number in your area, if you encounter someone who has collapsed or is found unresponsive. If the unconscious person is a child and you're alone, administer CPR, or chest compressions only, for two minutes before calling 911 or emergency medical help or before using a portable defibrillator.
Perform CPR. Quickly check the unconscious person's breathing. If he or she isn't breathing normally, begin CPR. Push hard and fast on the person's chest — at the rate of 100 to 120 compressions a minute. If you've been trained in CPR, check the person's airway and deliver rescue breaths after every 30 compressions.
If you haven't been trained, just continue chest compressions. Allow the chest to rise completely between compressions. Keep doing this until a portable defibrillator is available or emergency personnel arrive.
Use a portable defibrillator, if one is available. If you're not trained to use a portable defibrillator, a 911 or emergency medical help operator may be able to guide you in its use. Deliver one shock if advised by the device and then immediately begin CPR starting with chest compressions, or give chest compressions only, for about two minutes.
Using the defibrillator, check the person's heart rhythm. If necessary, the defibrillator will administer a shock. Repeat this cycle until the person recovers consciousness or emergency personnel take over.
Portable automated external defibrillators (AEDs) are available in an increasing number of places, including airports, casinos and shopping malls. You can also purchase them for your home. AEDs come with built-in instructions for their use. They're programmed to allow a shock only when appropriate.
The immediate cause of sudden cardiac arrest is usually an abnormality in your heart rhythm (arrhythmia), the result of a problem with your heart's electrical system.
Unlike other muscles in your body, which rely on nerve connections to receive the electrical stimulation they need to function, your heart has its own electrical stimulator — a specialized group of cells called the sinus node located in the upper right chamber (right atrium) of your heart. The sinus node generates electrical impulses that flow in an orderly manner through your heart to synchronize the heart rate and coordinate the pumping of blood from your heart to the rest of your body.
If something goes wrong with the sinus node or the flow of electric impulses through your heart, an arrhythmia can result, causing your heart to beat too fast, too slow or in an irregular fashion. Often these interruptions in rhythm are momentary and harmless. But some types of arrhythmia can be serious and lead to a sudden stop in heart function (sudden cardiac arrest).
The most common cause of cardiac arrest is an arrhythmia called ventricular fibrillation — when rapid, erratic electrical impulses cause your ventricles to quiver uselessly instead of pumping blood.
Most of the time, cardiac-arrest-inducing arrhythmias don't occur on their own. In a person with a normal, healthy heart, a lasting irregular heart rhythm isn't likely to develop without an outside trigger, such as an electrical shock, the use of illegal drugs or trauma to the chest at just the wrong time of the heart's cycle (commotio cordis).
Heart conditions that can lead to sudden cardiac arrest
A life-threatening arrhythmia usually develops in a person with a pre-existing heart condition, such as:
- Coronary artery disease. Most cases of sudden cardiac arrest occur in people who have coronary artery disease. In coronary artery disease, your arteries become clogged with cholesterol and other deposits, reducing blood flow to your heart. This can make it harder for your heart to conduct electrical impulses smoothly.
- Heart attack. If a heart attack occurs, often as a result of severe coronary artery disease, it can trigger ventricular fibrillation and sudden cardiac arrest. In addition, a heart attack can leave behind areas of scar tissue. Electrical short circuits around the scar tissue can lead to abnormalities in your heart rhythm.
- Enlarged heart (cardiomyopathy). This occurs primarily when your heart's muscular walls stretch and enlarge or thicken. In both cases, your heart's muscle is abnormal, a condition that often leads to heart tissue damage and potential arrhythmias.
- Valvular heart disease. Leaking or narrowing of your heart valves can lead to stretching or thickening of your heart muscle or both. When the chambers become enlarged or weakened because of stress caused by a tight or leaking valve, there's an increased risk of developing arrhythmia.
- Congenital heart disease. When sudden cardiac arrest occurs in children or adolescents, it may be due to a heart condition that was present at birth (congenital heart disease). Even adults who've had corrective surgery for a congenital heart defect still have a higher risk of sudden cardiac arrest.
- Electrical problems in the heart. In some people, the problem is in the heart's electrical system itself instead of a problem with the heart muscle or valves. These are called primary heart rhythm abnormalities and include conditions such as Brugada's syndrome and long QT syndrome.
Because sudden cardiac arrest is so often linked with coronary artery disease, the same factors that put you at risk of coronary artery disease may also put you at risk of sudden cardiac arrest. These include:
- A family history of coronary artery disease
- High blood pressure
- High blood cholesterol
- A sedentary lifestyle
- Drinking too much alcohol (more than two drinks a day)
Other factors that may increase your risk of sudden cardiac arrest include:
- A previous episode of cardiac arrest or a family history of cardiac arrest
- A previous heart attack
- A personal or family history of other forms of heart disease, such as heart rhythm disorders, congenital heart defects, heart failure and cardiomyopathy
- Age — the incidence of sudden cardiac arrest increases with age
- Being male — men are two to three times more likely to experience sudden cardiac arrest
- Using illegal drugs, such as cocaine or amphetamines
- Nutritional imbalance, such as low potassium or magnesium levels
When sudden cardiac arrest occurs, your brain is the first part of your body to suffer because, unlike other organs, it doesn't have a reserve of oxygen-rich blood. It's completely dependent on an uninterrupted supply of blood. Reduced blood flow to your brain causes unconsciousness.
If your heart rhythm doesn't rapidly return to its normal rhythm, brain damage occurs and death results. If sudden cardiac arrest lasts more than 8 minutes, survival is rare. Survivors of cardiac arrest may show signs of brain damage.
There's no sure way to know your risk of sudden cardiac arrest, so reducing your risk is the best strategy. Steps to take include regular checkups, screening for heart disease and living a heart-healthy lifestyle with the following approaches:
- Don't smoke, and use alcohol in moderation (no more than one to two drinks a day).
- Eat a nutritious, balanced diet.
- Stay physically active.
If you know you have heart disease or conditions that make you more vulnerable to an unhealthy heart, your doctor may recommend that you take appropriate steps to improve your health, such as taking medications for high cholesterol or carefully managing diabetes.
In some people with a known high risk of sudden cardiac arrest — such as those with a heart condition — doctors may recommend anti-arrhythmic drugs or an implantable cardioverter-defibrillator (ICD) as primary prevention.
If you have a high risk of sudden cardiac arrest, you may also wish to consider purchasing an automated external defibrillator (AED) for home use. Before purchasing one, discuss the decision with your doctor. AEDs can be expensive and aren't always covered by health insurance.
If you live with someone who is vulnerable to sudden cardiac arrest, it's important that you be trained in CPR. The American Red Cross and other organizations offer courses in CPR and defibrillator use to the public. Being trained will help not only your loved one but also those in your community. The more people who know how to respond to a cardiac emergency, the more the survival rate for sudden cardiac arrest can be improved.