Sudden cardiac arrest may not always be so sudden, heart experts say.
A recent study has found that cardiac arrest symptoms in men can appear at least a month ahead of time. Signs can include chest pain, shortness of breath, dizziness, fainting or palpitations.
Sudden cardiac arrest differs from a heart attack. Cardiac arrest occurs when electrical impulses in the heart become rapid or chaotic, causing the heart to stop beating. A heart attack happens when the blood supply to the heart is blocked.
Joining the show to discuss early heart attack symptoms, sudden cardiac arrest, and what you can do to prevent this from happening, is John J. Finley IV, MD, FACC, FSCAI. He is an interventional cardiologist with Lourdes Cardiology.
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Early Heart Attack Symptoms/Sudden Cardiac Arrest
Featured Speaker:
Dr. Finley is board-certified in internal medicine, interventional cardiology and cardiovascular disease. He is a diplomate of the National Board of Echocardiography and the Certification Board of Nuclear Medicine.
Learn more about John J. Finley IV, MD
John J. Finley IV, MD
John J. Finley IV, MD earned his medical degree from Thomas Jefferson University – Jefferson Medical College and his bachelor’s degree in chemistry from Dartmouth College, graduating with honors.Dr. Finley is board-certified in internal medicine, interventional cardiology and cardiovascular disease. He is a diplomate of the National Board of Echocardiography and the Certification Board of Nuclear Medicine.
Learn more about John J. Finley IV, MD
Transcription:
Melanie Cole (Host): Today’s topic is a sudden cardiac arrest, and it may not always be so sudden, heart experts are now saying. A recent study has found that cardiac arrest symptoms in men may appear at least a month ahead of time. We’re going to talk about the differences between sudden cardiac arrest and a heart attack. Here to speak with us today, is my guest, Dr. John Finley. He’s an Interventional Cardiologist with Lourdes Cardiology. Welcome to the show, Dr. Finley. Please give us a little physiology lesson. What is a heart attack?
Dr. John Finley (Guest): Hi, Melanie. Thanks for the introduction. Probably in its simplest understanding or explanation, a heart attack is when the flow to the myocardium or the heart tissue gets compromised in some way, usually suddenly. Sometimes the plaque can be build up over a series of months, years, decades, and then it hits a critical threshold whereby the plaque may rupture, a clot may occur to clog up the artery completely, and that creates a mismatch in what should be the supply and then what is needed in terms of the demand of the heart. At that point, the heart tissue is being strangulated and compromised in a way that yields symptoms and certainly, negative consequences for the patient.
Melanie: And so the heart tissue, as it were, is dying, but you might know more in advance, is that correct?
Dr. Finley: Yes, yes. Certainly, we use the term – or the expression, “Time is Tissue.” When that 100% blockage occurs, we have spent a lot of human and animal understanding that if we don’t get that artery in a better place in a matter of a couple of hours or even – our national metric is 90 minutes, but in reality, within those first few hours, it’s really critical in terms of preservation of that tissue and the overall heart function long-term.
Melanie: So then, what is a sudden cardiac arrest? What’s the difference?
Dr. Finley: Sudden cardiac arrest is the most lethal end of the spectrum. Now, there can be many causes of sudden cardiac arrest that can go beyond just due to a blockage in the heart. Certain younger individuals may have congenital abnormalities or arrhythmic conditions or susceptibilities to arrhythmias, but in terms of a heart attack that most people are aware of, that’s when really the heart attack size is so great that it may cause a lethal arrhythmia or a compromise in the overall heart pump function. Then, the heart can go into shock, and then, it’s basically a spiral downward ultimately to the point where a lethal arrhythmia occurs, and the heart is rendered basically non functioning and almost has stopped. The cardiac arrest is really on the most severe end of a heart attack consequences and spectrum.
Melanie: A cardiac arrest is a heart pumping blood around the body, and it stops doing that, whereas a heart attack could be a blockage where blood is just not getting to the heart itself, what makes a sudden cardiac arrest so dangerous? Is there any way for us to know in advance that this is happening?
