tag:theconversation.com,2011:/us/topics/sudden-cardiac-arrest-34821/articlesSudden cardiac arrest – The Conversation2023-01-08T13:26:19Ztag:theconversation.com,2011:article/1973442023-01-08T13:26:19Z2023-01-08T13:26:19ZDamar Hamlin’s cardiac arrest shows need for CPR training and emergency defibrillators in public spaces<figure><img src="https://images.theconversation.com/files/503471/original/file-20230106-16856-utpr0c.jpg?ixlib=rb-1.1.0&rect=0%2C238%2C4016%2C2619&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Buffalo Bills' Damar Hamlin is examined after collapsing on the field on Jan. 2. He received CPR and defibrillation on site before being sent to hospital by ambulance.</span> <span class="attribution"><span class="source"> (AP Photo/Jeff Dean)</span></span></figcaption></figure><p>Football — a sport that involves violent collisions — came under shocking scrutiny on Jan. 2 when Buffalo Bills player Damar Hamlin collapsed from a <a href="https://www.sportingnews.com/ca/nfl/news/damar-hamlin-injury-collapses-field-hit-tackle-cpr-ambulance-bills-bengals/hayshufiopjoaeuomfxagwt4">cardiac event immediately following an on-field collision</a>.</p>
<p>Most fans already knew <a href="https://www.espn.com/nfl/injuries">the sport was dangerous</a>, often leading to broken limbs, torn ligaments and life-altering <a href="https://theconversation.com/nfl-player-tua-tagovailoas-concussion-might-have-been-prevented-with-rugbys-stricter-protocols-191830">concussions</a>. What Damar Hamlin’s catastrophic incident reminded many is that death might be close by if critical medical equipment and care is not readily applied following a cardiac arrest.</p>
<p>Hamlin seems to have benefited from top-notch, immediate care from trained medics and team staff who responded with life-saving speed and skill. Doctors who treated Hamlin told reporters on Jan. 5 that <a href="https://www.usatoday.com/story/sports/nfl/2023/01/05/damar-hamlin-doctors-bills-player-health-recovery/10997780002/">both cardiopulmonary resuscitation (CPR) and an automated external defibrillator (AED) had been used</a> to restart his heart and restore a pulse on the field before being taken to hospital.</p>
<p>They placed a tube down his throat to help him breathe, supplied oxygen and transferred him to hospital where he is receiving intensive care. Later reports indicated that Hamlin was <a href="https://www.usatoday.com/story/sports/nfl/2023/01/06/damar-hamlin-health-updates-what-we-know-friday/10997169002/">responding and communicating</a> to family and doctors.</p>
<p>The average citizen — at home or at play, engaged in contact sports or casual interaction — may not be so lucky.</p>
<h2>Cardiac arrest</h2>
<p>Globally, 3.8 million people experience cardiac arrests outside a hospital setting, according to the <a href="https://doi.org/10.1161/CIR.0000000000001013">American Heart Association</a> (AHA). Fewer than three per cent get CPR and AED. Only eight to 12 per cent survive to hospital discharge.</p>
<p>CPR is the act of applying pressure to the heart manually, until its normal rhythm and activity resumes. An AED, a portable automated device that is easy and safe to use, can help shock the heart back into such an appropriate rhythm in certain circumstances.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/503472/original/file-20230106-9978-znu74w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person in a blue shirt with hands on the chest of a dummy, while other people observe." src="https://images.theconversation.com/files/503472/original/file-20230106-9978-znu74w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503472/original/file-20230106-9978-znu74w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503472/original/file-20230106-9978-znu74w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503472/original/file-20230106-9978-znu74w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503472/original/file-20230106-9978-znu74w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503472/original/file-20230106-9978-znu74w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503472/original/file-20230106-9978-znu74w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Demonstration of CPR on a first aid dummy. CPR is the act of applying pressure to the heart manually, until its normal rhythm and activity resumes.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p><a href="https://www.heartandstroke.ca/heart-disease/conditions/cardiac-arrest">Cardiac arrests</a> occur when the heart stops beating suddenly. They are not the same as <a href="https://www.heartandstroke.ca/heart-disease/conditions/heart-attack">heart attacks</a>, which are an interruption of blood flow to the heart that leads to damage to the heart muscle. Heart attacks can certainly lead to cardiac arrest, but they are not synonymous. </p>
<p>A third term, <a href="https://www.heartandstroke.ca/heart-disease/conditions/heart-failure">heart failure</a>, similarly represents a distinct condition in which the heart is not able to pump as effectively. Usually this syndrome, which has multiple causes, occurs more chronically to those who have sustained heart damage.</p>
<p>Canadian figures show more than 35,000 cardiac arrests every year — two-thirds of them at home. One in five occur in public where a defibrillator and/or CPR can increase the chance of survival. Bystander intervention with CPR and AED saves more than 400 lives annually, the <a href="https://www.heartandstroke.ca/-/media/pdf-files/canada/2017-position-statements/final-en-addressingcardiacarreststatement-nov-2019.Ashx?Rev=388eeef4069747dcb4ab6353d36b3f7b&hash=9e27a3232e8f908e45e115b0b9dcc9d5">Heart and Stroke Foundation (HSF) reports</a>.</p>
<h2>The life-saving importance of CPR and AEDs</h2>
<p>Academics and scientists who study CPR say cardiac arrest survival rates increase greatly when bystanders use an AED. However, these rates are still low and warrant further public awareness and education efforts as well as increased, widespread access to AEDs. This is especially so in rural, remote, and Indigenous communities, the HSF says.</p>
<figure class="align-center ">
<img alt="A white box reading Defibrillator with a red box inside it hanging on a wall" src="https://images.theconversation.com/files/503474/original/file-20230106-17-y5vchz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503474/original/file-20230106-17-y5vchz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503474/original/file-20230106-17-y5vchz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503474/original/file-20230106-17-y5vchz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503474/original/file-20230106-17-y5vchz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503474/original/file-20230106-17-y5vchz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503474/original/file-20230106-17-y5vchz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">In a cardiac arrest, survival is significantly decreased for every minute without access to CPR or an AED.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Dr. Mike Howlett, president of the Canadian Association of Emergency Physicians, said in an interview that he supports “widespread education for the public on CPR and AED use” as well as “increased availability of AEDs in public settings, especially recreational and sport settings.” This is consistent with the position of the AHA and the HSF.</p>
<p>The <a href="https://www.heartandstroke.ca/-/media/pdf-files/canada/2017-position-statements/final-en-addressingcardiacarreststatement-nov-2019.Ashx?Rev=388eeef4069747dcb4ab6353d36b3f7b&hash=9e27a3232e8f908e45e115b0b9dcc9d5">HSF data shows that when a bystander uses an AED, the chance of survival nearly triples</a>. Survival is significantly decreased for every minute without access to CPR or an AED.</p>
<h2>Installing AEDs in Canada</h2>
<p>Canada has made strides with the increase in AEDs at sporting facilities, notably thousands of arenas. Through a <a href="https://www.canada.ca/en/public-health/services/chronic-diseases/cardiovascular-disease/national-automated-external-defibrillator-initiative.html">pilot program that ran in conjunction with the HSF from 2012 to 2016</a>, officials installed 3,000 AEDs and trained 23,000 Canadians in their use.</p>
<p>Nine lives have been saved to date as a result of this initiative, according to a program summary from the government of Canada. Further expansion to other recreational facilities is planned.</p>
<p>While this is a step in the right direction, hurdles remain. A 2016 article in the <a href="https://doi.org/10.1503/cmaj.150544">Canadian Medical Association Journal</a> showed that living on higher floors in apartment buildings is associated with lower survival rates for cardiac arrest in Canada. The <a href="https://doi.org/10.1016/j.resuscitation.2021.11.001">closer one is</a> to life saving equipment, and providers trained in its use, the better the chance of recovery.</p>
<figure class="align-center ">
