CARDIAC ARREST• Sudden cardiac arrest is

the sudden, unexpected loss of heart function, breathing and consciousness usually results from an electrical disturbance in heart that disrupts its pumping action, stopping blood flow to the rest of the body.

ETIOLOGICAL FACTORS• I. CORONARY

ARTERY ABNORMALITIES

• A. Coronary atherosclerosis

• Acute or transient myocardial ischemia

• Acute myocardial infarction

• Chronic atherosclerosis

B. Congenital abnormalities of coronary arteries

• Anomalous origin from pulmonary artery

• Other coronary arteriovenous fistula

• Origin of a left coronary branch from right or noncoronary sinus of Valsalva

• Origin of right coronary artery from left sinus of Valsalva

• Hypoplastic or aplastic coronary arteries

• Coronary-intracardiac shunt

C. Coronary artery embolism

• Aortic or mitral endocarditis

• Prosthetic aortic or mitral valves

• Abnormal native valves or left ventricular mural thrombus

• Platelet embolism

D. Coronary arteritis

• progressive systemic sclerosis, giant cell arteritis• Mucocutaneous

lymph node syndrome (Kawasaki disease)• Syphilitic coronary

ostial stenosis

E. Miscellaneous mechanical obstruction of coronary arteries

• Coronary artery dissection in Marfan syndrome• Coronary artery

dissection in pregnancy• Prolapse of aortic valve

myxomatous polyps into coronary ostia• Dissection or rupture

of sinus of Valsalva

F. Functional obstruction of coronary arteries

• Coronary artery spasm with or without atherosclerosis• Myocardial bridges

II. HYPERTROPHY OF VENTRICULAR MYOCARDIUM• Left ventricular

hypertrophy associated with coronary heart disease

• Hypertensive heart disease without significant coronary atherosclerosis

• Hypertrophic myocardium secondary to valvular heart disease

• Hypertrophic cardiomyopathy

• Primary or secondary pulmonary hypertension

III. MYOCARDIAL DISEASES AND HEART FAILURE

• A. Chronic congestive heart failure

• Ischemic cardiomyopathy• Idiopathic dilated

cardiomyopathy• Alcoholic cardiomyopathy• Hypertensive

cardiomyopathy• Postmyocarditis

cardiomyopathy• Peripartum

cardiomyopathy

B. Acute and subacute cardiac failure

• Massive acute myocardial infarction

• Acute myocarditis• Acute alcoholic cardiac

dysfunction• Takotsubo syndrome

(uncertain sudden death risk)• Bail-valve embolism in aortic

stenosis or prosthesis• Mechanical disruptions of

cardiac structures• Acute pulmonary edema in

noncompliant ventricles

IV. INFLAMMATORY, INFILTRATIVE, NEOPLASTIC, AND DEGENERATIVE PROCESSES

• A. Viral myocarditis, with or without ventricular dysfunction• B. Myocarditis

associated with the vasculitides• C. Sarcoidosis• D. Progressive

systemic sclerosis• E. Amyloidosis

• F. Hemochromatosis• G. Idiopathic giant cell myocarditis• H. Chagas' disease• I. Cardiac ganglionitis• J. Arrhythmogenic right ventricular dysplasia; right

ventricular cardiomyopathy• K, Neuromuscular diseases • M. Obstructive intracavitary tumors

V DISEASES OF THE CARDIAC VALVES

• Valvular aortic stenosis/insufficiency• Mitral valve

disruption Mitral valve prolapse• Endocarditis• Prosthetic valve

dysfunction

VI. CONGENITAL HEART DISEASE

• A. Congenital aortic or pulmonic valve stenosis• B. Right-to-left

shunts with Eisenmenger physiology• C. Late after surgical

repair of congenital lesions (e.g., tetralogyof Fallot)

VII.ELECTROPHYSIOLOGICAL ABNORMALITIES

• A. Abnormalities of the conducting system

• 1. Fibrosis of the His-Purkinje system• Primary degeneration • Secondary to fibrosis and

calcification of the "cardiac skeleton"

• Postviral conducting system fibrosis

• Hereditary conducting system disease

• 2. Anomalous pathways of conduction

B. Abnormalities of repolarization

• 1. Congenital abnormalities of QT interval duration• a. Congenital

long-QT interval syndromes• b.Congenital short QT

interval syndrome

• 2.Acquired (or provoked) long QT interval syndromes

• a. Drug effect• b. Electrolyte abnormality• c. Toxic substances• d. Hypothermia• e. Central nervous system

injury; subarachnoid hemorrhage

3. Brugada syndrome- right bundle branch block and ST segment elevations in the absence of ischemia

C. Ventricular fibrillation of unknown or uncertain cause

• 1. Absence of identifiable structural or functional causes• "Idiopathic"

