Characteristics of the resuscitated out-of-hospital cardiac arrest victim with coronary heart disease.

Abstract

SUMMARY The clinical entry characteristics and medical history of 142 resuscitated out-of-hospital cardiac arrest victims with coronary heart disease were studied in order to identify factors that affect their longterm survival. The cardiac arrest event was classified as being secondary to an acute myocardial infarction (AMI) in 44% (62 of 142), an ischemic event (IE) in 34% (49 of 142) and a primary arrhythmic event (PAE) in 22% (31 of 142). The majority of patients in all groups had a history of angina pectoris. Twenty-seven percent of the AMI, 55% of the IE, and 71% of the PAE patients had a history of infarction. Ten percent of the AMI, 31% of the IE, and 55% of the PAE had used digitalis before their cardiac arrest. Cardiac arrest was the first cardiac event in 35% of the AMI, 16% of the IE and 6% of the PAE patients. One year after arrest, 89% of the AMI, 80% of the IE and 71% of the PAE were alive (p < 0.01). Covariate analysis for more than 40 variables indicates that a high-risk group that included 22% (31 of 142) of the cardiac arrest victims had 1-and 2-year survival rates of 71% and 55%, respectively, and was characterized as having used digitalis before arrest, experiencing blood urea nitrogen elevation and pulmonary congestion during the hospitalization for the event, and classification of the cardiac arrest event as a PAE. A low-risk group comprised 78% (111 of 142) of the survivors and had 1-and 2-year survival rates of 85%9 and 69%, respectively. These data indicate that cardiac arrest due to coronary heart disease is secondary to several mechanisms related to subsequent survival.

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

“…However, patients who survive the initial hospitalization after Q-wave MI have survival virtually identical to patients without VF in the acute phase of infarction (605). The low risk for late cardiac arrest appears to apply only to patients experiencing Q-wave infarction; patients with an infarction defined by biomarker elevations without development of new Q waves have a significantly higher risk of late cardiac arrest (606,607). Transient ischemia resulting from coronary artery spasm may cause polymorphic VT or VF (608).…”

Monophasic action potentials at discontinuation of cardiopulmonary bypass: evidence for contraction-excitation feedback in man.

“…Our objective was to (1) document changes in MAP duration (repolarization time) during the period of discontinuation of bypass, (2) relate changes in MAP duration to changes in systolic pressure and, (3) examine the relationship in terms of a possible contraction-excitation feedback mechanism in man, which could possibly be a contributor to the electrophysiologic changes preceding sudden death.…”

Protective Effects of Estrogen Against Reperfusion Arrhythmias Following Severe Myocardial Ischemia in Rats

“…3 However, life-threatening ventricular arrhythmias, such as ventricular tachycardia (VT) and ventricular fibrillation (VF), remain the most important causes of sudden cardiac death (SCD) in humans. 4 Epidemiological studies revealed that women appear to have a lower incidence of arrhythmia-related SCD than men, and that postmenopausal women are much more prone to SCD than premenopausal women. 5 Animal experiments revealed that estrogen could attenuate ischemia-or reperfusion-induced ventricular arrhythmias, 6 which suggests that female sex hormones may have protective effects against arrhythmias, including RA.…”