Summary
Definition
This monograph covers cardiac arrest in adults. Sudden cardiac arrest is a sudden state of circulatory failure due to a loss of cardiac systolic function. It is the result of 4 specific cardiac rhythm disturbances: ventricular fibrillation (VF), pulseless ventricular tachycardia (VT), pulseless electrical activity, and asystole. Torsades de pointes is a subgroup of polymorphic VT in patients with an underlying prolonged QT interval, sometimes related to hypomagnesemia.
[Figure caption and citation for the preceding image starts]:
Monomorphic ventricular tachycardia
From the personal collections of Dr A. Askari and Dr A. Krishnaswamy; used with permission
[Citation ends].
[Figure caption and citation for the preceding image starts]:
Torsades de pointes
From the personal collection of Dr A. Askari; used with permission
[Citation ends].
History and exam
Key diagnostic factors
- family history of sudden cardiac arrest
- pulmonary disease
- chest pain
- palpitations
- syncope
- presence of other risk factors
- medications which prolong the QT interval or cause electrolyte disturbances
- illicit substances
- trauma
Other diagnostic factors
- hypertension
- hypercholesterolemia
- diabetes mellitus
- kidney disease
- family history of coronary artery disease
- valvular heart disease
- elevated jugular venous pulse
- heart murmur
- abnormalities on auscultation of lungs
- tracheal deviation
- neurologic deficits
- history of eating disorders
Risk factors
- coronary artery disease (CAD)
- left ventricular dysfunction
- hypertrophic cardiomyopathy (HCM)
- arrhythmogenic right ventricular dysplasia (ARVD)
- long QT syndrome (LQTS)
- acute medical or surgical emergency
- Brugada syndrome
- smoking
Diagnostic investigations
1st investigations to order
- ECG
- CBC
- basic metabolic panel
- ABG
- cardiac biomarkers
- toxicology screen
- CXR
- echocardiogram
- coronary angiography
Investigations to consider
- cardiac magnetic resonance imaging
- signal-averaged ECG (SAECG)
- electrophysiologic study
Treatment algorithm
Contributors
Authors VIEW ALL
Professor and Department Head of Emergency Medicine
Cumming School of Medicine
University of Calgary
Alberta Health Services
Calgary
Canada
Disclosures
EL served as a consultant to the American Heart Association providing methods support using GRADE for cardiac arrest guidelines published in Circulation and Resuscitation in October 2015.
Professor Eddy Lang would like to gratefully acknowledge Dr Amar Krishnaswamy and Dr Arman T. Askari, previous contributors to this topic. AK and ATA declare that they have no competing interests.
Peer reviewers VIEW ALL
Professor of Medicine
Division of Cardiology
University of California
San Francisco
CA
Disclosures
VM declares that he has no competing interests.
Instructor
NYU Department of Medicine (Cardiology)
Leon H Charney Heart Rhythm Center and New York University
New York
NY
Disclosures
AA declares that he has no competing interests.
Honorary Clinical Senior Lecturer/Consultant
Department of Cardiology
Imperial College London
London
UK
Disclosures
MFP declares that he has no competing interests.
Use of this content is subject to our disclaimer