Arresting

By Peter Galvin, MD

When we think about cardiac arrest, we usually attribute it to older individuals. Unfortunately, the incidence of cardiac arrest, or the sudden cessation of heart pumping, is rising in younger people aged 18 to 40 years. It now occurs in for to 14 per 100,000 apparently healthy people per year worldwide. Cardiac arrest in those younger than 40 years may be caused by cardiac disease and non-cardiac causes. Based on autopsy studies, 55% to 69% of young adults who die after cardiac arrest have a heart rhythm disturbance (most common in athletes) or structural heart disease such as coronary artery disease or hypertrophic cardiomyopathy (HCM – abnormally thickened heart muscle). Common non-cardiac causes of cardiac arrest among young people include drug overdose, blood clots in the lungs (pulmonary embolism), bleeding around the brain (subarachnoid hemorrhage), seizure, anaphylaxis (severe allergic reaction), and infection.

More than half of young adults who die of cardiac arrest have a known cardiovascular risk factor such as diabetes or high blood pressure. Genetic cardiac disease such as long QT syndrome (abnormal electrical recovery of the heart rhythm) or HCM may be present in 13% to 34% of young adults who die of cardiac arrest and 2% to 22% of young adults who survive a cardiac arrest. The problem is twofold – many young adults consider themselves to be indestructible and do not consider their own mortality, and secondly, the four diseases/conditions listed above often do not have symptoms. This is why it is so important that young people go for at least one full checkup that includes an examination, blood tests, and an EKG.

Among all apparently healthy young adults who have a cardiac arrest, about 60% die before reaching a hospital, and only 9% to 16% of those who do reach a hospital are discharged alive. However, survival rates do increase to about 35% for those who have a witnessed arrest with a shockable cardiac rhythm and who receive prompt CPR and/or the use of an automated external defibrillator (AED). Bystanders who witness someone with a sudden cardiac arrest should call 911 and immediately start CPR. An AED should be used, if available. AEDs are now found in most public locations such as airports, government buildings, offices, schools, shopping malls, and gyms. Once its box is opened, the AED provides verbal instructions about how to apply sticky pads to the chest and advises when to press a button to deliver a shock to the heart. Some AEDs will announce that a shock will be given automatically. Resuscitation efforts should be continued until emergency medical personnel are on scene.

Those resuscitated after an arrest are transported to the nearest hospital and will undergo extensive testing to determine the cause of the arrest. Young adults with non-reversible causes of cardiac arrest, for example HCM, will often receive an implantable cardioverter-defibrillator (ICD) which can provide an electrical shock when a life-threatening heart rhythm is detected. Most young people will be reluctant to go for a medical checkup, but it cannot be stressed enough how important it is for them to go for a checkup, especially if they have a family member with cardiovascular disease or who suffered sudden cardiac arrest. Live long and prosper.

For more information go to www.cdc.gov

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