Dilated or hypertrophic cardiomyopathy – Causes 10-15 % of all cases.Acute or chronic ischemic heart disease cause 80% of all sudden cardiac deaths – Ventricular arrhythmias may arise during acute ischemia as well as in chronic ischemia.Sudden cardiac death due to bradycardia or pulseless electrical activity is much less common. The latter, asystole, means that there is no electrical activity in the heart and the ECG shows a flat line ( Figure 1). The death mechanism is usually the same regardless of the underlying disease: electrical instability triggers ventricular tachycardia which degenerates into ventricular fibrillation which leads to asystole. Cardiomyopathies (dilated or hypertrophic), valvular disease, genetic mutations (LQTS, Brugada syndrome, early repolarization) etc, are much less common than ischemic heart disease. Sudden cardiac death causes 7 million deaths annually worldwide. The most common cause of sudden cardiac death is acute or chronic coronary artery disease (ischemic heart disease). Moreover, the time limit (1 hour) is not absolute. The person may or may not have known cardiac disease. This immediately leads to syncope and soon death, unless resuscitation is attempted. Sudden cardiac death is defined as an unexpected death due to cardiac causes that occur within 1 hour of symptom onset. Cardiac arrest and sudden cardiac deathĬardiac arrest ensues when ventricular contractions cease or are meaningless. Ventricular fibrillation is treated according to the resuscitation algorithm. By Bagnall et al: BMC Medical Genetics 15 (2014): 99. ECG showing ventricular tachycardia degenerating into ventricular fibrillation. This is pathognomonic (unique) to ventricular fibrillation and must not be confused with any other arrhythmia.įigure 2. No P-wave, QRS complex or T-wave can be seen. The ECG shows irregular waves with varying morphology and amplitude. Electrolyte disorders, acidosis, hypoxemia and ischemia all aggravate the risk of developing ventricular fibrillation, in any situation. Other common causes are cardiomyopathy (hypertrophic or dilated), arrhythmogenic right ventricular cardiomyopathy, Brugada syndrome, early repolarization. Most of these have atherosclerotic heart disease (coronary artery disease) as the underlying cause. The prognosis is very poor, with the majority of patients dying.Īpproximately 80% of individuals who suffer a sudden cardiac arrest have ventricular fibrillation prior to the cardiac arrest. The mechanisms in ventricular fibrillation are, as in atrial fibrillation, the existence of multiple re-entry circuits which cause chaotic ventricular depolarization. The patient dies if the rhythm is not restored. The absence of contractions causes syncope and circulatory collapse. Ventricular fibrillation means that the ventricles do not produce any meaningful contractions, they merely fibrillate. These arrhythmias lead to death if cardiopulmonary resuscitation is not started immediately. This article will focus on ventricular fibrillation, pulseless electrical activity and sudden cardiac arrest. When done close the diagram.Ventricular fibrillation, pulseless electrical activity (PEA) and sudden cardiac arrest View the cardiac arrest algorithm diagram. The pulse check should be performed simultaneously with the rhythm check when treating PEA since by definition PEA is an organized rhythm and could have a pulse that generates blood perfusion. Limit the rhythm/pulse check to less than 10 seconds to minimize interruptions in CPR. High-quality CPR should be administered while giving epinephrine, and after the initial dose, epinephrine is given every 3-5 minutes.įor PEA a rhythm and pulse check should be performed after 5 cycles of CPR. When treating PEA, epinephrine can be given as soon as possible but its administration should not delay the initiation or continuation of CPR. Vasoconstriction is important during CPR because it will help increase blood flow to the brain and heart.
The vasopressor that is used for the treatment within the right branch of the Cardiac Arrest Algorithm is epinephrine.Įpinephrine is primarily used for its vasoconstrictive effects.
Medications used in PEA VasopressorsĪ vasopressor is a medication that produces vasoconstriction and a rise in blood pressure. Identification and correction of the cause of PEA. Positive outcome of an attempted resuscitation depends primarily on two actions: 1.
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