Dr. Finley: Right, I think we really need it lean on patients’ risk factors and their symptoms. A lot of it goes – obviously, the best offense is a good defense or somewhere where we can prevent even getting to the point of a heart attack. That would be ideal. Obviously, we don’t always have that opportunity. Can there be red flags or symptoms leading up to a heart attack? For sure. So, certainly, it’s up to us as a cardiology community to continue to educate patients and family members about those symptoms early on, and then do our part as soon as they get in the door and hopefully try to evaluate, and work these up, and diagnose them, and treat them as quickly and as fast – as quickly, and safely, and efficaciously as possible.
Melanie: Dr. Finley, you mentioned symptoms and having an awareness – and people have seen on TV, the media, and clutching your chest. Certainly, we’ve been learning over time, now, that women heart attack symptoms are different than they are in men. Describe some of the symptoms of sudden cardiac arrest. If somebody is experiencing any of these symptoms, is 9-1-1 and EMS enough as far as Time is Tissue? What are some of these symptoms we need to be aware of?
Dr. Finley: I think let’s back up and talk about the heart attack symptoms before we get into the cardiac arrest symptoms. I think you’re right, the classic TV show or movie of the guy clutching his chest and crashing on the table or dropping the briefcase, that really, while still true, it misses a great deal of a lot of cardiac symptoms that could be early signs of a heart attack. They can be as subtle as increased shortness of breath, increased work of breathing doing tasks at home -- doing yard work, house chores, things like that. A drop in exercise tolerance, sometimes it can be as subtle as that. It’s amazing. You see people who are quite fit, and their body is so conditioned, they can sometimes get around these issues or traditional symptoms, but it can be as subtle as I’m not able to do what I used to of on the treadmill or do on the elliptical or at work. I, personally, really press patients on are they able to do their activities of daily living as they normally have and is there a precipitous drop because, in my eyes, that can certainly be a red flag.
Melanie: So, would anything show up on EKG or screening? If we are screening – and you and I talked off air for a minute about sudden cardiac death in athletes – is there any screening that you can perform as far as watching symptom management, risk factors, awareness?
Dr. Finley: An EKG is valuable, but it’s quite limited in terms of a screening tool. There’s a lot of debate
in terms of screening younger kids and athletes -- and that’s a whole other discussion -- but even just
doing EKGs routinely on people as they get older. Certainly, that can show signs of an older heart
attack, it can show some abnormalities that can trigger downstream testing, but the reality is, it’s quite
limited. I always talk about – I use the heart analogy as a house. It would be like somebody just driving
down your street and taking a picture of your house saying, “Okay, it looks good here,” but that’s quite limited. You really need to delve deeper, and really, you need to assess the house. You really need to assess how well it’s working or how are the patients feeling? To me, an EKG is certainly helpful, but it’s more about really understanding the patients’ symptoms and their risk factors because not one thing on its own – I wouldn’t put – it’s a culmination of everything put together to really get an understanding of their risk for heart attacks and future events.
Melanie: This is difficult for some people to understand, Dr. Finley, and I get it because it’s not the easiest of topics to discern the difference. Does someone have to have existing heart disease to have sudden cardiac arrest?
Dr. Finley: No. Quite often, frankly, a lot of times we – not to stereotype, but we see a lot of 40, 50, 60-year-old gentlemen who – they could be on a business trip, they could be feeling fine, they could have no issues – haven’t seen a doctor for years. And then, unfortunately, sometimes they're coming out party can be in an arrest situation or in a sudden heart attack situation which really is a game changer. We talk in medicine about primary prevention and secondary prevention. In primary prevention, we’re trying to prevent that first heart attack – that cardiac arrest from ever happening. In the secondary case, we’re trying to prevent the second one from happening. Sometimes the risk factors or the conditions don’t announce themselves until quite suddenly, and then we’re kind of backpedaling trying to sort those out and to control them as best as possible.
Melanie: I mentioned in my intro that research is coming out a little bit that this may not be so sudden and there might be symptoms a month ahead of time even. Is this the case? Is this a myth? What’s going on with that?
Dr. Finley: Yeah, I think there is – again, I really think it comes to symptoms. It’s quite often, again in that scenario that I just described, of a patient coming in without really any prior conditions and coming out suddenly with a bad heart attack or a bad cardiac arrest. Often times, after the dust has settled, I’ll go back and really talk to the family and talk to the patient, and say, “Listen, be honest with yourself, was something not quite right?” I’ll often time – and this is anecdotal – they’ll say there were some subtle symptoms – some chest pressure, which they may have made excuses for or tried to blame it on something else or somebody else maybe tried to blame it on something else. I think again; it comes in different flavors. Sometimes, it can be as subtle as a reflux-like symptom or heartburn-like symptom, or what people thought – or somebody else thought was a heartburn-like symptom, and it turned out to be cardiac.
