Circulatory problems

Question 1

What are the primary cardiac causes of sudden cardiac arrest?

(Changes within the heart)

What happens to the heart immediately before the sudden arrest? - What are the steps? Are they always the same steps?

Answer 1

Most common is an arrhythmia step before arrest - arrhythmia is the common doorway for many conditions.
But arrest may also be just mechanical, without a arrhythmic step.

Arrhythmia is most commonly due to ischaemia or infarct (MI).

Causes of arrhythmia:
ACS
Hypovolaemia
Valve disease
Drugs (Antiarrhythmic drugs, TCAs, Digoxin, other)
Electrocution
Inherited cardiac disease (Long QT)
Acidosis
Abnormal electrolyte concentration
Heart disease causing arrhythmia

Arrest without arrhythmia (mechanical):
Heart failure
Cardiac tamponade
Cardiac rupture
Myocarditis
HOCM

• These share many of the same causes as arrhythmia
  e. g. an MI could cause heart failure, and then that could in turn cause arrest without an arrhythmia, or may cause an arrhythmia which then causes arrest

Question 2

What are the secondary cardiac causes of sudden cardiac arrest?

(Changes elsewhere in the body)

Answer 2

hypoxia
anaemia
hypothermia
oligaemia
severe septic shock
pneumothorax
airway obstruction

Question 3

What are the signs/symptoms of cardiac causes of arrest?

Answer 3

SOB
Syncope - dizziness, LOC
Tachycardia
Bradycardia
Tachypnoea
Hypotension
Long CRT
Altered mental state
Oliguria

Question 4

What treatment steps can we start for cardiac causes of arrest?

Answer 4

Circulatory failure - IV fluids for hypovolaemia (common)
Inotropic drugs and vasoconstrictors
ACS treatment - PCI, antiplatelet
Sit up - Pain may be worse when lying
Telemetry
ABG & correct any electrolyte/metabolic issues