Early
Symptoms May Foretell "Sudden Cardiac Death"
"Sudden cardiac death" often is not all that sudden, and
lives can be saved by training people about the symptoms of impending cardiac
arrest and what action to take, according to a report in the journal Circulation.
According to the American Heart Association
(AHA), cardiac arrest is the sudden loss of heart function. The victim
may or may not have diagnosed heart disease; the most common cause of death
is coronary heart disease.
The AHA estimates that 330,000
Americans die each year from heart disease before reaching a hospital and urges
cardiopulmonary resuscitation (CPR) training on a large scale.
Study lead author Dr. Dirk Muller says, "A study of 406
sudden cardiac death patients indicates that they often have symptoms, especially
the typical symptom angina pectoris [chest pain] for as long as 120 minutes
before an arrest."
Dr. Muller is a cardiologist and emergency physician at
the Medical Clinic II, Cardiology and Pulmonology, in Berlin, Germany.
"Two-thirds of cardiac arrest patients have a history that
predisposes them to sudden cardiac death," says Dr. Muller, so efforts to reduce
the toll should focus on teaching their family members to recognize the symptoms
and how to perform CPR.
In the study, 72 percent of cardiac-arrest cases occurred
at home, and two-thirds were witnessed by others. The researchers collected
information about symptoms preceding cardiac arrest for 323 patients.
The most common warning sign was chest pain, which occurred
for at least 20 minutes, and, in some cases, for hours, before cardiac arrest.
Chest pain occurred in 25 percent of the patients whose
cardiac arrest was witnessed by other persons and in one-third of other cases.
Breathlessness was the next most common symptom, seen in
17 percent of witnessed arrests and 30 percent of other cases. Other common
symptoms were nausea, vomiting, dizziness, or fainting.
CPR was performed on 57 patients, and 13 of them survived
to be discharged from the hospital. The survival rate for those who did not
get CPR was 4 percent - 13 of 349 patients.
One notable fact was that CPR was more likely to be performed
when cardiac arrest occurred in public cases - 26 percent of the time, compared
to 11 percent of the time when the attack occurred at home.
There are two significant messages from the study, explains
Dr. Ann Bolger, a professor of clinical medicine at the University of California,
San Francisco, and a spokeswoman for the AHA.
"The first is that people need to be educated about how
cardiac symptoms can present," says Dr. Bolger. "We always try to encourage
people not to discount such things as shortness of breath, things that really
should demand a response, because they could be a harbinger of early death.
"The second thing is that the family is important," she
adds. "Many of these patients have a known history of heart problems. They
are not taking us by surprise. We know that one of these things can happen
to them, so, it is important to get education that if there is chest pain that
does not respond to nitroglycerine, they should call 911.”
Dr. Bolger continues, “When a patient has active heart
disease, I try to make sure that they and their family get basic training about
calling 911 and get the emergency medical service on the scene. People who
don't get CPR before they get to the hospital have much worse outcomes."
Always consult your physician for more information.
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