<img alt="A sign reading AED with a heart icon in the foreground, with athletes in a gymnasium in the background." src="https://images.theconversation.com/files/503473/original/file-20230106-19-ytjfqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503473/original/file-20230106-19-ytjfqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503473/original/file-20230106-19-ytjfqf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503473/original/file-20230106-19-ytjfqf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503473/original/file-20230106-19-ytjfqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503473/original/file-20230106-19-ytjfqf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503473/original/file-20230106-19-ytjfqf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Canada has made strides with the increase in AEDs at sporting facilities, but more work is needed.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>This highlights again the importance of timely recognition and response as well as the availability of equipment in private settings. Survival rates decrease with every minute of delay. AEDs and trained providers need to be as close as possible.</p>
<p>Hamlin’s diagnosis is still unclear but what is evident is that he had a cardiac arrest due to an abnormal heart rhythm, and that prompt resuscitation restored his pulse.</p>
<p>The HSF and AHA both advocate for increased <a href="https://www.heartandstroke.ca/how-you-can-help/learn-cpr">CPR education</a> and AED use for the treatment of acute cardiac events. As Hamlin continues to heal, he provides proof that this approach seems to have merit.</p><img src="https://counter.theconversation.com/content/197344/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Pyle currently does education work with the Heart and Stroke Foundation on CPR and AED use.</span></em></p>Survival rates for cardiac arrest outside of hospitals is very low. The fast response to Damar Hamlin’s cardiac arrest during an NFL game shows the value of access to CPR and emergency defibrillators.Adam Pyle, Emergency Medicine Physician and Lecturer, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1786312022-03-07T08:45:41Z2022-03-07T08:45:41ZConcerned about your risk of a heart attack? Here are 5 ways to improve your heart health<p>The news of Shane Warne’s untimely death of a suspected heart attack at the age of only 52 years has left many cricket fans reeling.</p>
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<p>Heart disease is the leading cause of death in <a href="https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia/latest-release#australia-s-leading-causes-of-death-2020">Australia</a> – and worldwide, including in the <a href="https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm">United States</a>, where two in ten people who die of heart disease are <a href="https://www.cdc.gov/heartdisease/facts.htm">aged under 65</a>. </p>
<p>Heart disease is highly preventable, so it’s never too early to consider what you can do to improve the health of your heart. Here are five evidence-based ways to do this.</p>
<h2>1. Get a heart health check</h2>
<p>When someone dies suddenly and unexpectedly of heart disease, people will often say “but they exercised regularly, didn’t smoke and ate well”. </p>
<p>But some of the main risk factors for heart disease – including high blood pressure and high LDL cholesterol – are things you need to have checked by a doctor.</p>
<p>If you’re aged 45 years or older and do not already have heart disease, <a href="https://www.heartfoundation.org.au/getmedia/4342a70f-4487-496e-bbb0-dae33a47fcb2/Absolute-CVD-Risk-Full-Guidelines_2.pdf">Australia’s current guidelines</a> recommend having a heart health check by your GP. </p>
<p>A heart health check combines information on your risk factors and estimates how likely you are to develop heart disease in the next five years. </p>
<figure class="align-center ">
<img alt="Doctor listens to man's chest with stethoscope." src="https://images.theconversation.com/files/450274/original/file-20220307-83652-1w10scm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450274/original/file-20220307-83652-1w10scm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450274/original/file-20220307-83652-1w10scm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450274/original/file-20220307-83652-1w10scm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450274/original/file-20220307-83652-1w10scm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450274/original/file-20220307-83652-1w10scm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450274/original/file-20220307-83652-1w10scm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Medications can reduce the risk of heart disease for some people.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/crop-close-female-doctor-hold-stethoscope-1930960433">Shutterstock</a></span>
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<p>Your GP can use this information to identify whether you need to make lifestyle changes, and whether you would benefit from preventive medications to lower your blood pressure and cholesterol.</p>
<p><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61212-5/fulltext">Blood pressure</a>- and <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960367-5/fulltext">cholesterol-lowering</a> medications each lower the risk of developing heart disease by around 25%. So if they’re recommended for you, using them long-term is an effective way to reduce your risk. </p>
<p>However, a <a href="https://www.mja.com.au/journal/2016/204/8/absolute-risk-cardiovascular-disease-events-and-blood-pressure-and-lipid">study</a> using data from 2012 found around 76% of Australians aged 45 to 74 years at high risk of a first-time heart attack or stroke weren’t using these life-saving treatments.</p>
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Read more:
<a href="https://theconversation.com/cervical-breast-heart-bowel-heres-what-women-should-be-getting-screened-regularly-148575">Cervical, breast, heart, bowel: here’s what women should be getting screened regularly</a>
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<p>Diabetes is another important <a href="https://www.heartfoundation.org.au/heart-health-education/diabetes-and-heart-disease#:%7E:text=Over%20time%2C%20high%20blood%20sugar,diabetes%20also%20have%20CVD1.">cause of heart disease</a>. Your GP will be able to guide you about whether or not you need a check for diabetes. </p>
<p>If you have diabetes, your GP will help to ensure it’s managed well, to reduce your risk of heart disease. </p>
<h2>2. Quit smoking</h2>
<p>Although Australia has some of the lowest smoking rates in the world, <a href="https://www.aihw.gov.au/getmedia/b0cbb555-ebec-4bc1-8ca1-0d6b567e321f/aihw-phe-271-NDSHS-2019-in-brief.pdf.aspx?inline=true">around 11%</a> of Australians still smoke daily. </p>
<p>Smoking damages blood vessels and contributes to the underlying processes that lead to heart disease. </p>
<p>People who are current smokers are around <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1351-4">two times</a> as likely to have a heart attack or stroke than people who have never smoked. </p>
<p>A <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0281-z">landmark Australian study</a> showed people who smoked died around ten years earlier than people who have never smoked, and up to two-thirds of ongoing smokers died from their habit. </p>
<p>But quitting smoking can reverse these effects. Quitting at any age was found to be beneficial – the earlier the better. In the long term, those who quit before the age of 45 had a <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0281-z">similar life expectancy</a> as people who had never smoked. </p>
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Read more:
<a href="https://theconversation.com/explainer-what-happens-during-a-heart-attack-and-how-is-one-diagnosed-55874">Explainer: what happens during a heart attack and how is one diagnosed?</a>
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<h2>3. Improve your nutrition</h2>
<p>In Australia, poor diet, excess weight and obesity are <a href="http://ihmeuw.org/5pee">leading causes</a> of heart disease. </p>
<p>However, many popular diets are not supported by science. </p>
<p>A healthy diet is important for heart health. For most people, small <a href="https://www.heartfoundation.org.au/heart-health-education/healthy-eating">changes to your diet</a>, such as increasing your intake of fruit, vegetables and wholegrains and reducing salt intake, can have large benefits. </p>
<p>For suggestions on healthier alternatives when you’re grocery shopping, try The George Institute’s <a href="https://www.georgeinstitute.org/projects/foodswitch">FoodSwitch</a> app.</p>
<h2>4. Cut your salt</h2>
<p>On average, Australians consume almost twice the World Health Organization’s recommended <a href="https://www.who.int/data/gho/indicator-metadata-registry/imr-details/3082">daily maximum of 5g salt</a>. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/23558162/">Randomised trials</a> of salt reduction show clear effects on reducing blood pressure, a leading contributor to heart disease. </p>
<p>To reduce your salt intake, you can try reducing the amount of processed foods you eat and cutting down on the amount of salt you add to your food. </p>
<p>Salt substitutes, although not widely available on supermarket shelves, can <a href="https://www.nejm.org/doi/full/10.1056/nejmoa2105675">also play a role</a>. Salt is made up of sodium chloride; salt substitutes involve replacing a portion of the sodium chloride with potassium chloride which acts to lower blood pressure. </p>
