Heart Attack vs. Sudden Cardiac Arrest: Understanding the Difference

Mary M. Newman

Image result for heart spaceshipAwake or Not Awake. That Is the Question.

October is National Sudden Cardiac Arrest Awareness Month. Understanding the difference between heart attack and sudden cardiac arrest could help save lives. One way to understand the difference between the two conditions is this distinction: The heart attack victim is awake and the heart is beating. In contrast, the sudden cardiac arrest victim is not awake and the heart is not beating. To survive sudden cardiac arrest, the victim needs immediate CPR and treatment with a defibrillator. [1]

Sudden unexpected cardiac arrest is the third leading cause of death in the U.S. [2], affecting 326,200 people each year, including 6,000 youth [3]. On average, about 10 percent of victims survive, though nearly 40 percent survive when bystanders call 911, start CPR, and use automated external defibrillators, or AEDs, before emergency medical services (EMS) arrives at the scene. [4]

It’s a common misconception that heart attack and sudden cardiac arrest are the same thing. In reality, the two conditions are quite different.

Heart attack, or myocardial infarction, occurs when part of the heart’s blood supply is reduced or blocked, causing the heart muscle to become injured or die. Victims may complain of various symptoms including:

• Mild intermittent chest discomfort that lasts a few minutes and comes and goes over a period of days

• Pain or discomfort in one or both arms that spreads to the shoulders, upper back, neck or jaw

• Shortness of breath

• Nausea, sweating, lightheadedness

• A general sense of anxiety

• A tendency to deny that anything serious is happening.

Women sometimes experience additional symptoms including:

• Stomach or abdominal pain

• Weakness and overwhelming fatigue

• Swelling of the ankles and lower legs.

When someone has a heart attack, he or she is awake and the heart is beating. It’s important to act right away to maximize the odds of survival and minimize permanent damage to the heart. Bystanders should call 911 and have the person lie down and rest until EMS arrives.

While heart attack is often described as a “plumbing problem,” sudden cardiac arrest is more of an “electrical problem” that prevents the heart from functioning effectively. Heart attacks can lead to sudden cardiac arrest, but there are many other causes as well, including congenital and electrophysiological abnormalities, severe heart failure, electrocution, and drug overdose.

In contrast, when sudden cardiac arrest occurs, the heart stops beating altogether. As a result, blood is no longer pumped throughout the body, including the brain. The person suddenly passes out, loses consciousness, and appears lifeless — except for abnormal gasping, which may last several minutes. Sometimes victims experience seizure activity at the onset of the event.

The sudden cardiac arrest victim is not awake and the heart is not beating. If no one provides immediate help, the victim will die within minutes.

When sudden cardiac arrest occurs, it is critically important for bystanders to call 911, give CPR, and use the nearest AED.

This is lifesaving care that anyone can provide. While it is best to be trained in CPR and the use of AEDs, even without formal training, bystanders can call 911, follow dispatcher instructions, push hard and fast on the center of the victim’s chest, and follow the directions on the AED while waiting for EMS to arrive.

Sometimes people hesitate to help because they are afraid they might do something wrong and hurt the victim. But since the cardiac arrest victim is clinically dead and cannot get any worse, bystander actions can only help. In addition, state and federal Good Samaritan laws provide protection to bystanders who render aid to sudden cardiac arrest victims in good faith.

Risk factors for sudden cardiac arrest include:

• A previous heart attack

• A previous episode of cardiac arrest

• A low (<35 percent) ejection fraction (the heart’s ability to pump blood)

• Underlying heart conditions such as coronary artery disease, congenital heart disease (e.g., hypertrophic cardiomyopathy), electrophysiological abnormalities (e.g., long QT syndrome, Wolff-Parkinson-White disease, Brugada syndrome)

• Severe heart failure

• Marked changes in electrolytes in the blood

• A tendency to faint

• Hyperthyroidism

• Electrocution

• Drug abuse

• A family history of heart disease or stroke, especially having relatives who died suddenly before age 50.

If your loved ones have one or more of these risk factors, they may be at risk for sudden cardiac arrest. If this is the case, they should see a cardiologist or heart rhythm specialist (electrophysiolgist) for an evaluation. The physician may recommend implantable cardioverter defibrillator therapy, medications, or other measures to prevent sudden cardiac death.

In summary, heart attack victims are awake and typically experience discomfort or pain. While they do not need CPR or treatment with a defibrillator, it’s essential to call 911 so they can be transported immediately to the hospital. In contrast, sudden cardiac arrest victims are not awake and need immediate CPR and treatment with a defibrillator. You can save a life by learning to recognize these conditions and being prepared to take appropriate action.


