Cardiac Arrest Versus Heart Attack: What You Need to Know

MORE THAN 559,000 PEOPLE SUFFERED CARDIAC ARREST IN BOTH OUT-OF-HOSPITAL AND IN-HOSPITAL SETTINGS IN 2016. Meanwhile, 790,000 Americans experienced a heart attack, or myocardial infarction, during the same year, explains the American College of Cardiology (ACC). Although similar, cardiac arrest is not an interchangeable term for a heart attack. Unfortunately,  cardiac arrest and heart attack assumptions often lead to skewed survival rates, understanding of intervention methods and treatment of such conditions.

The best way to manage cardiac arrest is different from treatment options for a heart attack and vice versa. As explained by CNN, the differences between cardiac arrest and heart attack are a stark reminder that most U.S. adults cannot perform cardiopulmonary resuscitation (CPR). Furthermore, the continued domination of cardiovascular disease (CVD) as a leading cause of death in the U.S. means your staff members need to understand how to differentiate heart attack from cardiac arrest and respond when called upon, which could save lives during a cardiac event.

What is Cardiac Arrest?

Cardiac arrest occurs when the electrical notes that control heart rhythm malfunction or produce an abnormal heart rhythm, otherwise known as arrhythmias. While different arrhythmias exist, including atrial or ventricular tachycardia, bradycardia, fibrillation, or asystole, not all arrhythmias result in cardiac arrest. Sudden cardiac arrest (SCA) occurs when an arrhythmia develops that prevents the heart from beating, asserts MedlinePlus. The term, sudden, derives from the unintended, unexpected seizure of cardiac muscle during SCA.

What Causes Cardiac Arrest?

The causes of cardiac arrest can range from damage to the heart’s electrical system to overwhelming stress. Deprivation of oxygenated blood flow, blunt force injury to the chest and electrocution may contribute to the development of an arrhythmia that results in SCA. Although these three causes appear simple, it is important to note the hundreds of potential causes of deprivation of oxygenated blood flow.

For example, overdose, ingestion of stimulant medications or drugs, consumption of excess benzodiazepines, drowning, an obstructed airway or any other activity that impede breathing ability can lead to SCA. However, SCA may also develop due to loss of heart function, as in the case with chronic heart failure. Cardiac arrest can result from a severe heart attack too.

How Is Severe Cardiac Arrest (SCA) Treated?

SCA is a medical emergency, and if not treated within minutes of development, it usually causes death. In 2016, only 12 percent of individuals who suffered cardiac arrest outside of a hospital survived, and only 46.1 percent of those people received CPR from a bystander. Yet, those suffering in-hospital cardiac arrest had a survival rate of 24.8 percent. While these statistics allude to a mortality rate in excess of 75 percent, the higher survival rate in a hospital indicates immediate action, performed by health care professionals trained in CPR and Advanced Care Life Support (ACLS), during which medications are used to help the heart regain its normal rhythm, decreases SCA mortality risk.

If SCA develops following a heart attack, the same life-saving measures of CPR, Basic Life Support (BLS), ACLS are used to restore the heart to a normal rhythm, explains the National Heart, Lung and Blood Institute (NHLBI).

As explained by the American Red Cross, CPR today is much simpler for bystanders and untrained professionals to perform. If nothing else, hands-only CPR may be used. During hands-only CPR, a person should push hard and fast in the center of an unconscious victim’s chest until help arrives.

The most important thing to remember about cardiac arrest is that it can kill within minutes due to complete loss of pulse and oxygenated blood flow to the organs and body.

