Asystole

Asystole

What is sudden cardiac arrest? — Sudden cardiac arrest (SCA) is when the heart suddenly stops beating. This is a medical emergency that needs to be treated right away. SCA that isn't treated right away causes death (called "sudden cardiac death"). But even with treatment, most people with SCA do not survive.
The heart has a built-in electrical system that keeps it beating in a normal rhythm. In SCA, a problem happens with the electrical system. This leads to an abnormal heart rhythm. The abnormal heart rhythm that happens most often in SCA is called "ventricular fibrillation" or "v fib." In this rhythm, the lower chambers of the heart (ventricles) twitch, but do not pump blood (figure 1).
SCA is different than a heart attack. In a heart attack, 1 of the arteries that bring blood to the heart gets blocked, and heart muscle dies. But the heart still beats.
What causes SCA? — SCA is most likely to happen in people who already have a heart problem, whether they know about their heart problem or not. Heart problems that can cause SCA include:
Coronary heart disease, which is when the arteries that bring blood to the heart get clogged with fatty deposits
A heart attack
Thickening of the heart muscle, called "cardiomyopathy"
Other problems with the heart's electrical system
Heart failure, which is when the heart doesn't pump as well as it should
Other conditions and events that can also cause SCA include:
Certain lung problems
A severe injury, drowning, or getting electrocuted
Illegal drugs, such as cocaine, heroin, or methamphetamine ("meth")
Electrolyte problems – Electrolytes are substances in the body (like sodium or potassium) that the body needs to work normally.
What are the symptoms of SCA? — Many people do not have any "warning" symptoms before their SCA. But up to half of people do have symptoms before their SCA. These can happen either just before their SCA, or in the days leading up to it. Symptoms might include:
Having chest pain or trouble breathing
Feeling their heart racing, skipping beats, or beating out of sync
Feeling weak or dizzy
When SCA happens, a person loses consciousness, has no pulse, and is not breathing.
How is SCA treated? — SCA needs to be treated right away with both:
Cardiopulmonary resuscitation (CPR) – CPR is a way to get blood and oxygen moving through the body of someone whose heart has stopped beating. It involves "compressions," which is when another person presses hard and fast (over and over again) on the person's chest. This squeezes the heart and gets the blood moving again, although not as well as when the heart pumps blood on its own.
Defibrillation – This involves using a device to send an electrical shock to the heart. This shock can sometimes get a normal heart rhythm started again. Defibrillation has the best chance of working when it is done right away.
If these treatments are done within a few minutes of SCA, they sometimes work to restart the heart. After the heart is beating again and blood is flowing through the body, further treatment and tests will happen.
Doctors or emergency workers sometimes start a treatment called "hypothermia" to cool the body down. This treatment can give people a better chance of surviving in the days after SCA. For this treatment, the body is cooled down to a few degrees below normal for 1 to 2 days. This helps reduce brain injury. This is important, because brain injury is the most common cause of death after SCA.
Most people need a breathing tube. A breathing tube is a tube that goes down the throat and into the lungs. The other end is attached to a machine that helps with breathing.
Your doctor will also look for the cause of your SCA and treat it, if it can be treated. To look for the cause, your doctor will do a lot of tests. These usually include:
An electrocardiogram (ECG) – This test measures the electrical activity in your heart (figure 2).
A chest X-ray
Blood tests
An echocardiogram (or "echo") – This test uses sound waves to create a picture of your heart as it beats (figure 3).
Other imaging tests – Imaging tests create pictures of the inside of the body.
Your doctor might decide to do a procedure called cardiac catheterization, also called "cardiac cath." For this, the doctor puts a thin tube into a blood vessel in your leg or arm. Then he or she moves the tube up to your heart. When the tube is in place, the doctor can do tests or unblock a clogged artery (figure 4).
Most people who survive SCA are also treated with an implantable cardioverter-defibrillator (ICD). An ICD is a device that goes under a person's skin near his or her heart. It can sense abnormal heartbeats and then treat them with an electrical shock.
What will my life be like if I survive? — It depends, in part, on what caused your SCA and how quickly it was treated. Some people recover completely from SCA without any long-term problems. But many survivors have long-term brain problems.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 82912 Version 10.0
Release: 28.2.2 - C28.105
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