Sudden cardiac arrest

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Sudden Cardiac Arrest: Insights and Implications

Epidemiology and Risk Factors of Sudden Cardiac Arrest

Sudden cardiac arrest (SCA) is a significant public health issue, accounting for 15-20% of all natural deaths in adults in the USA and Western Europe, and up to 50% of all cardiovascular deaths. The incidence of SCA varies with age, with primary arrhythmia syndromes and inherited cardiomyopathies being predominant causes in younger patients, while coronary artery disease is the leading cause in those aged 35 and older. Understanding the complex interaction of inherited and acquired causes is crucial for designing personalized prevention and treatment strategies.

Anxiety, Mental Stress, and SCA

Anxiety and mental stress have long been associated with SCA, although their precise roles remain unclear. Anxiety appears to predispose physically healthy populations to SCA, potentially by contributing to other risk factors such as cardiovascular disease and diabetes mellitus through mechanisms like unhealthy lifestyle choices and metabolic abnormalities. Mental stress, on the other hand, may precipitate SCA by directly impacting cardiac ion channels, leading to ventricular fibrillation, the arrhythmia underlying SCA.

Circadian Rhythms and SCA Incidence

The time of day significantly influences the incidence and survival rates of SCA. Research indicates a bimodal distribution with a primary peak in the morning and a secondary peak in the afternoon, particularly in older individuals and males. Survival rates are notably lower between midnight and 06:00 a.m., suggesting that circadian rhythms play a crucial role in SCA patterns.

SCA in Athletes

SCA is the leading cause of death in young athletes, with an incidence of 0.76 cases per 100,000 athlete-years during competitive sports. Despite efforts to improve preparedness, such as emergency action plans (EAPs) and training in cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use, bystander awareness and readiness remain inadequate. Preparticipation screening programs aimed at identifying at-risk athletes have shown limited efficacy, with structural heart disease being an uncommon cause of SCA during competitive sports.

Prevention and Treatment Strategies

Internal cardioverter defibrillators (ICDs) are the mainstay of primary and secondary prevention of SCA. In the acute phase, the cardiac chain of survival, early reperfusion, and therapeutic hypothermia are key steps in improving outcomes. In chronic settings, ventricular tachycardia ablation can improve quality of life by reducing the frequency of defibrillator shocks and may increase survival. Neuromodulation is emerging as a novel therapeutic modality with potential benefits for treating ventricular arrhythmias.

Survivorship and Post-SCA Care

The number of SCA survivors is increasing due to improved coordination of community, emergency medical services, and hospital efforts. However, survivors often face lingering physical, cognitive, and emotional effects. Expanding the cardiac arrest resuscitation system of care to include rehabilitative healthcare partnerships is essential for addressing the long-term needs of patients and caregivers.

Home Use of AEDs

For survivors of anterior-wall myocardial infarction who are not candidates for ICD implantation, access to a home AED does not significantly improve overall survival compared to conventional resuscitation methods. This finding underscores the need for continued research into effective home-based interventions for SCA.

Conclusion

Sudden cardiac arrest remains a major health burden with complex etiologies and significant implications for public health. Understanding the roles of anxiety, mental stress, circadian rhythms, and specific risk factors is crucial for developing effective prevention and treatment strategies. Continued efforts to improve preparedness, particularly in high-risk populations like athletes, and to enhance post-SCA care are essential for reducing the morbidity and mortality associated with this condition.