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<img alt="Older woman sitting in a chair puts a hand to her chest." src="https://images.theconversation.com/files/450273/original/file-20220307-85901-1s3djjz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450273/original/file-20220307-85901-1s3djjz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450273/original/file-20220307-85901-1s3djjz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450273/original/file-20220307-85901-1s3djjz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450273/original/file-20220307-85901-1s3djjz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450273/original/file-20220307-85901-1s3djjz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450273/original/file-20220307-85901-1s3djjz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Reducing your salt intake will also reduce your risk of heart disease.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/good-looking-aged-woman-having-heart-1131954146">Shutterstock</a></span>
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<h2>5. Get moving</h2>
<p>Physical activity, in addition to being good for the waistline, helps improve cardiac functioning. Studies have linked regular exercise with a lower risk of having a <a href="https://www.ahajournals.org/doi/10.1161/JAHA.117.007725">heart attack</a>. </p>
<p><a href="https://www.health.gov.au/health-topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians">Australian guidelines</a> recommend adults get at least 30 minutes of moderate intensity exercise most days, but even smaller amounts are beneficial. </p>
<p>Any kind of movement is good, so if you are just starting out, choose an activity you like and get moving. </p>
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<strong>
Read more:
<a href="https://theconversation.com/getting-a-heart-check-early-can-prevent-heart-attack-and-stroke-in-indigenous-australians-97699">Getting a heart check early can prevent heart attack and stroke in Indigenous Australians</a>
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<img src="https://counter.theconversation.com/content/178631/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ellie Paige has received funding from the National Heart Foundation of Australia, the National Health and Medical Research Council of Australia and the Australian Government Department of Health.</span></em></p><p class="fine-print"><em><span>Bruce Neal s the Executive Director of The George Institute Australia which advocates strongly for healthier diets. Through The George Institute he receives funding from health and medical research councils and philanthropy in support of work to optimize diets for human health. He is an inventor of the FoodSwitch smartphone application.</span></em></p><p class="fine-print"><em><span>Through the Australian National University, Emily Banks has received research funding from the National Health and Medical Research Council of Australia, the National Heart Foundation of Australia and the Australian Government Department of Health</span></em></p><p class="fine-print"><em><span>Jason Wu does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Shane Warne’s untimely death from a suspected heart attack has prompted some people to consider their own heart health and what improvements they can make.Ellie Paige, Senior Research Fellow, George Institute for Global HealthBruce Neal, Executive Director, George Institute Australia, George Institute for Global HealthEmily Banks, Professor of Epidemiology and Public Health, Australian National UniversityJason Wu, George Institute for Global HealthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1632762021-06-24T08:35:20Z2021-06-24T08:35:20ZCardiac arrests in young people — what causes them and can they be prevented or treated? A heart expert explains<figure><img src="https://images.theconversation.com/files/408054/original/file-20210624-15-1dndcxk.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3623%2C2460&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Wolfgang Rattay/AP/AAP</span></span></figcaption></figure><p>On June 12, 16,000 spectators at Copenhagen’s Parken Stadium and millions of viewers around the world watched in shock as <a href="https://www.reuters.com/lifestyle/sports/denmarks-eriksen-given-cpr-during-euro-2020-clash-2021-06-12/">Danish midfielder Christian Eriksen’s heart stopped</a>.</p>
<p>Late in the first half of Denmark’s opening game of the Euro 2020 soccer tournament against Finland, the 29 year-old was running just after a throw-in and suddenly collapsed. It appears he suffered a <a href="https://www.bbc.com/sport/football/57526058">sudden cardiac arrest</a>.</p>
<p>Fortunately, he was quickly attended to by a medical team with full resuscitation equipment, who administered CPR and successfully used a defibrillator. Erikson survived and has been fitted with an <a href="https://edition.cnn.com/2021/06/17/football/christian-eriksen-icd-heart-starter-spt-intl/index.html">implantable cardiac defibrillator</a>. This is a <a href="https://www.heart.org/en/health-topics/arrhythmia/prevention--treatment-of-arrhythmia/implantable-cardioverter-defibrillator-icd">small device</a> which is connected to the heart and fitted under the skin. If a dangerously abnormal rhythm is detected, it will deliver an electric shock to the heart to try to restore a normal rhythm. </p>
<p>So how often do cardiac arrests happen in young people? What are the risk factors, and can they be prevented?</p>
<p>Cardiac arrests during sport are extremely rare. If you’re playing sport next weekend, you should go ahead in the knowledge it’s almost certain not to happen. The benefits of exercise far outweigh the risks.</p>
<p>But because events like this do happen, albeit very rarely, we need public venues to have good emergency plans to improve survival, including the widespread availability of defibrillators.</p>
<p>There have been some recent improvements in this regard in Australia. For example, defibrillators are <a href="https://pubmed.ncbi.nlm.nih.gov/31820576/">now installed in all Coles and Woolworths stores nationally</a>, and there are <a href="https://bmjopensem.bmj.com/content/5/1/e000536">several programs</a> to support rollout of defibrillators and <a href="https://sma.org.au/resources-advice/policies-and-guidelines/medical-emergency-plannning-guide/">emergency action plans</a> to community sports clubs. But there’s still room for improvement. </p>
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<h2>Am I at risk? How often does this happen?</h2>
<p>Sudden death from cardiac arrest in a young person is a very rare but tragic outcome. The baseline risk in Australia for people under 35 is 1.3 per 100,000 people per year, with <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1510687">15% occurring either during or immediately after exercise</a>.</p>
<p>Across all ages, there are 20,000 sudden cardiac arrests in Australia that occur out of hospital every year, and sadly <a href="https://www.resuscitationjournal.com/article/S0300-9572(21)00141-6/fulltext">only 10% of people survive</a>.</p>
<p>It’s also worth remembering a cardiac arrest isn’t exactly the same thing as a heart attack. A <a href="https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/heart-attack-and-cardiac-arrest">heart attack</a> occurs when one of the coronary arteries is blocked, stopping blood supply to part of the heart. A cardiac arrest is when the heart stops pumping blood around the body, and can occur due to a heart attack or another cause.</p>
<p>The major causes of cardiac arrest depend on age. In people over 35, the vast majority are <a href="https://www.sciencedirect.com/science/article/pii/S1936878X13004786">caused by coronary artery disease</a>, where arteries supplying blood to the heart are blocked or damaged. </p>
<p>In people aged under 35, there’s no single major cause of cardiac arrest. Some of the conditions that can cause cardiac arrest in young people include: </p>
<ul>
<li><p>a condition where the <a href="https://www.mayoclinic.org/diseases-conditions/hypertrophic-cardiomyopathy/symptoms-causes/syc-20350198">heart muscle becomes too thick</a>, called “hypertrophic cardiomyopathy”</p></li>
<li><p>other <a href="https://www.mayoclinic.org/diseases-conditions/cardiomyopathy/symptoms-causes/syc-20370709">conditions of the heart muscle</a> that make it harder for the heart to work properly (called “cardiomyopathies”)</p></li>
<li><p>a condition called “<a href="https://www.mayoclinic.org/diseases-conditions/long-qt-syndrome/symptoms-causes/syc-20352518">Long QT syndrome</a>” which can cause a dangerously erratic heartbeat</p></li>
<li><p>“<a href="https://www.mayoclinic.org/diseases-conditions/brugada-syndrome/symptoms-causes/syc-20370489">Brugada syndrome</a>”, which is a heart rhythm disorder. </p></li>
</ul>
<p>However, 40% of sudden cardiac deaths in young people <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1510687">remain unexplained</a> even after autopsy.</p>
<h2>Is cardiac screening the answer?</h2>
<p>Cardiac screening in young people looks for certain heart abnormalities that haven’t yet been detected. It’s <a href="https://journals.lww.com/cjsportsmed/Abstract/9000/Cardiovascular_Screening_of_Elite_Athletes_by.98979.aspx">common for elite and professional athletes in Australia</a> and internationally, and is mandatory for young athletes in some countries, for example Italy and Israel. </p>
