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The terms heart attack and cardiac arrest are often used interchangeably, but they are not the same thing. Heart attack and cardiac arrest are two different conditions.

Heart Attack

A heart attack (or myocardial infarction) is a “circulation” problem.

Heart attack occurs when a part of the heart muscle does not get enough blood due to a blocked artery caused by atherosclerosis and dies in the process as a result of oxygen deprivation, giving rise to crushing chest pain.

Symptoms

Symptoms of a heart attack may be immediate. More often though, symptoms occur slowly and may persist for hours, days or weeks.

Common symptoms are:

• Chest pain
• Shortness of breath
• Cold sweat

Other symptoms may also include:

• Heart palpitations
• Giddiness
• A choking sensation
• Heartburn/indigestion
• Nausea

Caregivers and family members of cardiac patients should also look out for sudden and complete loss of responsiveness on the patient’s part as well as a cessation of signs of circulation, as these may likewise be warning signs of a heart attack.

In diabetic patients, heart attacks are generally silent without any accompanying chest pain.

Causes

The following factors may increase the risk of heart attacks.

• Age and sex
• Family history
• High blood pressure
• High cholesterol
• Diabetes
• Physically inactive
• Overweight or obese
• Smoke
• Excessive drinking
• Medical history, such as
  • Coronary artery disease or coronary heart disease
  • Atrial fibrillation
  • Carotid artery disease
  • Transient Ischaemic Attack
  • Disease of leg arteries
  • A high red blood cell count
  • Sickle cell anaemia
  • A previous heart attack

What to do

Call 995 immediately!

Even if you are not sure if it is a heart attack, call 995. Every minute matters. It is best to call for medical care right away. Paramedics on emergency medical services can begin treatment as soon as they arrive.

Do not attempt to drive yourself or the patient to the hospital, as you do not have the necessary lifesaving equipment and medication.

Prevention

Start by becoming aware of your risks, the personal characteristics and habits that may increase your chances of having a heart attack or stroke. Some you cannot change or control; some you can, by making a few changes in your habits or taking medicines as prescribed.

Treatment

1. Prevention of further blood clot formation with medication such as aspirin or other antiplatelet agents
2. Pain relief with medication
3. Re-opening of the blocked artery as soon as possible by either:
   • Infusion of drugs to dissolve the clot known as a fibrinolytic agent
   • Coronary angioplasty to restore blood flow
   • Further investigations to look for complications of the heart and to assess and reduce the risk of another heart attack
   • Long term medication and cardiac rehabilitation to control your risks and prevent a recurrence

Cardiac Arrest

Cardiac arrest is an “electrical problem”.

Sudden cardiac arrest occurs when the heart stops beating unexpectedly or malfunctions.

A cardiac arrest is triggered by an electrical malfunction in the heart that causes an irregular heartbeat (arrhythmia). When the pumping action is disrupted, the heart cannot pump oxygen-rich blood to the brain, lungs and other organs. This can lead to death within minutes.

Signs

Sudden cardiac arrest can be preceded by the classic symptoms of a heart attack, which then rapidly progress into:

• Loss of consciousness
• Fits (convulsion)
• Gasping
• No breathing

Causes

Coronary Heart Disease

About 80% of sudden cardiac arrest is due to coronary heart disease (CHD). Since CHD is a condition that increases with age, sudden cardiac arrest is also more likely to be due to CHD in older patients.

Sudden cardiac arrest is particularly likely to occur more severely with CHD when more coronary arteries are affected and when the main trunk of the left coronary artery is obstructed (sometimes called the “widow maker’s disease).

Sudden cardiac arrest risk is also higher in those who previously had a heart attack resulting in extensive heart muscle damage and heart failure.

Since CHD is the most common underlying cause of sudden cardiac arrest, the risk factors would be those that cause atherosclerosis, the disease process of CHD. These include age, smoking, hypertension, high cholesterol, diabetes, obesity, sedentary lifestyle, stress and family history.

Genetics

In younger patients in whom CHD is less frequent, other causes arising from genetics may be present. These conditions include:

• Abnormalities of the heart’s electrical system e.g. the “long QT interval syndromes”
• Brugada syndrome
• Abnormalities of the heart muscle e.g. hypertrophic cardiomyopathy
• Various forms of congenital heart disease (“hole-in-the-heart”, “blue babies”)
• Various heart valve disease

Prevention

The risk of sudden cardiac arrest can be lowered by reducing the risk of CHD.

• Screening and effective control of the causes of CHD e.g. high blood pressure, high cholesterol, etc.
• In those with known CHD, various types of tests can be conducted to identify those at higher risk of heart attack and cardiac arrest. These tests include ECG, exercise or other types of stress tests, echocardiography, imaging techniques e.g. CT scans, isotope scans, coronary angiography, ECG Holter Monitoring and electrophysiologic study.
• Those at increased risk may be treated with medications, angioplasty, pacemakers or implantable defibrillators.

Younger individuals with a family history of sudden cardiac arrest or other types of heart disease may be screened by a doctor and referred if there are suggestive signs e.g. an abnormal ECG.

Individuals planning to participate in strenuous exercise should have a medical examination, including an ECG, a stress test (e.g. a treadmill test), and other types of cardiac examination.

Treatment

Cardiac arrest can be reversible in some victims if it is treated within a few minutes.

• Call 995 for an ambulance and perform CPR (Cardiopulmonary Resuscitation) right away.
• If an AED (Automated External Defibrillator) is available, use it as soon as possible.

If two people are available to help, one should begin CPR immediately while the other calls 995 and finds an AED.

Resuscitation of a cardiac arrest casualty should be initiated within 4 minutes, as any delay beyond this period may result in permanent brain and cardiac damage.

What’s the Difference?

Sudden cardiac arrest is different from a heart attack.

A heart attack occurs when blood flow to the heart is blocked, resulting in the death of parts of the heart muscle.

Most heart attacks do not lead to cardiac arrests. But when cardiac arrest occurs, a heart attack is a common cause. Other conditions may also disrupt the heart’s rhythm and lead to sudden cardiac arrests. Unlike a cardiac arrest, the heart usually does not stop beating during a heart attack.

Sudden cardiac arrest occurs when the heart stops pumping blood around the body and the victim stops breathing. It is one of the complications of a heart attack. In fact, about half of heart attack victims present with sudden cardiac arrest.

The immediate cause of sudden cardiac arrest is often a sudden development of an abnormal heart rhythm called ventricular fibrillation (VF) or less commonly due to asystole (heart stops contracting). In VF, there is chaotic electrical activity without mechanical contraction so that there is a rapid cessation of blood circulation. VF can be preceded by ventricular tachycardia (VT) with a rapid heart rate, e.g. 200 beats per minute, but very low blood pressure.

When the pumping action is disrupted, the heart cannot pump blood to the brain, lungs and other organs. Seconds later, a person loses consciousness and stops breathing (or gasps for air). Death occurs within minutes if the victim does not receive treatment immediately.

Summary

In both scenarios, fast action save lives. Choose a heart-healthy lifestyle to prevent the onslaught of a heart attack and cardiac arrest and equip yourself with CPR+AED skills to help save lives.

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