Presentation on theme: "Rasim ENAR; M.D Professor of Cardiology İstanbul University"— Presentation transcript:
1 SUDDEN CARDIAC DEATH PREVENTION AND CARDIO-PULMONARY RESSUSSITATION (CPR) Rasim ENAR; M.DProfessor of Cardiologyİstanbul UniversityCerrahpaşa Medical FacultyDepartment of Cardiology
2 SUDDEN CARDIAC DEATH (SCD) Definition:“Natural Death due to cardiac causes(1) Loss of consciousness within one hour after start of the symptoms(2) Pre-existing heart disease may be present; but the cause or the timing of the death can not be predictedKeys of Definition :(a) Non-taumatic nature(b) Unexpected and sudden
3 CARDIAC ARREST Definition: Sudden cessation of cardiac pump function Reversible with rapid and effective intervention;otherwise cardiac death is unevitable►►► The common electrophysological mechanism which cause cardiac arrest as a cause of SCD:(1)- Ventricular Tachyarrhytmias; Ventricular Fibrillation, Ventricular Tachycardia(2)- Non-Tachyarrhytmic causes ; Other important causes of cardiac arrest;Pulseless electrical activity (Electromachanical Dissosiation);Asistoly;Bradiarrhythmias
7 ECG: Complete AV BlockDissociate P an QRS waves.
8 ETY-1: SCD- CARDIOVASCULAR DISEASES:. ►1- Coronary artery diseaseAcute coronary sydrome,Chronic ischemic heart disease►2- Dilated cardiomyopathy*► “The above two cinical states is responsible for >90% of SCD events”.►3- Other cardiomyopathies;(a) hipertrophic cardiomyopathy,(b) arrhythmogenic right ventricular cardiomyopathy►4- Primary “electrical” disturbances.►5- Mechanical cardiovascular diseases.
9 ETY -2:► 4- Primary “electrical” disturbances: (a) Long QT syndrome(b) Brugada syndrome(c) Cathecholaminergic polimorphic VT.(d) Wolf-Parkinson-White syndrome (WPW).(e) Sinus and AV node related conductiondisturbances
10 ETY-3 SCD - Mechanical Cardiyovascular Diseases; a- Aortic stenosis.b- Mitral valve prolapsec- Myocardial bridgingd- Anolomous coronary artery originETY-4 ► SCD- Other Causes:(a) Myocarditis(b) Chest trauma(c) Drug overdose - Torsade de Pointes(d) Atheletes heart _ trained heart(e) SCD in normal heart (idiopathic VF).
11 Prevention from SCD:►Principal: Multi-factorial etiology and various treatment targets.►Primary prophlaxis: Prevention of fatal arrhythmias in patients without prior sustainead VT and high risk for SCD►Secondary prophlaxis: Prevention of fatal arrhythmias in patients who exprerienced cardiac arrest and sustained ventricular tachyarrhytmias
12 Primary Proflaxis: 3 different proflactic treatment modalities: 1- Drugs without electrophysiologic effects2- Drugs with electrophysiologic effects3- ICD(Implantable Cardiac Defibrillator)
13 1- Drugs without electrophysiologic effects : Importance of the treatment: Both total mortality and SCD is reduced.3 different class drugs:1- ACE-I (angiootensin converting enzyme inhibitors), ARB (+?)2- Aldosterone receptor blockers3- Poli-unsaturated fatty acids (omega-3)+- Statins
14 RESSUSİTATION.Return of spontaneous circulation (ROS) can be achived only 15% of cardiac arrest cases, and only 50% of those could be dischargedAs a result; There is only a 5-7% chance of survival in cardiac arrst victims.Survival from cardiac arrest:(a) Etiolgy of cardiac arrest (VF>EM-Diss),(b) Pre- cardiac arrest status,(c) Unwitnessed cardiac arrest(d) Emergency CPR and availability ofautomated external defibrilator
15 CHAIN OF SURVIVAL: (ABLS: Adult Basic Life Support) “Call 112,+Chest compression +Defibrilltor + IV DrugTherapy”.
16 Electrical meaning of Ressussitation: VF is the most common cause of cardiac arrestSpontaneous termination does not occurVF more than 3-4 minutes causes irrversible organ damage.Prevention of death secondary to cardiac arrestImmediate, rapid Defibrillation (DFB).* Every minute delay with DFB reduces life expactancy by 7-10% according to direct CPR with chest compression or entubation
17 External Defibrillator. Devices with automated rhythm analysis and shock delivery featuresExternal defibrilator (EDFB); should be used only in patients who are unresponsive, not breathing and without effective circulation
18 DEFIBRILATOR(DFB): Manually operated; Paddeles and Monitore.
21 CPR; Cardio-Pulmonary Ressussitation If immediate DFB is not possible, then CPR should be started without delay.Late-CPR and/or advanced cardiac life support (ACLS) should be discouraged.Only 10-20% of out-of hospital VF cases survive and 50% of those will have neurological problems.As a result: If cardiac arrest is not diagnosed within 4 minutes and CPR and DFB is not given within 8 minutes; ressussitation will be unsuccessful.
22 How to do CPR ? BLS (Basıc Life Support) Algorhthm: 1- Check the responsiveness ; if unresponsive- start CPR:2- Open Airway; “Head tilt-jaw trust”►► 3- Check the breathing- not breathing; Start mouth-to-mouth breathing4- Give your breath ; - Give 1-1,5 seconds break for breathing and observe the patient after the first two full breaths5- Assess circulation;- Check pulse at carotide artery►► 6- If no sign of circulation (no pulse); start chest compression1- 2 rescuer CPR : 15 compression - 2 ventilation.Rate of compression : /minAt the end of compression 2 full breaths should be given;if endotracheal tube is inplace; 5 chest compression / 1 ventilation