<p>This screening usually includes a “12-lead electrocardiogram” or ECG, which is a painless test that involves putting some sticky dots on the body and recording the electrical activity of the heart over a ten second period.</p>
<p>However, ECG screening <a href="https://www.sciencedirect.com/science/article/pii/S0033062012000023?via%3Dihub">cannot detect all of the conditions</a> which can cause sudden cardiac arrests. This is because some conditions don’t show ECG abnormalities before a cardiac arrest.</p>
<p>Eriksen’s condition was likely in that category, because we know he had regular <a href="https://www.dailymail.co.uk/sport/sportsnews/article-9680381/Christian-Eriksens-former-doctor-Tottenham-claims-miracle-footballer-survived.html">heart screenings while at Tottenham</a> and these hadn’t shown any problems.</p>
<p>Medicare in Australia funds <a href="http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=699&qt=item">heart health checks</a> for people who are middle aged or older, but not in younger people. This is similar to most countries. Other than in professional athletes and those with a family history, most professional bodies don’t recommend <a href="https://www.heartrhythmjournal.com/article/S1547-5271(19)30294-2/fulltext">widespread screening of younger people</a> because the risk of cardiac arrests is so low overall.</p>
<h2>How else can we prevent sudden cardiac death? Defibrillators and data</h2>
<p>The best strategy for preventing sudden cardiac death at any age is having defibrillators widely available. A <a href="https://www.healthdirect.gov.au/defibrillators">defibrillator</a> is a device that can analyse the heart’s rhythm and deliver an electric shock if needed. This can shock the heart back into a normal rhythm. </p>
<p>While they obviously can’t stop the cardiac arrest happening in the first place, they are crucial to survival once they do happen. Early access to a defibrillator can improve survival to <a href="https://journals.sagepub.com/doi/full/10.1177/1941738118799084">almost 90%</a>. </p>
<p>However, access needs to be very quick, ideally within 2-5 minutes, as we know the <a href="https://journals.sagepub.com/doi/full/10.1177/1941738118799084">chances of survival drop by 10% for every minute of delay</a> before defibrillation.</p>
<p>We also need as many as people as possible to be regularly trained to provide CPR.</p>
<p>Fabrice Muamba, a former midfielder for the Bolton Wanderers soccer team in the UK, was lucky to survive after he collapsed and his heart stopped on the field during a 2012 FA cup quarter-final.</p>
<p>Muamba, who recovered after he received CPR and 26 defibrillator shocks, <a href="https://www.mirror.co.uk/sport/football/news/fabrice-muambas-desperate-plea-save-24326905">last week</a> voiced his support for defibrillators to be a legal requirement in public places in the UK. Ideally, Australia could also introduce a similar requirement to have defibrillators in public venues, supported by widespread CPR training (including how to use a defibrillator) to improve survival rates from out of hospital cardiac arrests.</p>
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<p>In addition to defibrillators and CPR training, venues such as schools and sporting stadiums need to have good cardiac emergency plans so they can respond efficiently and effectively if someone’s heart stops. </p>
<p>Some of the conditions that are diagnosable prior to a cardiac arrest run in families, such as “Long QT syndrome”. So, it’s important to seek medical advice for anyone with a family member who has had cardiac arrest under the age of 40.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/in-cases-of-cardiac-arrest-time-is-everything-community-responders-can-save-lives-126491">In cases of cardiac arrest, time is everything. Community responders can save lives</a>
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<p>Importantly, anyone who has any worrying symptoms should seek medical advice, especially fainting or collapse during exercise. </p>
<p>Finally, research projects such as the Australian <a href="https://pubmed.ncbi.nlm.nih.gov/33199184/">End Unexplained Cardiac Death (EndUCD) registry</a> are urgently needed to identify the underlying causes of cardiac death in young people so we can prevent deaths from sudden cardiac arrest.</p><img src="https://counter.theconversation.com/content/163276/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Jessica Orchard is a Postdoctoral Fellow at the Centenary Institute, University of Sydney and honorary Cardiac Research Fellow at Cricket Australia. She is supported by a Heart Foundation fellowship.</span></em></p>Up to 40% of sudden cardiac deaths in young people remain unexplained. But defibrillators and data are key to preventing them.Jessica Orchard, Postdoctoral Fellow, Centenary Institute; and Adjunct Senior Lecturer, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1264912020-01-17T01:05:54Z2020-01-17T01:05:54ZIn cases of cardiac arrest, time is everything. Community responders can save lives<figure><img src="https://images.theconversation.com/files/309896/original/file-20200114-103971-utmijk.jpg?ixlib=rb-1.1.0&rect=18%2C9%2C5988%2C3998&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cardiac arrest can occur with little or no warning in people who were previously healthy, including young people.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>Each year more than <a href="https://www.resuscitationjournal.com/article/S0300-9572(18)30106-0/fulltext">24,000</a> Australians experience a sudden cardiac arrest. This means their heart unexpectedly stops beating. A cardiac arrest leads to loss of consciousness and will result in death if not recognised and treated immediately.</p>
<p>While <a href="https://www.ncbi.nlm.nih.gov/pubmed/20828914">survival rates vary</a> depending on the exact cause of the cardiac arrest, the person’s age and other factors, survival invariably depends on <a href="https://www.ahajournals.org/doi/full/10.1161/circoutcomes.109.889576">early cardiopulmonary resuscitation (CPR) and defibrillation</a>. Each minute of defibrillation delay significantly decreases the person’s chance of <a href="https://www.ncbi.nlm.nih.gov/pubmed/29483086">survival</a>. </p>
<p>So in the instance of a cardiac arrest, in the time before emergency services arrive, help from members of the public can be critical in saving a person’s life.</p>
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<strong>
Read more:
<a href="https://theconversation.com/tom-petty-died-from-a-cardiac-arrest-what-makes-this-different-to-a-heart-attack-and-heart-failure-85245">Tom Petty died from a cardiac arrest – what makes this different to a heart attack and heart failure?</a>
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<h2>Anyone can have a cardiac arrest</h2>
<p>Many cases of cardiac arrest occur in older people due to underlying heart disease. But cardiac arrest can occur with little or no warning in people who were previously well, including <a href="https://theconversation.com/childhood-heart-disease-has-a-profound-impact-and-is-under-recognised-84377">children</a> and young adults. This can be due to heart disease or cardiac rhythm disorders that may be undiagnosed.</p>
<p>Immediate treatment involves CPR. CPR is not the cure, but can save a person’s life by maintaining some blood flow to vital organs until the underlying cause of the cardiac arrest can be treated.</p>
<p>Most cases of cardiac arrest are a result of heart disease that can produce a <a href="https://www.victorchang.edu.au/arrhythmia">sudden disruption</a> to the heart’s normal rhythm. Resuscitation in these cases depends on the use of a defibrillator to deliver a calculated electrical current or “shock” through electrodes applied to the patient’s chest. This aims to return the heart to a normal rhythm, which is essential to restore blood flow from the heart.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/309899/original/file-20200114-103990-iu4i7x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/309899/original/file-20200114-103990-iu4i7x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/309899/original/file-20200114-103990-iu4i7x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/309899/original/file-20200114-103990-iu4i7x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/309899/original/file-20200114-103990-iu4i7x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/309899/original/file-20200114-103990-iu4i7x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/309899/original/file-20200114-103990-iu4i7x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">First aid training includes learning how to operate a defibrillator.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Defibrillators in public places</h2>
<p>A paramedic or other first responder has traditionally performed defibrillation. But there can be a delay from the time of the emergency call to the arrival of emergency service personnel, due to factors like the location of the incident and traffic conditions.</p>