How Changing My Diet Changed My Life

By Thomas Larson, Special to Everyday Health

Thomas Larson

After my third heart attack in five years, I became a vegan, or a plant-based eater. Then I wrote about it in my book, The Sanctuary of Illness: A Memoir of Heart Disease, which tells the journey of my having gone from a non-recovery recovery to healing after those near-fatal trials,which finally forced me to change my diet.

I was already a vegetarian, a “right” eater — or so I thought. That earlier journey began thirty years ago, while reading Francis Moore Lappe’s ground-breaking book Diet for a Small Planet. I was shaken to the core by the scale of factory farming and clear-cutting of Central American rain forests by McDonalds and other fast-food corporations.

Back then, like tens of thousands of my fellow climate-conscious, meat-is-murder, animal-sparing Californians (I wish I could say Americans), I renounced all sides of beef, bird, and goat. But not their edible byproducts — those tasty commodities like chicken eggs, whole milk, Swiss cheese, vanilla yogurt, and deep-dish pizza.

Yes, I ate right for the sake of the animal’s corporeal life but not for the sake of the planet’s: animal waste is the number one source of methane, scourge of global-warming. I was also not eating right for the sake of my arteries.

But by becoming vegan, I underwent a metamorphosis. I gave up every quarter of the cow for one simple–albeit less-than-obvious–reason: dairy is the devil.

How do I know?

Consider how my traumas and treatments unraveled.

Heart attack #1 — angioplasty, three stents, and a statin drug save me.

Heart attack #2 — angioplasty, one stent, increased exercise, more drugs and higher dosessave me.

Heart attack #3 — angioplasty, two stents, more drugs . . . save — no. Stop! Why do my arteries keep occluding? Why do I keep getting saved but not getting better?

I renewed my study. I found books and a couple movies on plant diets for heart patients. I consulted two lipidologists who ordered detailed blood panels and targeted with supplements the bad strains of cholesterol that continually clogged me.

And, finally, I learned this truth: my arteries inflame at those passageways where lipid deposits jelly-up as vulnerable plaque, that is, plaque likely to burst and block — because of two things. First is my dairy-rich diet and my inability (not that I’d ever really tried) to quit eating eggs and cheese. Second is the spongy cast of my arteries. These are gene-bred from my father, which for him, my older brother, and me guaranteed that we Larsons accrue sludgy pustules of cholesterol in our coronaries, just as Tim Russert and James Gandolfini did (to name two spectacular falls). Thereby, we were more susceptible to cardiac arrest (a.k.a., sudden death) than most Americans.

So, could it be any clearer that the only thing left for me to do, in addition to interventional treatment, exercise, and drugs, was to give up dairy and eat plants? No animal protein. Just plants. Which I did.

What do plants offer?

  1. No cholesterol and no casein, artery-closers extraordinaire
  2. Easily assimilated nitrous oxide, key to arterial self-repair
  3. Plenty of protein that’s nutritionally more beneficial than protein from animals
  4. Soluble fiber for bowel regularity
  5. A stomach-pleasing ban on hard-to-metabolize fat
  6. Enhanced sexual potency in males and females
  7. Less end-of-life disability
  8. Prevention of some cancers

I did ride a rough road from veggie to vegan. In addition to their initial canyon-ledge terror, my heart attacks were confusingly mild and harsh. Mild because each attack, for which I rushed myself to the nearest hospital (it’s smarter to call 911), was less grave than the preceding one, which made me think I was getting better. The statin drug, post-number-one, helped defuse the severity as well. Harsh because the infarctions came three times — carpet-bagging relatives who wouldn’t leave — which meant I was not getting better and my healing regimen was not rooting out the cause. This further said that at the rate I was going, I was never going to improve.

However, I did improve — but only after I discovered that what went in my mouth made me sick and kept me sick. I improved, dramatically, after I cut out the cow.

plant-based diet is a friend with many benefits — I rarely have angina or other chest pains. I dropped thirty-five pounds; I don’t count calories; I don’t diet. I seldom suffer heartburn, so I don’t think it’s masked angina (I used to). I can drink red wine; my LDL is super low (46) as is my total cholesterol (106) and my arteries are less inflamed than they were. My sex life has been reborn with a fit, desirous partner. And while I do have the occasional fatigue-ridden day, it’s probably my old plaques, packed in during my dairy days, still seeping into, and gumming up, my stented coronaries.

I’ll trade that last misfortune for all the other post-vegan advantages.