ventricular fibrillation• polymorphic

ventricular tachycardia• Nonspecific

fibrofatty infiltration in previously healthyvictim

VIII. ELECTRICAL INSTABILITY RELATED TO NEUROHUMORAL AND CENTRA! NERVOUS SYSTEM INFLUENCES

• Catecholamine-dependent lethal arrhythmias

• Central nervous system related

• Psychic stress, emotional extremes

• Auditory related• "Voodoo death" in primitive

cultures• Diseases of the cardiac nerves• Arrhythmia expression in

congenital long-QT interval syndrome

IX. SUDDEN INFANT DEATH SYNDROME AND SUDDEN DEATH IN CHILDREN

• • A. Sudden infant death

syndrome• Immature respiratory control

functions• Long-QT interval syndrome• Congenital heart disease

• B. Sudden death in children• Eisenmenger syndrome, aortic

stenosis, hypertrophic cardiomyopathy, pulmonary atresia

• After corrective surgery for congenital heart disease

• Genetic disorders of electrical function

X. MISCELLANEOUS

• A. Sudden death during extreme physical activity

• B. Commotio cordis—blunt chest trauma

• C. Mechanical interference with venous return

• D. Dissecting aneurysm of the aorta

• E. Toxic and metabolic disturbances

• F. Mimics sudden cardiac death

Risk factor• A family history• Smoking• High blood pressure• High blood

cholesterol• Obesity• Diabetes• A sedentary lifestyle• Drinking too much

alcohol

• Other factors :• A previous episode of

cardiac arrest• A previous heart attack• A personal or family

history of other forms of heart disease• Age• Being male• Using illegal drugs• Nutritional imbalance

Symptoms

• Sudden collapse• No pulse• No breathing• Loss of consciousness

Warning signs• fatigue,

fainting,• blackouts, • dizziness,• chest pain,• shortness of

breath, • weakness,

• palpitations or vomiting

Pathophysiology

• Contributing factorsBrady arrythmias

Tachy arrythmias

End of cascade

Cardiac arrest

Tests and diagnosis

1)Electrocardiogram 

2)Blood tests

Cardiac enzyme test. Electrolyte test. Drug test.3) Hormone test.4)Imaging tests

Chest X-ray. Nuclear scan. Echocardiogram.

• 4) Other tests Electrical system

(electrophysiological) testing and mapping.

Ejection fraction testing.

Coronary catheterization (angiogram).

Treatments

•CPR

Emergency room management

• Airway:• Endotracheal

intubation.• Combitube• Laryngeal mask

airway• Breathing:

• Circulation:• intravenous(I/V)

access ,• attachment of

monitors, electrodes/leads, • rhythm identification, • blood pressure and

medication administration.

• VF and pulse less VT:

• Pulseless electrical activity

• Asystole: • Symptomatic

bradycardia • Unstable tachycardia

Defibrillation:

• delivery of an electrical current to the heart through the chest wall by the use of external paddles, connected to cablesworks by completely depolarizing the heart disrupting the impulses causing dysrrythmia

Automated external defibrillation

• AED is an external defibrillator with rhythm analysis capabilities ,analyses patients rhythm and give counter shock.

Implantable Cardioverter defibrillator • ICD is a device

consist of a generator and at least one lead that can sense an intrinsic electrical activity and deliver an electrical impulse and terminates life threatening episodes of VT and VF.

Cardio Version

• Cardio version is the delivery of a counter shock that is synchronized with patient's cardiac rhythm and is mainly used in atrial fibrillation and atrial flutter.

Drugs • Diltiazem• Dopamine:• Lidocaine;• Sodium bicarbonate• Norepinephrine

(Noradrenalin):• Atropine

VerapamilVasopressinprocainamide

SURGICAL MANAGEMENT

• Coronary angioplasty. • Coronary bypass

surgery. • Radiofrequency

catheter ablation. • Corrective heart

surgery.• Heart

transplantation.

Therapeutic hypothermia

• Therapeutic hypothermia is the act of cooling a patient to 32 to 34 degrees Celsius (89.6 to 93.2 degrees Fahrenheit) in order to minimize the brain injury that often occurs after a cardiac arrest.

NURSING MANAGEMENT

• potential for Arrhythmias• Fluid Volume Excess• Anxiety related to fear of death• Activity intolerance• Risk for infection• Knowledge deficit

BIBLIOGRAPHY

• smeltzer,S.C and Bare,B.G (2011),Brunner and suddarth's text

book of medical surgical nursing VOL I ,(12th edition).Philadelphia:lippincot Williams and wilkins publishers Pp 843- 845 .

• Field,M.J andSoderberg,S.E ;(2006).Advanced cardiovascular life support-provider's manual.American heart association(lst edition)Pp 25-130.

• Libby , Bonow,Ziper ,Braunwalds Heart Diseases,A Text book of cardiovascular Medicine,eighth edition ,saunders publishers ,pp

933-970

• sole,D.G and Klein.G; (2001).Introduction to critical care nursing (4 edition).philadelphia:Elsevier publishersPp 223-225.

• Keen,J.H(1995).mannual of critical care nursing.st.Louis company.

• Black,J.M and hawks,J.K.(2005).medical surgical nursing:clinical management for positive outcomes(7th edition).st.Louis:W.B Saunders company.Pp 345-348

• Lewis ,Heitkemper ,Dirksen ,Medical Surgical Nursing ,6 th edition ,mosby publishers ,pp -834 – 836

• E. Brooke Lerner, Michael R. Sayre, Jane H. Brice, Lynn J. White, Amy J. Santin, Anthony J. Billittier IV and Samuel D. Cloud Resuscitation, Online December 26, 2007

Then ,with the perfect timing ,he silently leans forward and with a familiar and practiced gesture, offer his arm and smiles Extract from :wise traveller relationships.

Thank u….

nidheesha 1st yr msc nursing