Summary
Definition
History and exam
Key diagnostic factors
- patient unresponsive
- absence of normal breathing
- absence of circulation
- cardiac rhythm disturbance
Risk factors
- coronary artery disease (CAD)
- left ventricular dysfunction
- hypertrophic cardiomyopathy (HCM)
- arrhythmogenic right ventricular dysplasia (ARVD)
- long QT syndrome (LQTS)
- medications that prolong the QT interval or cause electrolyte disturbances
- acute medical or surgical emergency
- illicit substances
- Brugada syndrome
- valvular heart disease
- smoking
- history of eating disorders
Diagnostic investigations
1st investigations to order
- continuous cardiac monitoring
- CBC
- serum electrolytes
- ABG
- cardiac biomarkers
- point of care ultrasound (POCUS)
Investigations to consider
- ECG
- coronary angiography
- echocardiogram
- chest x-ray
- toxicology screen
- cardiac magnetic resonance imaging
- coronary computed tomography angiography
- signal-averaged ECG (SAECG)
- electrophysiologic study
Treatment algorithm
unwitnessed cardiac arrest
shockable rhythms (pulseless ventricular tachycardia or ventricular fibrillation)
nonshockable rhythms (pulseless electrical activity or asystole)
return of spontaneous circulation
no return of spontaneous circulation
Contributors
Authors
John Wink, MD
Resident Physician
Department of Emergency Medicine
University of Calgary
Calgary
Canada
Disclosures
JW declares that he has no competing interests.
Eddy Lang, MD
Professor and Department Head of Emergency Medicine
Cumming School of Medicine
University of Calgary
Alberta Health Services
Calgary
Canada
Disclosures
EL declares that he has no competing interests.
Acknowledgements
Dr John Wink and Professor Eddy Lang would like to gratefully acknowledge Dr Amar Krishnaswamy and Dr Arman T. Askari, previous contributors to this topic.
Disclosures
AK and ATA declare that they have no competing interests.
Peer reviewers
Vaikom Mahadevan, MD
Professor of Medicine
Division of Cardiology
University of California
San Francisco
CA
Disclosures
VM declares that he has no competing interests.
Anthony Aizer, MD, MS
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.
Massimo F. Piepoli, MD, PhD, FESC
Honorary Clinical Senior Lecturer/Consultant
Department of Cardiology
Imperial College London
London
UK
Disclosures
MFP declares that he has no competing interests.
Guidelines
- 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death
- 2022 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendation
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