Therapy
Those suffering from cardiac arrest need immediate care in order to survive; therefore, anyone in his vicinity or in his company must give him help as soon as possible.
Figure: cardiac massage should be performed by compressing the chest with two hands, one above the other.
The first thing a rescuer needs to do is call 118, to call in specialized hospital staff and receive information on what to do; the second thing is to practice defibrillation (if you have the appropriate instrument) and cardiopulmonary resuscitation ( CPR ), in order to keep the most important organs of the body alive and avoid their permanent damage.
Once the medical help arrives, they will take care of the person affected by the cardiac arrest, taking her to the hospital and subjecting her to the most appropriate therapies.
CARDIOPULMONARY RESUSCITATION (CPR)
Cardiopulmonary resuscitation ( CPR ), if carried out immediately, can be essential to save the lives of individuals subjected to cardiac arrest, heart attack, drowning or suffocation.
Its execution, in fact, allows the oxygenated blood to reach the different organs of the body, primarily the brain, and keep them alive.
The SPC consists of alternating the so-called cardiac massage with artificial respiration . The cardiac massage, performed with strong manual compressions at chest level, simulates the pumping action of the heart; while artificial respiration, carried out mouth to mouth and with the patient's nostrils closed, allows new oxygen to be introduced into the airways.
| CPR for those who are inexperienced | Frequently asked questions about cardiopulmonary resuscitation |
RSP inexperienced rescuers will receive all the necessary information when they call 118. They will also be advised, unless it is a question of drowning or suffocation (for which new oxygen is essential), to practice a continuous cardiac massage, with as many as 100 compressions per minute, until the arrival of hospital aid. | In the event of cardiac arrest, is cardiac massage or artificial respiration more important? Cardiac massage is of primary importance, as oxygen remains in the blood for several minutes. When should the SPC be stopped? The CPR must be performed until the arrival of hospital aid or until the rescuer does not exhaust his strength (NB: the cardiac massage is very tiring). If the rescuers are more than one, they can alternate in the practice of cardiac massage and in this way to rest. What should be done before artificial respiration? First of all, the patient's head must be gently tilted backwards so as to open the airways and then close the nasal passages to prevent the air entering through breathing from coming out of the nostrils. |
DEFIBRILLATION
Defibrillation is performed, before CPR (if there is the possibility), in order to restart the heart and restore normal heart rhythm.
It requires the use of a special instrument, the defibrillator, capable of emitting electric shocks.
The electric shocks emitted are adequate to the situation, as the instrument is constructed in such a way as to be able to measure the electrical activity of the heart and recognize the cardiac problems in progress.
Defibrillators, therefore, can be used by anyone, since it is sufficient to follow the instructions they are provided with, relative to their operation.
What to do if you don't have a defibrillator?
The rescuer must not be alarmed, but call 118 quickly and dedicate himself immediately to cardiopulmonary resuscitation. The defibrillator is important, but an individual's life can be saved even with the SPC.
IN THE HOSPITAL
Cures to stabilize the situation and investigations related to the origins of cardiac arrest can only start after the patient has arrived in the hospital and his heart has started beating again. The most common treatments are:
- Drug therapy based on antiarrhythmics and ACE inhibitors . The administration of these drugs is aimed at restoring and maintaining a normal heart rhythm. The most commonly used antiarrhythmic drugs are beta-blockers (metoprolol), potassium channel blockers (amiodarone) and calcium channel blockers (diltiazem); while the most commonly administered ACE inhibitors are captopril or enalapril.
Treatment risks: sometimes, they can create other arrhythmias or worsen pre-existing rhythm disorders. It is important, especially in the first phase of treatment, to monitor the patient's condition step by step.
- The implantation of a cardioverter defibrillator (ICD) . The ICD is a small defibrillator that is housed in the left side of the chest and connected to the heart by means of leads. As soon as the heart changes its heartbeat abnormally, it records the variation and emits a corrective electrical discharge, aimed at restoring normal heart rate.
Treatment risks: sometimes the instrument can emit electric shocks for no reason.
- Coronary angioplasty . It is the surgical procedure, performed through a catheter, which allows the reopening of the occluded coronary arteries. Clearly, its execution is required when, from diagnostic tests performed after cardiac arrest, coronary artery disease has emerged.
Treatment risks: it is an invasive and potentially dangerous procedure, because the catheter crosses the arteries of the body and because a contrast liquid is diffused in the blood vessels.
- Coronary bypass surgery . It is an alternative to coronary angioplasty, so it is also performed when the coronaries are occluded or restricted. Its purpose is to "build" an artificial bridge (bypass), which eludes the obstacle present in the coronary arteries.
Treatment risks: it is an invasive procedure, because it involves a direct intervention on the heart.
- Radiofrequency cardiac ablation . It involves the use of an electrocathars, called an ablator, which, once carried to the heart, is able to destroy the area responsible for the arrhythmia. For any further information on this we recommend consulting the article on cardiac ablation.
- Corrective surgery of heart defects . It is the surgical procedure to correct valvular defects (ie heart valves) and dilated cardiomyopathies.
Treatment risks: it is an invasive procedure, because it requires a direct intervention on the heart.
- Heart transplantation . Those suffering from cardiac arrest can be an ideal candidate to receive a new heart from a compatible donor.
Treatment risks: it is a highly invasive procedure that, even when it is successfully concluded, is at high risk of rejection.
Prognosis
Without adequate treatment, cardiac arrest is almost always lethal. In fact, the survival rate is only 2%.
Figure: an implantable cardioverter defibrillator, or ICD
Furthermore, even when treatments are applied in time, there is a fair probability that complications arise, such as coma, or that the patient suffers permanent and highly debilitating brain damage.
Prevention
To individuals at risk of cardiac arrest, the doctor advises to adopt a healthy lifestyle (so do not smoke, stay active, stick to a balanced diet, etc.) and regularly undergo cardiological checks, in order to monitor the health of one's heart .
Furthermore, in case of hypercholesterolemia or diabetes, it suggests the regular intake of drugs suitable for such circumstances; while, in case of serious heart diseases, it recommends the regular intake of antiarrhythmic drugs and the installation of an ICD, or an implantable cardioverter defibrillator.
Attention: it is advisable for family members of people with severe heart problems to learn to practice cardiopulmonary resuscitation in an excellent way, so that they already know how to deal with a possible episode of cardiac arrest.