<p>Public health initiatives to reduce the time to defibrillation have installed automated external defibrillators (AED) in public places. These devices are designed to be used by members of the public without prior training. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/according-to-tv-heart-attack-victims-are-rich-white-men-who-clutch-their-hearts-and-collapse-heres-why-thats-a-worry-120894">According to TV, heart attack victims are rich, white men who clutch their hearts and collapse. Here's why that's a worry</a>
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<p>The number of AEDs in public spaces has increased significantly in the past few years. AEDs are now commonly found in workplaces and public spaces such as airports, casinos, sporting venues, and shopping centres. Both <a href="https://www.woolworthsgroup.com.au/page/media/Latest_News/woolworths-to-roll-out-defibrillators-across-all-stores-nationally-to-treat-sudden-cardiac-arrest">Woolworths</a> and Coles have recently installed AEDs in stores across Australia.</p>
<h2>Bystanders can save more lives</h2>
<p>Research shows <a href="https://www.ncbi.nlm.nih.gov/pubmed/31430512">a marked improvement</a> in survival from cardiac arrest in the past two decades. One study reviewed cases of cardiac arrest in adults attended by Ambulance Victoria from 2000 to 2017 to examine trends in the number of survivors.</p>
<p>This research found an eight-fold increase in patients shocked by bystanders where the cardiac arrest occurred in a public place, from 2.9% in 2000-2002 to 23.5% in 2015-2017. Compared to patients in cardiac arrest shocked by paramedics, those shocked in the first instance by bystanders had double the chance of surviving to hospital discharge (55.5% versus 28.8%). </p>
<p>These results are consistent with international research, which shows defibrillation by members of the public using AEDs is associated with significantly improved <a href="https://www.ncbi.nlm.nih.gov/m/pubmed/28687709/">chances of survival</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-australians-die-cause-1-heart-diseases-and-stroke-57423">How Australians Die: cause #1 – heart diseases and stroke</a>
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<h2>Mobilising trained volunteers</h2>
<p>The Heart Foundation found <a href="https://www.heartfoundation.org.au/campaigns/big-heart-appeal/lifesaving-research-cant-happen-without-you/cardiac-arrest-survey">70% of adults</a> would be willing to use an AED to help someone in an emergency. But only about one-third of respondents would feel confident doing so.</p>
<p>The need to reduce time to CPR as well as the need to quickly locate and operate AEDs in an emergency has led to the development of smartphone apps that enable members of the public to register as volunteer responders. </p>
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<img alt="" src="https://images.theconversation.com/files/308240/original/file-20191226-11946-io50hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/308240/original/file-20191226-11946-io50hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=928&fit=crop&dpr=1 600w, https://images.theconversation.com/files/308240/original/file-20191226-11946-io50hp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=928&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/308240/original/file-20191226-11946-io50hp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=928&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/308240/original/file-20191226-11946-io50hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1166&fit=crop&dpr=1 754w, https://images.theconversation.com/files/308240/original/file-20191226-11946-io50hp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1166&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/308240/original/file-20191226-11946-io50hp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1166&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A screenshot from the GoodSAM app.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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<p>One of the most widely used apps in Australia and New Zealand is <a href="https://www.goodsamapp.org/">GoodSAM</a> (Smartphone Activated Medics), which Ambulance Victoria has recently integrated with its emergency call-taking and dispatch system.</p>
<p>This app allows people with approved first aid or emergency health-care qualifications to register as a responder. Ambulance services that have integrated GoodSAM within their dispatch systems can alert a registered <a href="https://www.ambulance.vic.gov.au/goodsam-responder-helps-save-swiss-tourists-life/">GoodSAM responder</a> at the same time an ambulance is dispatched. So the responder receives the location of the suspected cardiac arrest – as well as the location of the nearest AED – often enabling care prior to the arrival of emergency services. </p>
<p><a href="https://www.ambulance.vic.gov.au/goodsam/">Ambulance Victoria</a> and the <a href="https://www.premier.vic.gov.au/victorias-army-of-smartphone-lifesavers-to-grow/">Victorian government</a> have been active in promoting GoodSAM, and the large number of responders currently available in Victoria makes this state one of the <a href="https://www.ambulance.vic.gov.au/defibrillator-saves-a-hat-trick-of-lives-in-record-year-for-bystanders/">safest places in the world to have a cardiac arrest</a>. </p>
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<img alt="" src="https://images.theconversation.com/files/301439/original/file-20191113-77291-p5897a.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/301439/original/file-20191113-77291-p5897a.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=295&fit=crop&dpr=1 600w, https://images.theconversation.com/files/301439/original/file-20191113-77291-p5897a.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=295&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/301439/original/file-20191113-77291-p5897a.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=295&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/301439/original/file-20191113-77291-p5897a.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=371&fit=crop&dpr=1 754w, https://images.theconversation.com/files/301439/original/file-20191113-77291-p5897a.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=371&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/301439/original/file-20191113-77291-p5897a.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=371&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A map of the GoodSAM responders around Melbourne as of November 2019.</span>
<span class="attribution"><a class="source" href="https://www.goodsamapp.org/mapOfResponders">GoodSAM</a>, <span class="license">Author provided</span></span>
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<p>Both the South Australian Ambulance Service and NSW Ambulance Service are planning to follow Victoria and integrate the app into their operations. In order to save more lives, all state ambulance services should fully integrate GoodSAM with their ambulance dispatch systems.</p>
<p>And what can you do? Everyone who is able to should undertake first aid and CPR training. If you have the relevant training, I would urge you to sign up to GoodSAM. You never know when you may be able to save a life.</p>
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<strong>
Read more:
<a href="https://theconversation.com/when-is-it-ok-to-call-an-ambulance-91751">When is it OK to call an ambulance?</a>
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<img src="https://counter.theconversation.com/content/126491/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bill Lord does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Immediate CPR and defibrillation can be key to surviving a cardiac arrest. A smartphone app is mobilising community responders who can help before emergency services arrive.Bill Lord, Adjunct Associate Professor, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/852452017-10-06T00:43:33Z2017-10-06T00:43:33ZTom Petty died from a cardiac arrest – what makes this different to a heart attack and heart failure?<p>Rolling Stone magazine landed in a spot of bother on Monday after publicising news of rock star Tom Petty’s <a href="http://money.cnn.com/2017/10/03/media/tom-petty-death-media/index.html">death prematurely</a>, while others said it was the <a href="http://www.independent.co.uk/arts-entertainment/music/news/tom-petty-dead-dies-death-latest-cause-age-life-career-music-heartbreakers-a7979696.html">result of a heart attack</a> rather than a cardiac arrest. Petty unfortunately did subsequently pass away, from a <a href="http://www.abc.net.au/news/2017-10-03/tom-petty-dies-aged-66-after-cardiac-arrest-manager-says/9011538">cardiac arrest</a>, but it’s important to note neither a cardiac arrest nor a heart attack is synonymous with death.</p>
<p>Albeit infrequently, sufferers of cardiac arrest <a href="https://www.bhf.org.uk/heart-health/conditions/cardiac-arrest">can be revived</a> and a heart attack is associated with a <a href="https://www.mja.com.au/journal/2015/203/9/survival-after-acute-coronary-syndrome-18-month-outcomes-australian-and-new">relatively low</a> risk of dying within 18 months with current treatment in Australia. Both are types of heart disease, as is heart failure. So what are the differences between cardiac arrest, heart attack and heart failure?</p>