As a refresher, follow these steps to perform CPR:

1. Check the scene for safety, and while tapping the person on the shoulder, yell “Are you okay?”
2. If the person is unable to respond, call 911 immediately, or ask a bystander to call 911. If available, ask a bystander to get your facility’s automated external defibrillator (AED).
3. With the person laying flat on his or her back, open the airway by tilting my head back slightly to lift the chin.
4. Look, listen and feel for signs of breathing by placing your ear close to the person’s mouth and nose. Furthermore, do not mistake gasping or grunting noises for breath sounds.
5. Begin CPR. Traditional CPR has taught people to check for a pulse before beginning compressions. However, recent guidelines and research by the ILCOR found many people, including health care professionals, spend too much time trying to locate a pulse, which increases mortality risk. So, it is best to begin compressions immediately.
6. Using your full-bodyweight, push down in the middle of the chest with your hands positioned with one on top of the other at a rate of 100 compressions per minute. Compressions should be at least two-inches deep as well.
7. After a minute of compressions, deliver two rescue breaths by pinching the person’s nose and placing your mouth over the person’s mouth. Exhale into the person’s mouth until you see the chest rise. If the chest does not rise, reposition the head and chin. If air still does not go in, the person may be choking. Check for an object lodged in the throat. If you do not see anything, continue chest compressions again.
8. Continue CPR until an AED is available or a properly trained medical professional arrives.

Please Note: If using an AED, follow the instructions located on the device or its bag for assistance in applying the pads. The AED will also “talk” to you, advising when to deliver a shock, stand clear or continue CPR.

However, having suffered a SCA, a person is more likely to enter another period of SCA, and if a person has suffered SCA following a heart attack, the underlying cause of cardiac arrest, such as the heart attack, must be treated to prevent SCA recurrence.

The most important thing to remember about cardiac arrest is that it can kill within minutes due to complete loss of pulse and oxygenated blood flow to the organs and body.

How Is a Heart Attack Different From Cardiac Arrest?

A heart attack occurs when the coronary arteries, which supply blood to the heart muscle itself, become obstructed. This may occur when a blood clot forms within the coronary artery or if a blood clot travels to the heart and blocks a vessel. Furthermore, a severe tightening of a coronary artery, also known as a coronary artery spasm, may inhibit blood flow through the artery. If left untreated, the blockage begins to result in the death of cardiac muscle tissue. However, the heart may continue beating even if a heart attack occurs.

The symptoms of a heart attack can begin slow and build gradually or appear suddenly. Unusual shortness of breath, nausea and vomiting, unusual tiredness, back, shoulder and jaw pain, and chest pain or discomfort are the most common symptoms of a heart attack, but some heart attacks may occur without causing symptoms. This is called a silent heart attack.

How Is a Heart Attack Treated?

Similar to cardiac arrest, a heart attack is treated by obtaining medical intervention, such as the administration of nitroglycerin, aspirin to prevent further blood clotting, oxygen and clot-busting medication as soon as possible, explains the NHLBI. However, it is unnecessary to perform CPR on someone experiencing a heart attack unless the person loses consciousness, stops breathing or loses a pulse.

If someone does suffer a heart attack, another common treatment is the use of cardiac catheterization. However, this procedure may be performed hours after a heart attack occurs and uses microscopic implants, known as stents, to force a coronary artery back open. In severe cases, such as a heart attack involving multiple occluded vessels, heart surgery may be necessary to bypass the obstruction.

What Does It Mean to You?

Although heart attack and cardiac arrest are both severe conditions affecting the heart, how you approach someone suffering from one or the other condition is drastically different. CPR is the right course of action for cardiac arrest, but it is not going to help someone suffering a heart attack who still has a proper heart rhythm. Not to mention, people suffering a heart attack may be conscious and able to explain their symptoms and problems.

If someone in your organization or whom your organization provides services to suffers a sudden loss of consciousness, it could be cardiac arrest. Fortunately, employees and bystanders in your facility can help save that person’s life by performing CPR. If the person experiences the symptoms of a heart attack, contact EMS, and listen to what the victim is saying.

If you have not completed your CPR certification previously, or if it has been a while since your last training session, it is time to obtain or renew your certification. Of course, those working in the medical field may need to complete additional Pediatric Advanced Life Support (PALS), BLS, or ACLS certification courses as well.