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Difference between Sudden Cardiac Death and heart attack

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Oleh
Sudden Cardiac Death (SCD) is often equated with a heart attack (myocardial infarction). Though both of them are two different things.


Difference between Sudden Cardiac Death and heart attack.
Sudden Cardiac Death : electrical disorders, this condition occurs due to malfunction of the heart's electrical system which causes the heart to stop beating. Death can occur quickly if not handled properly.

Heart attack : circulatory disorders, a condition when blood flow to the heart stops due to a blockage in the arteries that causes death of heart muscle cells.

From various studies, it is estimated that Sudden Cardiac Death occurs in 50-100 people out of 100,000 population in the world.

Risk factors for Sudden Cardiac Death.
Risk factors for SCD are related to their etiology. The following are Sudden Cardiac Death risk factors :
Demographics ➡
  • Increasing age. 
  • Male gender. 
  • African-American or non Asian ethnicity. 
Coronary heart disease risk factors ➡
  • Hypertension. 
  • Diabetes. 
  • Dyslipidaemia. 
  • Cigarette smoking. 
  • Obesity. 
Electrocardiographic parameters ➡
  • Heart rate. 
  • QRS duration or fragmentation. 
  • Q waves or dynamics ST segment changes.
  • QTc interval. 
  • QRS-T angle. 
  • QRS transition zone. 
  • T-peak-to-T-end interval. 
  • Increased R wave voltage. 
  • Specific abnormalities associated with primary arrhythmic disorders. 
Lifestyle/ psychosocial factors ➡ 
  • Depression and anxiety. 
  • Diet (greater fish, n-3 fatty polyunsaturated acids, Mediterranian diet protective). 
  • Heavy alcohol use. 
  • Limited physical activity. 
Genetics ➡
  • Family history of Sudden Cardiac Death. 
  • Specific mutations/ polymorphisms. 
Specific condition ➡
  • Coronary heart disease. 
  • Atrial fibrillation. 
  • Chronic kidney disease. 
  • Obstructive sleep apnea. 
  • Dilated cardiomyopathies. 
  • Hypertrophic cardiomyopathies. 
  • Arrhythmogenic right ventricular dysplasia. 
  • Infiltrative disease (e.g. sarcoidosis, amyloidosis). 
  • Valvular heart disease. 
  • Congenital abnormalities. 
Inherited arrhythmic syndromes ➡
  • Long and short QT syndromes. 
  • Brugada syndrome.
  • Catecholaminergic polymorphic ventricular tachycardia. 
  • Early repolarisation syndrome. 
Etiology of Sudden Cardiac Death.
Most young people who experience Sudden Cardiac Death have structural heart problems that cause ventricular tachycardia/ fibrillation, leading to cardiac arrest. At the age of 1-4 years the most frequent possibility is due to congenital heart abnormalities and primary electrical disorders (if the heart structure is normal). Sudden Cardiac Death in people aged 1-35 years is the result of Sudden Arrythmic Death (SADS).

Clinical manifestations of Sudden Cardiac Death.
Common prodromal symptoms associated with the risk of Sudden Cardiac Death arrhythmias are :
  • Palpitations.
  • Chest pain.
  • Dipsnea.
  • Syncope.
  • Convulsions.
  • Other symptoms are in accordance with the basic etiology of the cause.
Cardiovascular screening.
  • Screening begins with anamnesis to look for risk factors and a history of congenital heart disease and Sudden Cardiac Death.
  • Physical examination, ECG and if needed Echocardiogram can also be used as a strategy for screening. ECG is a sensitive and efficient screening tool for screening young people.
Handling of Sudden Cardiac Death.
The principles of handling Sudden Cardiac Death are the same as cardiac arrest guidelines.

ADVANCE CARDIAC LIVE SUPPORT (ACLS). 

Start heart-lung resuscitation : give O² and attach a defibrillator monitor ➡ rhythm shockable? Yes ➡ ventricular/ pulseless ventricular tachycardia ➡ schock ➡ heart-lung resuscitation for 2 minutes : intravenous/ intraosscous access ➡ shock shockable rhythm? No ➡ schock ➡ heart-lung resuscitation for 2 minutes : epinephrine every 3-5 minutes and consider advanced airway; capnography ➡ rhythm shockable? No ➡ schock ➡ heart-lung resuscitation for 2 minutes : amiodarone/ lidocain and treat reversible causes.

Start heart-lung resuscitation : give O² and attach a defibrillator monitor ➡ rhythm shockable? No ➡ asistol/ pulseless electrical activity ➡ heart-lung resuscitation for 2 minutes : intravenous/ intraosscous access, epinephrine every 3-5 minutes and consider advanced airway; capnography ➡ rhythm shockable? No ➡ heart-lung resuscitation for 2 minutes : intravenous/ intraosscous access ➡ rhythm shockable? No ➡ if there is no ROSC sign: repeat heart-lung resuscitation for 2 minutes : intravenous/ intraosscous access, epinephrine every 3-5 minutes and consider advanced airway; capnography or heart-lung resuscitation for 2 minutes : intravenous/ intraosscous access ➡ if ROSC : to Post Cardiac Arrest Care. 

Start heart-lung resuscitation : give O² and attach a defibrillator monitor ➡ rhythm shockable? No ➡ asistol/ pulseless electrical activity ➡ heart-lung resuscitation for 2 minutes : intravenous/ intraosscous access, epinephrine every 3-5 minutes and consider advanced airway; capnography ➡ rhythm shockable? Yes ➡ schock. 

Quality of heart-lung resuscitation. 
  • Minimum pressure of 5 cm.
  • Speed ​​of 100-120 ×/minute.
  • Minimal interruptions during compression.
  • Avoid excessive ventilation.
  • Change the compressor every 2 minutes or if you are tired.
  • If there is no advanced airway, the compression ratio is 30: 2.
Drug dosage.
Epinefrin intravenous/ intraosscous :
  • 1 mg every 3-5 minutes. 
Amiodarone intravenous/ intraosscous :
  • First dose : 300 mg dolus.
  • Second dose : 150 mg. 
Lidocain intravenous/ intraosscous :
  • First dose: 1-1,5 mg/kg.
  • Second dose: 0,5-0,75 mg/kg.
Defibrillation energy. 
Biphasic : 120-200 J
Monophasic : 360 J

Advanced airway. 
  • Endotracheal intubation/supraglotic advanced airway. 
  • Capnography waveform/capnometry for monitoring endotracheal tube placement.
  • After the advanced airway is installed, give 10 breaths/ minute (1 every 6 seconds) with continuous chest compression. 
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