Melanie: And what about AEDs. If somebody is suspected of having sudden cardiac arrest, are these defibrillators – if they’re in the presence of whoever is around – would these help with that?
Dr. Finley: Absolutely, absolutely. I think you can see the impact in terms of casinos and airports and high traffic areas where it has made an impact. There’s a little bit of controversy in terms of should they be everywhere? Certainly, in schools and athletic fields, that’s been a big push and rightfully so. Should everyone have them in their home? I don’t think that’s necessarily cost-effective. They’ve even looked at potentially having them in homes of patients who have had cardiac arrests or cardiac – heart attacks, and that hasn’t necessarily shown that there’s a tremendous benefit, but it’s an individual decision. By no means am I telling every heart attack victim or every sudden cardiac arrest victim to go out and get an AED? No. But I think it’s an important understanding that people are aware that these devices are amongst us and can help us in a sudden situation where they witness a patient or somebody goes down because these tools are extremely valuable for increasing the likelihood of survival.
Melanie: So in summary, wrap it up for us, Dr. Finley. What a change in how you, as a cardiologist might treat -- whether it’s a heart attack or sudden cardiac arrest – and why Time is Tissue and so important that people, if they suspect that they are having some of these symptoms, if they understand their risk factors, and have an awareness of these things -- they don’t just brush off things that could be cardiac related. How are you treating them? Wrap it up with your best advice.
Dr. Finley: Sure, I think nationally, and globally, cardiologist, especially interventional cardiologists are being held to a high standard of making sure that they respond to acute heart attack patients as quickly as possible. There’s the national metric of door-to-balloon time – and that is the time for which the patient enters hospital care to when we get the artery open in 90 minutes. We’re really trying to improve upon that, and nationally, everybody has made tremendous strides. Unfortunately, that has done a lot and has improved outcomes, but it has kind of plateaued. Part of the reason for that is we’re only as good as the patients recognizing their symptoms and getting to us in time. If there is a delay on the front end, we can still do as much as we can, but again, that Time is Tissue mantra, we’re limited in what we can do from a recovery standpoint. The earlier patients can acknowledge these symptoms of chest pain, shortness of breath, windedness, dizziness, fatigue, again, even subtle findings. The more they can bring them to the attention of a physician, maybe the earlier we can get to a point where they’re not as far sick on the spectrum and the heart tissue is not at the point where it’s not salvageable.
Melanie: Thank you so much, for being with us today, Dr. Finley. It’s important information for listeners to hear. This is Lourdes Health Talk, and for more information, please visit LourdesNet.org, that’s LourdesNet.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Today’s topic is a sudden cardiac arrest, and it may not always be so sudden, heart experts are now saying. A recent study has found that cardiac arrest symptoms in men may appear at least a month ahead of time. We’re going to talk about the differences between sudden cardiac arrest and a heart attack. Here to speak with us today, is my guest, Dr. John Finley. He’s an Interventional Cardiologist with Lourdes Cardiology. Welcome to the show, Dr. Finley. Please give us a little physiology lesson. What is a heart attack?
Dr. John Finley (Guest): Hi, Melanie. Thanks for the introduction. Probably in its simplest understanding or explanation, a heart attack is when the flow to the myocardium or the heart tissue gets compromised in some way, usually suddenly. Sometimes the plaque can be build up over a series of months, years, decades, and then it hits a critical threshold whereby the plaque may rupture, a clot may occur to clog up the artery completely, and that creates a mismatch in what should be the supply and then what is needed in terms of the demand of the heart. At that point, the heart tissue is being strangulated and compromised in a way that yields symptoms and certainly, negative consequences for the patient.
Melanie: And so the heart tissue, as it were, is dying, but you might know more in advance, is that correct?
Dr. Finley: Yes, yes. Certainly, we use the term – or the expression, “Time is Tissue.” When that 100% blockage occurs, we have spent a lot of human and animal understanding that if we don’t get that artery in a better place in a matter of a couple of hours or even – our national metric is 90 minutes, but in reality, within those first few hours, it’s really critical in terms of preservation of that tissue and the overall heart function long-term.