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<a href="https://images.theconversation.com/files/188895/original/file-20171005-21985-173tgw5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/188895/original/file-20171005-21985-173tgw5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/188895/original/file-20171005-21985-173tgw5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=601&fit=crop&dpr=1 600w, https://images.theconversation.com/files/188895/original/file-20171005-21985-173tgw5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=601&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/188895/original/file-20171005-21985-173tgw5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=601&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/188895/original/file-20171005-21985-173tgw5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=755&fit=crop&dpr=1 754w, https://images.theconversation.com/files/188895/original/file-20171005-21985-173tgw5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=755&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/188895/original/file-20171005-21985-173tgw5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=755&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The heart beats in a very controlled and synchronised manner.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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</figure>
<h2>Cardiac arrest</h2>
<p>The easiest way to understand these conditions is to think of the heart like a building and approach it like a tradesman. Cardiac arrest is the sparkie’s domain because it’s essentially an electrical failure. The heart beats in a very controlled and synchronised manner, due to a flow of electricity from the “pacemaker” cells at the top of the heart (sinoatrial node) steadily down to the base.</p>
<p>The wiring is present throughout the heart, because the heart muscle cells themselves transmit and respond to this electrical signal, beating as it travels through and powers them. But there are also “mains” electricity circuits that direct the flow of energy and can act as backups along the way if one part of the circuit fails. These are the atrioventricular node, “bundle of His” and “Purkinje fibres” – all can cause the heart to beat, but at a slower rate than the sinoatrial node.</p>
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Read more:
<a href="https://theconversation.com/how-australians-die-cause-1-heart-diseases-and-stroke-57423">How Australians Die: cause #1 – heart diseases and stroke</a>
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</em>
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<p>All this doesn’t always go according to plan. Diseases such as blocked arteries, genetic conditions and degeneration of the heart with ageing can cause disruptions to the circuit. </p>
<p>This may result in two things. The first is a power failure, with no electricity whatsoever – called “asystole”. The second is a surge of electricity from an area of the heart muscle that is disruptive and prevents the heart from pumping properly – the most dangerous of these surges are commonly referred to as ventricular arrhythmias. These are the two main types of cardiac arrest.</p>
<p>Both these conditions will stop the heart pumping. Because blood can no longer travel to the brain, the person will lose consciousness. </p>
<p>In the movies, they are treated with defibrillator paddles delivering electric shocks in a dramatic manner. But while this is an important treatment for ventricular arrhythmias, as it is able to re-organise the surge of electricity, it is ineffective for asystole (where there is no electricity at all). </p>
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<a href="https://images.theconversation.com/files/188889/original/file-20171005-21980-1b9ascl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/188889/original/file-20171005-21980-1b9ascl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/188889/original/file-20171005-21980-1b9ascl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/188889/original/file-20171005-21980-1b9ascl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/188889/original/file-20171005-21980-1b9ascl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/188889/original/file-20171005-21980-1b9ascl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/188889/original/file-20171005-21980-1b9ascl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/188889/original/file-20171005-21980-1b9ascl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">In the movies, people with cardiac arrest are treated with paddles delivering electric shocks in a dramatic manner.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>In this case, <a href="https://resus.org.au/guidelines/">good-quality CPR</a> is crucial. If someone is left too long without blood supply to their brain and the rest of the body, they will die. Survival from cardiac arrest occurring outside of a hospital setting <a href="https://www.ncbi.nlm.nih.gov/pubmed/17227269">in Australia</a> is 24% after the day of event, dropping to 11.5% at one year later.</p>
<h2>Heart attack</h2>
<p>This is the plumber’s area. While a heart attack is often used to describe a range of heart problems, it actually refers to what is medically termed an acute myocardial infarction, or AMI. </p>
<p>The heart provides blood to the rest of the body, but it also needs its own blood supply and does not get it from the blood that flows through its chambers. Instead, the heart is supplied with blood, giving oxygen and taking away carbon dioxide, by arteries and veins that sit on the outside of the heart.</p>
<p>But our Western diet and lifestyle have contributed to extremely high rates of disease inside these arteries, termed “<a href="https://www.bhf.org.uk/heart-health/conditions/atherosclerosis">atherosclerosis</a>”. This causes the arteries to narrow and can lead to sudden blockages, which result in heart attacks. </p>
<p>AMIs usually occur when there is a sudden rupture of the atherosclerotic plaque, containing cholesterol, fatty cells and immune cells. This causes a large blood clot to form, blocking off the blood flow.</p>
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<a href="https://images.theconversation.com/files/188898/original/file-20171005-21999-197eo17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/188898/original/file-20171005-21999-197eo17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/188898/original/file-20171005-21999-197eo17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/188898/original/file-20171005-21999-197eo17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/188898/original/file-20171005-21999-197eo17.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/188898/original/file-20171005-21999-197eo17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/188898/original/file-20171005-21999-197eo17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/188898/original/file-20171005-21999-197eo17.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The heart is supplied with blood, giving oxygen and taking away carbon dioxide, by arteries and veins that sit on the outside of the heart.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>When the heart muscle tissue that is usually supplied by these arteries no longer receives blood and oxygen, it starts to die within minutes, causing intense pain. Within <a href="https://www.ncbi.nlm.nih.gov/pubmed/3154690">90 minutes</a>, that whole section of heart wall can die, meaning it will not beat. This reduces the overall performance of the heart and predisposes it to the aforementioned ventricular arrhythmias (the dangerous surge of electricity).</p>
<p>Fortunately, modern medicine has markedly improved survival from heart attacks. In 1960, <a href="https://www.ncbi.nlm.nih.gov/pubmed/1831213">one-third</a> of people died within a month of having a heart attack. This improved to <a href="https://www.mja.com.au/journal/2015/203/9/survival-after-acute-coronary-syndrome-18-month-outcomes-australian-and-new">16% 18 months after having one</a> in Australia in 2012. </p>
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<p><strong><em>Read more: <a href="https://theconversation.com/women-have-heart-attacks-too-but-their-symptoms-are-often-dismissed-as-something-else-76083">Women have heart attacks too, but their symptoms are often dismissed as something else</a></em></strong></p>
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<p>Even though the survival rate from heart attacks is quite high, the burden of disease is heavy. Heart attacks are responsible for 12% of all deaths in Australia, and one Australian dies from a “heart attack” <a href="https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia/heart-disease-fact-sheet">every 27 minutes</a>.</p>
<h2>Heart failure</h2>
<p>Heart failure is a structural issue, so it’s the carpenter’s problem. It results from the heart being unable to adequately supply the body with blood, so the tissues don’t receive oxygen and other nutrients, and blood pools in the legs, abdomen and lungs. Heart failure either results from weakness in the strength of the pump, or stiffening of the heart so it loses elasticity and can’t fill with blood in the first place. </p>
<p>It is the end result of a <a href="http://blogs.plos.org/globalhealth/2017/08/taking-the-pulse-of-heart-disease/">myriad of conditions</a>, from genetic disorders, to heart attacks, to infections and high blood pressure.
