Arrested heart
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Understanding Arrested Heart: Metabolism, Revascularization, and Post-Cardiac Arrest Care
Metabolism of the Arrested Heart
Oxygen Uptake and Energy Production
The metabolism of the artificially arrested heart, particularly when induced by potassium chloride, shows that oxygen uptake is influenced by several factors including time after arrest, temperature, and perfusion pressure in the coronary vascular bed. Potassium chloride reduces oxygen uptake, but the levels of creatine phosphate (CrP), adenosine triphosphate (ATP), and lactic acid remain normal, indicating that energy production is not disturbed under aerobic conditions. Under anaerobic conditions, lactic acid production and glucose uptake increase, but energy production is not limited by glycolysis capacity.
Comparison with Beating and Fibrillating Hearts
Studies comparing the metabolism of naturally perfused, beating, fibrillating, and arrested hearts show that the oxygen usage of the arrested heart is slightly less than that of the fibrillating heart. The oxygen usage in these states is significantly lower than in naturally perfused hearts, suggesting that the heart's external work primarily determines its oxygen usage.
Revascularization Techniques: Beating vs. Arrested Heart
Cardiac Troponin I Release
A study comparing beating and arrested heart revascularization in coronary artery bypass grafting found that the total release of cardiac troponin I, a marker of myocardial injury, was significantly higher in the arrested heart group. This indicates that conventional coronary artery bypass grafting with cardioplegic arrest causes more myocardial damage compared to off-pump myocardial revascularization.
Functional Capillary Beds
In potassium chloride-arrested hearts, the distribution of open capillaries and the orientation of erythrocytes differ significantly from those in normally beating hearts. Arrested hearts show a reverse gradient in capillary distribution and a weakening of connective tissue elements, which increases with the duration of arrest.
Post-Cardiac Arrest Care
Immediate vs. Delayed Coronary Angiography
For patients resuscitated after out-of-hospital cardiac arrest without ST-segment elevation myocardial infarction (STEMI), immediate coronary angiography does not improve 90-day survival rates compared to delayed angiography. Both strategies show similar outcomes in terms of survival and secondary endpoints such as myocardial injury and neurologic status.
Post-Cardiac Arrest Syndrome
Post-cardiac arrest syndrome includes brain injury, myocardial dysfunction, systemic ischemia/reperfusion response, and persistent precipitating pathology. These components are potentially treatable, and a growing body of knowledge is focused on improving outcomes through targeted interventions.
Survivorship and Rehabilitation
Survivors of sudden cardiac arrest often face long-term physical, cognitive, and emotional challenges. Effective cardiac arrest systems of care are essential for improving survival rates, but there is a need for comprehensive rehabilitative healthcare partnerships to support patients and caregivers post-stabilization.
Conclusion
The metabolism and functional characteristics of the arrested heart differ significantly from those of the beating heart, with implications for revascularization techniques and post-cardiac arrest care. Understanding these differences is crucial for optimizing treatment strategies and improving outcomes for patients undergoing cardiac arrest and subsequent interventions.
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