Melanie: So then, what is a sudden cardiac arrest? What’s the difference?
Dr. Finley: Sudden cardiac arrest is the most lethal end of the spectrum. Now, there can be many causes of sudden cardiac arrest that can go beyond just due to a blockage in the heart. Certain younger individuals may have congenital abnormalities or arrhythmic conditions or susceptibilities to arrhythmias, but in terms of a heart attack that most people are aware of, that’s when really the heart attack size is so great that it may cause a lethal arrhythmia or a compromise in the overall heart pump function. Then, the heart can go into shock, and then, it’s basically a spiral downward ultimately to the point where a lethal arrhythmia occurs, and the heart is rendered basically non functioning and almost has stopped. The cardiac arrest is really on the most severe end of a heart attack consequences and spectrum.
Melanie: A cardiac arrest is a heart pumping blood around the body, and it stops doing that, whereas a heart attack could be a blockage where blood is just not getting to the heart itself, what makes a sudden cardiac arrest so dangerous? Is there any way for us to know in advance that this is happening?
Dr. Finley: Right, I think we really need it lean on patients’ risk factors and their symptoms. A lot of it goes – obviously, the best offense is a good defense or somewhere where we can prevent even getting to the point of a heart attack. That would be ideal. Obviously, we don’t always have that opportunity. Can there be red flags or symptoms leading up to a heart attack? For sure. So, certainly, it’s up to us as a cardiology community to continue to educate patients and family members about those symptoms early on, and then do our part as soon as they get in the door and hopefully try to evaluate, and work these up, and diagnose them, and treat them as quickly and as fast – as quickly, and safely, and efficaciously as possible.
Melanie: Dr. Finley, you mentioned symptoms and having an awareness – and people have seen on TV, the media, and clutching your chest. Certainly, we’ve been learning over time, now, that women heart attack symptoms are different than they are in men. Describe some of the symptoms of sudden cardiac arrest. If somebody is experiencing any of these symptoms, is 9-1-1 and EMS enough as far as Time is Tissue? What are some of these symptoms we need to be aware of?
Dr. Finley: I think let’s back up and talk about the heart attack symptoms before we get into the cardiac arrest symptoms. I think you’re right, the classic TV show or movie of the guy clutching his chest and crashing on the table or dropping the briefcase, that really, while still true, it misses a great deal of a lot of cardiac symptoms that could be early signs of a heart attack. They can be as subtle as increased shortness of breath, increased work of breathing doing tasks at home -- doing yard work, house chores, things like that. A drop in exercise tolerance, sometimes it can be as subtle as that. It’s amazing. You see people who are quite fit, and their body is so conditioned, they can sometimes get around these issues or traditional symptoms, but it can be as subtle as I’m not able to do what I used to of on the treadmill or do on the elliptical or at work. I, personally, really press patients on are they able to do their activities of daily living as they normally have and is there a precipitous drop because, in my eyes, that can certainly be a red flag.
Melanie: So, would anything show up on EKG or screening? If we are screening – and you and I talked off air for a minute about sudden cardiac death in athletes – is there any screening that you can perform as far as watching symptom management, risk factors, awareness?
Dr. Finley: An EKG is valuable, but it’s quite limited in terms of a screening tool. There’s a lot of debate
in terms of screening younger kids and athletes -- and that’s a whole other discussion -- but even just
doing EKGs routinely on people as they get older. Certainly, that can show signs of an older heart
attack, it can show some abnormalities that can trigger downstream testing, but the reality is, it’s quite
limited. I always talk about – I use the heart analogy as a house. It would be like somebody just driving
down your street and taking a picture of your house saying, “Okay, it looks good here,” but that’s quite limited. You really need to delve deeper, and really, you need to assess the house. You really need to assess how well it’s working or how are the patients feeling? To me, an EKG is certainly helpful, but it’s more about really understanding the patients’ symptoms and their risk factors because not one thing on its own – I wouldn’t put – it’s a culmination of everything put together to really get an understanding of their risk for heart attacks and future events.
Melanie: This is difficult for some people to understand, Dr. Finley, and I get it because it’s not the easiest of topics to discern the difference. Does someone have to have existing heart disease to have sudden cardiac arrest?