Heart failure is more chronic than the other two. People with heart failure see a gradual worsening of shortness of breath, fatigue, swelling and light-headedness, with a significant impact on quality of life.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-heart-failure-its-not-as-common-a-cause-of-death-as-reports-would-have-us-believe-71151">What is heart failure? It's not as common a cause of death as reports would have us believe</a>
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<p>Death from heart failure is often as a result of cardiac arrest, as disruption to the construction of the house causes electricity problems too; along with organ failure from lack of oxygen supply due to failure to pump the blood and also fluid in the lungs reducing oxygen transfer.</p>
<p>The good news is all three of these conditions can <a href="https://www.heartfoundation.org.au/your-heart/know-your-risks">largely be prevented</a> and treated with a healthy lifestyle, seeing your doctor and taking medications to reduce your risk of heart disease.</p><img src="https://counter.theconversation.com/content/85245/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anna Beale does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People generally assume all heart-related death is due to heart attack. But there are differences between cardiac arrest, heart attack and heart failure – and none are synonymous with death.Anna Beale, Medical doctor, PhD candidate in cardiology, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/747612017-03-23T19:14:16Z2017-03-23T19:14:16ZPainkillers like ibuprofen can increase the risk of heart disease and should be restricted<figure><img src="https://images.theconversation.com/files/161953/original/image-20170322-31180-nre29d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Over-the-counter medicines such as Ibuprofen and Voltaren are not without some risk.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Medications such as ibuprofen and aspirin, known as non-steroidal anti-inflammatory drugs or NSAIDs, are widely available over the counter from pharmacies and supermarkets. But health providers have <a href="https://www.theguardian.com/uk/2006/oct/25/science.health">known for some time</a> they can be unsafe for people with chronic health problems such as kidney disease, high blood pressure or heart failure. </p>
<p>NSAIDs can also have dangerous <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4508078/">interactions with other commonly taken medications</a>, notably many types of blood pressure and blood-thinning pills such as warfarin and aspirin. </p>
<p>Two recently published studies have brought back into the spotlight the possible heart-related side effects of NSAIDs. One found an increased risk of <a href="http://www.bmj.com/content/354/bmj.i4857">heart failure</a> in users of NSAIDs, while another an increased risk of <a href="https://academic.oup.com/ehjcvp/article/3/2/100/2739709/Non-steroidal-anti-inflammatory-drug-use-is">cardiac arrest</a>.</p>
<p>Heart failure is a disease that presents with symptoms such as shortness of breath, fluid retention, leg swelling, and fatigue. This is a result of the heart not being able to pump blood around the body effectively. There are many causes of heart failure, including heart attacks, high blood pressure and excessive alcohol consumption. </p>
<p>A cardiac arrest occurs when the heart stops functioning abruptly and results in complete loss of effective blood flow through the body. The most common cause of a cardiac arrest is a heart attack, where heart muscle is damaged from loss of blood supply due to a blockage in a heart blood vessel. There are many other causes of a cardiac arrest that include structural heart abnormalities and inherited heart diseases of muscle and electrical function. </p>
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<a href="https://images.theconversation.com/files/162106/original/image-20170322-25776-ed2kf5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/162106/original/image-20170322-25776-ed2kf5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/162106/original/image-20170322-25776-ed2kf5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=698&fit=crop&dpr=1 600w, https://images.theconversation.com/files/162106/original/image-20170322-25776-ed2kf5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=698&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/162106/original/image-20170322-25776-ed2kf5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=698&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/162106/original/image-20170322-25776-ed2kf5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=877&fit=crop&dpr=1 754w, https://images.theconversation.com/files/162106/original/image-20170322-25776-ed2kf5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=877&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/162106/original/image-20170322-25776-ed2kf5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=877&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Heart failure is when the heart isn’t able to pump blood around the body effectively.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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</figure>
<p>The recent studies are an important reminder that over-the-counter medicines are not without risk. This class of anti-inflammatory pain killers should no longer be available for sale in grocery stores, but instead restricted to prescription-only or behind-the-counter status in pharmacies. </p>
<h2>How they work</h2>
<p>Non-steroidal anti-inflammatory drugs are commonly used to relieve pain. They can be either prescribed by a doctor or purchased by the patient over the counter from a supermarket or pharmacy.</p>
<p>NSAIDs are used in a broad range of health conditions associated with pain and inflammation, including types of arthritis, headaches, musculoskeletal injuries and menstrual cramps. Their easy availability, effectiveness and presumption of safety contribute to their widespread use. </p>
<p>They work by inhibiting enzymes called cyclooxygenase 1 (COX-1) and 2 (COX-2). These are involved in a number of internal pathways that result in production of hormone-like substances called prostaglandins, which promote inflammation and increase pain perception.</p>
<p>Prostaglandins also protect the stomach lining from acid, by decreasing acid production and increasing mucus secretion and its neutralising properties. So inhibiting prostaglandins also reduces their protective functions. This is why <a href="https://theconversation.com/do-you-need-to-take-some-painkillers-with-food-to-protect-your-stomach-47156">frequent users of anti-inflammatories</a> may suffer from gastric ulcers.</p>
<p>NSAIDs can either inhibit both COX-1 and COX-2 (non selective) or inhibit COX-2 only (selective). Drugs like ibuprofen and aspirin are <a href="https://en.wikipedia.org/wiki/Ibuprofen">non selective</a> and inhibit both the COX enzymes.</p>
<p>COX-1 mediates gastrointestinal, kidney, and clotting function, while COX-2 is induced primarily in states of inflammation and tissue repair. That’s why blocking the COX-2 pathway reduces the effects of inflammation such as fever, swelling, redness and pain.</p>
<p>Importantly, COX-2 inhibition accounts for the anti-inflammatory drug effects of NSAIDs, while COX-1 inhibition can lead to side effects including gastrointestinal ulcers, prolonged bleeding and impaired kidney function. However, it’s not entirely safe for the drugs to inhibit COX-2 only. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/163250/original/image-20170330-15581-1y5jd5j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/163250/original/image-20170330-15581-1y5jd5j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/163250/original/image-20170330-15581-1y5jd5j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=465&fit=crop&dpr=1 600w, https://images.theconversation.com/files/163250/original/image-20170330-15581-1y5jd5j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=465&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/163250/original/image-20170330-15581-1y5jd5j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=465&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/163250/original/image-20170330-15581-1y5jd5j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=584&fit=crop&dpr=1 754w, https://images.theconversation.com/files/163250/original/image-20170330-15581-1y5jd5j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=584&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/163250/original/image-20170330-15581-1y5jd5j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=584&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Ibuprofen works by inhibiting both COX enzymes.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p><a href="http://circ.ahajournals.org/content/115/3/326.long">Animal studies</a> have shown blocking COX-2 and the subsequent pathway of prostaglandin production may have the unwanted effects of increasing the tendency of blood to clot inside arteries, and a reduced ability of the heart to heal after a heart attack. </p>
