By Leandrae T. Lapinig
When it comes to how many die of sudden cardiac arrests in the Philippines, no one knows. After all, statistics are hard to come by. If ever there is, the figure would be staggering.
“With heart diseases being the most common cause of death (accounting for close 20% of all deaths, according to the recent Department of Health statistics) among adults, it would be no surprise if this condition constituted the predominant mode of death of most cardiac diseases,” the Philippine Heart Association (PHA) said in a statement.
Some health experts, however, estimate that around eight to 11 Filipinos are suffering from cardiac arrest every hour. “A big number of them may have this fatal event in the church, malls, markets, bus stations or in the streets while walking,” says Dr. Rafael D. Castillo, former PHA president and one of the country’s noted cardiologists.
These deaths caused by cardiac arrest could be trimmed down if only cardiopulmonary resuscitation (CPR) is performed on these victims, added the PHA, noting that sudden cardiac arrests happened outside of the hospitals, 80% of which occurred at home.
CPR is considered the cornerstone of emergency medicine. “When done properly, CPR can help preserve the brain and heart functions, until the actual cause of the arrest can be addressed,” says PHA’s Dr. Roberto A. Raymundo.
Based on PHA records, it was found that “roughly 50% of deaths from cardiovascular diseases happened as sudden cardiac arrest and most were witnessed by a family member,” said a Philippine Daily Inquirer report.
Unfortunately, “only four to six percent of sudden cardiac arrest patients survived because the majority of those who witnessed it were clueless about CPR,” according to Dr. Francis Lavapie, another PHA official.
Dr. Lavapie cited global figures which showed 53% of all out-of-hospital cardiac arrest cases were witnessed by a bystander but only 36% of these cases received CPR, making survival rate to hospital admission at 23.8%.
CPR needs to begin immediately. “CPR must begin within 4 to 6 minutes and advanced life support measures must begin within 8 minutes, to avoid brain death,” the PHA reminds.
“Every minute that a CPR is delayed reduces the chances of survival and recovery by 10%,” reminds Dr. Castillo. “If it’s delayed by five minutes, a 50% chance of recovery shall have gone down the drain. If it’s delayed by more than ten minutes, the prospect of recovery is nil.”
How to do CPR
The Heart Foundation Organization of Australia shares this information on how to do CPR: Place the heel of your hand in the center of the chest and the other hand on top. Push hard and fast in the center of the chest. Push to a rate of 100-200 compressions every minute (two compressions every second). Push hard; you can’t do any harm, but you may save a life. If you have learned how to do it, provide two rescue breaths between every 30 compressions, otherwise, push the chest continuously.
The big question among lesser mortals, however, is this: is cardiac arrest the same as heart attack?
“People often use these terms interchangeably, but they are not synonyms,” explains the American Heart Association (AHA). “A heart attack is when blood flow to the heart is blocked, and sudden cardiac arrest is when the heart malfunctions and suddenly stops beating unexpectedly. A heart attack is a ‘circulation’ problem and sudden cardiac arrest is an ‘electrical’ problem.”
The Minnesota-based Mayo Clinic has this to say: “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.”
AHA agrees as these two distinct heart conditions are linked. “Sudden cardiac arrest can occur after a heart attack, or during recovery. Heart attacks increase the risk for sudden cardiac arrest. Most heart attacks do not lead to sudden cardiac arrest,” the US heart association says.
Electrical problem
The heart has its own electrical stimulator – a specialized group of cells called the sinus node located in the upper right chamber (right atrium) of the heart.
“The sinus node generates electrical impulses that flow in an orderly manner through the heart to synchronize the heart rate and coordinate the pumping of blood from your heart to the rest of the body,” the Mayo Clinic explains.
Now, if something goes wrong with the sinus node or the flow of electric impulses through the heart, abnormal heart rhythms called arrhythmia can result. During an arrhythmia, the heart can 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, which is then known as a sudden cardiac arrest.
Causes
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 (which includes heart attack). In coronary artery disease, the arteries become clogged with cholesterol and other deposits, reducing blood flow to the heart. This can make it harder for the heart to conduct electrical impulses smoothly.
Enlarged heart (cardiomyopathy): This occurs primarily when the heart’s muscular walls stretch and enlarge or thicken. In both cases, the heart’s muscle is abnormal, a condition that often leads to heart tissue damage and potential arrhythmias.
Valvular heart disease: Leaking or narrowing of the heart valves can lead to stretching or thickening of the 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 long QT syndrome, which affects repolarization of the heart after a heartbeat.
Risk factors and symptoms
Because sudden cardiac arrest is so often linked with coronary artery disease, the same factors that put a person at risk of coronary artery disease may also put him or her at risk of cardiac arrest.
The Mayo Clinic identifies them as follows: a family history of coronary artery disease, smoking, high blood pressure, high blood cholesterol, obesity, diabetes, a sedentary lifestyle, and drinking too much alcohol (more than two drinks a day).
Cardiac arrest symptoms are immediate and drastic, according to the Mayo Clinic. These include sudden collapse, no pulse, no breathing, and loss of consciousness. “Sometimes other signs and symptoms precede sudden cardiac arrest,” it says. “These may include fatigue, fainting, blackouts, dizziness, chest pain, shortness of breath, weakness, palpitations or vomiting.”
Management
As there’s no sure way to know your risk of cardiac arrest, reducing the risk is your best strategy. Among the steps most doctors recommend which you can do include regular checkups, and screening for heart disease.
The May Clinic also suggests living a heart-healthy lifestyle with the following approaches: avoid smoking and drink 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, consult your doctor. He 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 as primary prevention. – ###