Dr. Finley: No. Quite often, frankly, a lot of times we – not to stereotype, but we see a lot of 40, 50, 60-year-old gentlemen who – they could be on a business trip, they could be feeling fine, they could have no issues – haven’t seen a doctor for years. And then, unfortunately, sometimes they're coming out party can be in an arrest situation or in a sudden heart attack situation which really is a game changer. We talk in medicine about primary prevention and secondary prevention. In primary prevention, we’re trying to prevent that first heart attack – that cardiac arrest from ever happening. In the secondary case, we’re trying to prevent the second one from happening. Sometimes the risk factors or the conditions don’t announce themselves until quite suddenly, and then we’re kind of backpedaling trying to sort those out and to control them as best as possible.
Melanie: I mentioned in my intro that research is coming out a little bit that this may not be so sudden and there might be symptoms a month ahead of time even. Is this the case? Is this a myth? What’s going on with that?
Dr. Finley: Yeah, I think there is – again, I really think it comes to symptoms. It’s quite often, again in that scenario that I just described, of a patient coming in without really any prior conditions and coming out suddenly with a bad heart attack or a bad cardiac arrest. Often times, after the dust has settled, I’ll go back and really talk to the family and talk to the patient, and say, “Listen, be honest with yourself, was something not quite right?” I’ll often time – and this is anecdotal – they’ll say there were some subtle symptoms – some chest pressure, which they may have made excuses for or tried to blame it on something else or somebody else maybe tried to blame it on something else. I think again; it comes in different flavors. Sometimes, it can be as subtle as a reflux-like symptom or heartburn-like symptom, or what people thought – or somebody else thought was a heartburn-like symptom, and it turned out to be cardiac.
Melanie: And what about AEDs. If somebody is suspected of having sudden cardiac arrest, are these defibrillators – if they’re in the presence of whoever is around – would these help with that?
Dr. Finley: Absolutely, absolutely. I think you can see the impact in terms of casinos and airports and high traffic areas where it has made an impact. There’s a little bit of controversy in terms of should they be everywhere? Certainly, in schools and athletic fields, that’s been a big push and rightfully so. Should everyone have them in their home? I don’t think that’s necessarily cost-effective. They’ve even looked at potentially having them in homes of patients who have had cardiac arrests or cardiac – heart attacks, and that hasn’t necessarily shown that there’s a tremendous benefit, but it’s an individual decision. By no means am I telling every heart attack victim or every sudden cardiac arrest victim to go out and get an AED? No. But I think it’s an important understanding that people are aware that these devices are amongst us and can help us in a sudden situation where they witness a patient or somebody goes down because these tools are extremely valuable for increasing the likelihood of survival.
Melanie: So in summary, wrap it up for us, Dr. Finley. What a change in how you, as a cardiologist might treat -- whether it’s a heart attack or sudden cardiac arrest – and why Time is Tissue and so important that people, if they suspect that they are having some of these symptoms, if they understand their risk factors, and have an awareness of these things -- they don’t just brush off things that could be cardiac related. How are you treating them? Wrap it up with your best advice.
Dr. Finley: Sure, I think nationally, and globally, cardiologist, especially interventional cardiologists are being held to a high standard of making sure that they respond to acute heart attack patients as quickly as possible. There’s the national metric of door-to-balloon time – and that is the time for which the patient enters hospital care to when we get the artery open in 90 minutes. We’re really trying to improve upon that, and nationally, everybody has made tremendous strides. Unfortunately, that has done a lot and has improved outcomes, but it has kind of plateaued. Part of the reason for that is we’re only as good as the patients recognizing their symptoms and getting to us in time. If there is a delay on the front end, we can still do as much as we can, but again, that Time is Tissue mantra, we’re limited in what we can do from a recovery standpoint. The earlier patients can acknowledge these symptoms of chest pain, shortness of breath, windedness, dizziness, fatigue, again, even subtle findings. The more they can bring them to the attention of a physician, maybe the earlier we can get to a point where they’re not as far sick on the spectrum and the heart tissue is not at the point where it’s not salvageable.
Melanie: Thank you so much, for being with us today, Dr. Finley. It’s important information for listeners to hear. This is Lourdes Health Talk, and for more information, please visit LourdesNet.org, that’s LourdesNet.org. This is Melanie Cole. Thanks so much for listening.
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