Sudden Cardiac Death

Dr Wajeeha Sahar
 Sudden Cardiac Death
• Sudden cardiac arrest (SCA) is the sudden and
unexpected cessation of the heart’s pumping
activity.
• The resultant lack of blood flow to the brain
leads to unconsciousness in about 20 to 30
seconds. If flow is not resumed, permanent
brain damage will begin to occur in 4 to 6
minutes, and the condition is generally fatal if
not treated in 10 minutes.
 Sudden Cardiac Death
• When sudden cardiac arrest results in death, it
is termed sudden cardiac death.
• SCA presents with one of three cardiac
rhythms:
– Ventricular fibrillation (VF)
– Pulseless electrical activity
– Asystole
 Sudden Cardiac Death
• Ventricular fibrillation is the most common
– initial rhythm,
– occurring in about 60% of cases
– when assessed by an on-site automated external
defibrillator (AED) and likely even higher among
athletes.
– rhythm represents electrical chaos not a
mechanical problem
– It is the rhythm most amenable to treatment,
which is a high energy shock delivered to the
heart called defibrillation.
Ventricular fibrillation
ECG recording of ventricular
fibrillation
 Asystole
• Asystole, or “flatline,” means the absence of
any cardiac electrical activity and therefore
the absence of any mechanical cardiac
function.
 Incidence and Etiology of Sudden
Death in the General Population
• In the general population, SCA most often
occurs in people age 50 to 75 years, which is
consistent with the development of ischemic
heart disease and congestive heart failure.
• About two thirds of people who experience
SCA have coronary artery disease; SCA is often
the first manifestation of underlying heart
disease.
 Sudden Cardiac Arrest in Athletes
• Exercise-related SCA has been defined as
sudden cardiac arrest occurring within 1 hour
of participation in sport or exercise.
• SCA is the leading cause of death in athletes.
• The death of a competitive athlete is usually
an event of high visibility, is emotionally
disturbing, and may create significant liability
concerns.
 Sudden Cardiac Arrest in Athletes
• External factors may also directly cause or
predispose to SCA in athletes. Most prominent
is the condition called Commotio cordis,
– which is the provocation of ventricular fibrillation
or ventricular tachycardia by a blow to the
anterior chest over or near the heart.
 Preventive Measures: Screening and
Recognition of Cardiac Warning Signs
• Preparticipation Screening
– “Preparticipation physical” or screening
examination should be performed by a medical
practitioner.
– Assessment of the athlete’s medical.
– History to identify symptoms that might indicate
the presence of underlying conditions.
– Symptoms include
• syncope, palpitations, episodic or exertional dyspnea,
exertional chest pain, and early fatigue.
Preventive Measures: Screening and
Recognition of Cardiac Warning Signs
• Recognition of Warning Signs
– Symptoms occurring during or immediately after
exertion are most worrisome, as are symptoms that
occur repeatedly.
– Athletes of all ages are often reluctant to admit to the
presence or seriousness of physical illness.
– Counseling on avoidance of performance enhancing
• Drugs and supplements (especially androgenicSteroids),
• alcohol, caffeine and other stimulants
– Excessive use of vitamin supplements; ensuring
proper nutrition. Hydration, and rest; and paying
attention to environmental Stress.
 Preparation for Cardiac Emergencies
• SCA Awareness
• Everyone in any way involved with the athletic
program, including the athletes themselves,
should receive education on SCA and the
program’s emergency action plan (EAP).
• It is strongly recommended that all receive
formal training in basic CPR and use of an AED.
 Preparation for Cardiac Emergencies
• Training and Education for Responders
– Response Planning SCA victim lives or dies is often
determined by whether the EAP was properly
designed and implemented.
– Coaches and other staff especially for practices,
should have formal training in CPR, AED use, and
basic first aid and a thorough knowledge of the
EAP, how to contact local EMS, and location of the
nearest AED.
 Preparation for Cardiac Emergencies
• Equipment and Supplies
– These include the following:
• Defibrillators
• Ventilation aids
• Telephone or other communications equipment to call
1122 and other resources.
• Defibrillators are of two main types: manual
and automated (also called automatic).
 Manual defibrillators
• Manual defibrillators must be used by
medical personnel with specific training in
cardiac rhythm recognition and management.
• This type of defibrillator requires the user to
interpret the ECG rhythm and determine if an
electric counter shock should be delivered; if
so, the user must be able to set the energy
level, activate the charging process, and then
push a button to deliver the shock.
 Automated external defibrillator
• Automated external defibrillator or AED
devices can be used by virtually anyone, even
without prior training ,although training is
highly advise.
• Portable, battery powered devices provide
verbal and visual prompts to the user once the
device is turned on.
 Defibrillators
Manual defibrillators Automated external defibrillator
Standard location of defibrillation
pads on an adult.
Function of the automated external defibrillator.
 Ventilation Aids
• Ventilation adjuncts are not absolutely necessary
because mouth-to-mouth resuscitation can be
performed.
• Face shields and masks that cover the victim’s
mouth and nose and provide a port for the
rescuer’s mouth.
– Nasopharyngeal and oropharyngeal airways
• (which help to maintain an open airway in an unresponsive
person)
• Ventilation bags that attach to the face mask(commonly
called bag mask, or bag valve mask, devices).
Example of a pocket mask (left)
and a face shield (right).
Management of Sudden Cardiac Arrest
• Successful resuscitation of the victim of SCA
requires the proper interventions to be
provided in a very short time.
• The actions that must occur have been called
the “Chain of Survival.”
– Early recognition of SCA and call to 911
– Early CPR
– Early defibrillation
– Early Advanced Life Support
 Recognition of SCA and Activation of
Local EMS
• Immediate recognition of condition followed
by prompt action is the key to survival.
• Collapsed person is spotted, the athletic
trainer should immediately and quickly move
to the person’s side.
• Verbal stimulus, then the athletic trainer
should gently shake or physically stimulate the
person’s body to see if this elicits a response.
 Recognition of SCA and Activation of
Local EMS
• If there is no response, local EMS should be
summoned immediately, CPR should be
started, and the AED should be brought to the
victim.
 CPR
• The athletic trainer must open the airway and
determine if spontaneous breathing is
present/ absent.
• Rescuer should tilt the head back by pushing
on the forehead and pulling up on the bony
part of the lower jaw (head tilt–chin lift
maneuver).
• Air movement against your cheek (look, listen,
and feel).
 CPR
• Breaths for 1 second each should be provided,
with each breath just large enough to make
the victim’s chest rise.
• Check for a carotid pulse and, if not found
within 10 seconds, begin chest compressions.
 AED Use
• An AED is present or known to be available on
the premises, it should be brought to the
victim and used as soon as possible.
• The AED should be allowed to reassess for a
shockable rhythm after every 2 minutes of
CPR or as per current guidelines.
 Transfer of Care
• The athletic trainer must continue performing
CPR along with using the AED until more
advanced providers assume care of the
patient.
• Advanced providers.
 Documentation and Reporting
• Key events include time collapse recognized,
time help arrived, time AED was used, time of
any specific interventions, and time when
advanced help arrived.
• The record of the AED (ECG recording and
time stamping of AED actions) should be
saved with the written report.
 Debriefing and Follow-Up
• The response and actions taken should be
evaluated to determine if improvements could
be made in future incidents.