الجمعة، 17 يوليو 2020

Cardiac arrest

Cardiac arrest

Cardiac arrest is a sudden loss of blood flow resulting from the failure of the heart to pump effectively.  Signs include loss of consciousness and abnormal or absent breathing.  Some individuals may experience chest pain, shortness of breath, or nausea before cardiac arrest.  If not treated within minutes, it typically leads to death. 

The most common cause of cardiac arrest is coronary artery disease. Less common causes include major blood loss, lack of oxygen, very low potassium, heart failure, and intense physical exercise.  A number of inherited disorders may also increase the risk including long QT syndrome.  The initial heart rhythm is most often ventricular fibrillation.  The diagnosis is confirmed by finding no pulse.  While a cardiac arrest may be caused by heart attack or heart failure, these are not the same. 

Prevention includes not smoking, physical activity, and maintaining a healthy weight.  Treatment for cardiac arrest includes immediate cardiopulmonary resuscitation (CPR) and, if a shockable rhythm is present, defibrillation. Among those who survive, targeted temperature management may improve outcomes.  An implantable cardiac defibrillator may be placed to reduce the chance of death from recurrence. 

In the United States, approximately 535,000 cases occur a year.  About 13 per 10,000 people (326,000 or 61%) experience cardiac arrest outside of a hospital setting, while 209,000 (39%) occur within a hospital.  Cardiac arrest becomes more common with age.  It affects males more often than females.  The percentage of people who survive out of hospital cardiac arrest with treatment by emergency medical services is about 8% Many who survive have significant disability.  However, many American television programs have portrayed unrealistically high survival rates of 67%. 
Cardiac arrest is preceded by no warning symptoms in approximately 50 percent of people  For those who do experience symptoms, they will be non-specific, such as new or worsening chest pain, fatigue, blackouts, dizziness, shortness of breath, weakness and vomiting.  When cardiac arrest occurs, the most obvious sign of its occurrence will be the lack of a palpable pulse in the victim. Also, as a result of loss of cerebral perfusion (blood flow to the brain), the victim will rapidly lose consciousness and will stop breathing. The main criterion for diagnosing a cardiac arrest, as opposed to respiratory arrest, which shares many of the same features, is lack of circulation; however, there are a number of ways of determining this. Near-death experiences are reported by 10 to 20 percent of people who survived cardiac arrest. 

Certain types of prompt intervention can often reverse a cardiac arrest, but without such intervention, death is all but certain.  In certain cases, cardiac arrest is an anticipated outcome of a serious illness where death is expected
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