<p>In the early 2000s, a number of large studies found a significant association of negative heart events, such as <a href="http://www.nejm.org/doi/full/10.1056/NEJM200011233432103">heart attack</a> and <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa050493">stroke</a>, with the use of <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa050330">selective COX-2 inhibitors</a>. This resulted in two of these drugs, Valdecoxib and Rofecoxib or Vioxx, being <a href="https://www.tga.gov.au/media-release/regulator-takes-tough-action-arthritis-drugs-amended">withdrawn from the market</a>. </p>
<p>In Australia there are only a small number of COX-2 inhibitors available, including Celecoxib and Meloxicam. These are prescription-only medicines and the maximum prescribed dose is at a level at which the heart risks are minimal. </p>
<p>COX-2 inhibitors are used in people who require a non-steroidal anti-inflammatory but have a history of stomach upset or ulcers, or who were thought to be at risk of developing stomach ulcers. </p>
<h2>Risk of heart failure</h2>
<p>Non-steroidal anti-inflammatory drugs are associated with elevating blood pressure as well as sodium and fluid retention. Both of these effects may unmask previously undiagnosed heart failure, or worsen the symptoms in people known to already have heart failure.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/162121/original/image-20170323-25783-o1wn3m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/162121/original/image-20170323-25783-o1wn3m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/162121/original/image-20170323-25783-o1wn3m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=814&fit=crop&dpr=1 600w, https://images.theconversation.com/files/162121/original/image-20170323-25783-o1wn3m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=814&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/162121/original/image-20170323-25783-o1wn3m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=814&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/162121/original/image-20170323-25783-o1wn3m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1023&fit=crop&dpr=1 754w, https://images.theconversation.com/files/162121/original/image-20170323-25783-o1wn3m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1023&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/162121/original/image-20170323-25783-o1wn3m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1023&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vioxx was a selective inhibitor and take off the market for its adverse effects on the heart.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/en/9/97/VIOXX_sample_blister_pack.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Research published in the <a href="http://www.bmj.com/content/354/bmj.i4857.long">British Medical Journal in September 2016</a> studied 92,163 people admitted to hospital with heart failure, and found NSAID use in the two weeks prior to admission was associated with a 19% increased risk of hospital admission for heart failure. This was compared with people who had not used NSAIDs prior to admission. </p>
<p>The association of NSAIDs with an exacerbation of heart failure was also seen in many older studies. For example, an <a href="http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/485256">Australian study in 2000</a>, suggested almost 20% of all heart failure related admissions to hospital may be attributed to recent NSAID use. </p>
<h2>Risk of cardiac arrest</h2>
<p>Further heart safety concerns with NSAIDs were raised in a recent study from the University of Copenhagen, published in the <a href="https://academic.oup.com/ehjcvp/article/3/2/100/2739709/Non-steroidal-anti-inflammatory-drug-use-is">European Heart Journal</a>. </p>
<p>Data was collected from nearly 30,000 patients who had suffered cardiac arrest between 2001 and 2010. Of these, around 3,500 were found to have been treated with an NSAID within 30 days of having a cardiac arrest. </p>
<p>Use of any NSAID was associated with a 31% increased risk of cardiac arrest. The commonly used non-selective NSAIDs, diclonenac (Voltaren) and ibuprofen were associated with a 50% and 31% increased risk respectively. </p>
<p>A large proportion of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5248660/">cardiac arrest is a result of clot formation in the arteries of the heart</a> and underlying plaque formation which can rupture. NSAIDs may increase the risk of cardiac arrest by raising blood pressure, forming blood clots and blocking the heart’s own blood vessels. </p>
<p>It is important to emphasise that in people with no known heart disease and who don’t have any heart risk factors, short term use of these anti-inflammatories carries a minimal increase in heart-related risk.</p>
<p>These recent studies should not create community panic about the safety of NSAIDs when used for short periods of time and at low dosage.</p>
<p>But the high burden of heart disease and heart disease risk factors, such as high blood pressure, obesity and diabetes (which are often unrecognised), warrant a personalised approach to NSAIDs, which weighs the benefits and risks of their use.</p>
<p>This was recommended in the <a href="https://www.tga.gov.au/review-cardiovascular-safety-non-steroidal-anti-inflammatory-drugs">Therapeutic Goods Administration review</a> of the heart related effects of NSAIDs in 2014. These anti-inflammatories should be available for purchase through prescription by a medical practitioner or behind the counter at the pharmacy.</p><img src="https://counter.theconversation.com/content/74761/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Stokes receives scholarship funding from the Royal Adelaide Hospital Research Committee.</span></em></p><p class="fine-print"><em><span>Peter Psaltis receives research funding from the National Health and Medical Research Council of Australia, National Heart Foundation of Australia and Abbott Vascular Pty Ltd. </span></em></p>Anti-inflammatory pain killers such as ibuprofen should no longer be available for sale in grocery stores, but instead restricted to pharmacies.Michael Stokes, Cardiologist and PhD Candidate, University of AdelaidePeter Psaltis, Co-director, Vascular Research Centre, South Australian Health & Medical Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/711512017-01-12T23:56:02Z2017-01-12T23:56:02ZWhat is heart failure? It’s not as common a cause of death as reports would have us believe<figure><img src="https://images.theconversation.com/files/152349/original/image-20170111-6425-1fwy68k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most people erroneously believe 'heart failure' is when the heart suddenly stops. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>When George Michael died last year <a href="http://www.news.com.au/entertainment/celebrity-life/george-michaels-long-battle-with-health-issues/news-story/45101ac02ba9f7716d6c55c440e460c2">news reports</a> all over the <a href="http://hollywoodlife.com/2016/12/25/george-michael-cause-of-death-heart-failure/">world</a> announced the cause as heart failure.</p>
<p>The same condition was cited as the cause of death of 61 year old Devo band member <a href="http://edition.cnn.com/2014/02/18/showbiz/devo-bob-casale-dead/">Bob Casale</a>, 27 year old Ecuadorian footballer <a href="http://edition.cnn.com/2013/07/31/sport/football/football-christian-benitez-dies/">Christian Benitez</a>, actor <a href="http://www.nydailynews.com/news/national/actor-river-phoenix-dies-23-1993-article-1.2762206">River Phoenix</a>, The Doors lead singer <a href="https://en.wikipedia.org/wiki/Jim_Morrison">Jim Morrison</a>, former First Lady <a href="http://www.mirror.co.uk/news/world-news/nancy-reagan-dead-former-first-7506681">Nancy Reagan</a> and Lord of the Rings’ <a href="https://www.theguardian.com/film/2015/jun/11/christopher-lee-dies-at-the-age-of-93-dracula">Christopher Lee</a>, well known for playing Saruman the White. </p>
<p>There is even a <a href="http://www.ranker.com/list/famous-people-who-died-of-heart-failure/reference">website</a> that lists celebrities who have died of heart failure. As a general physician I know “heart failure” was unlikely to be the cause of death of most of these people.</p>
<h2>What actually is heart failure?</h2>
<p>While they are all related to each other, “heart failure”, “heart attack” and “sudden cardiac arrest” are not synonyms. A lay person could be excused for thinking a heart that has “failed” has suddenly stopped, but this is not the medical meaning. </p>
<p>Heart failure occurs when the heart is unable to pump enough blood to the other organs to satisfy their need for oxygen and nutrients. It usually manifests as tiredness and weakness, breathlessness and swelling of the legs and abdomen. Sudden death may occur as a consequence of heart failure, but it is not a feature of the disease.</p>
<p>The most important causes of heart failure are coronary artery disease (which causes a heart attack) and high blood pressure, but it can also be the result of damage to the heart muscle itself (cardiomyopathy), problems with the valves (such as “aortic stenosis”) or when the heart’s rhythm is disturbed and it beats too fast, too slow or irregularly (“atrial fibrillation”).</p>
<h2>What’s a heart attack?</h2>
<p>A “heart attack” occurs when one of the arteries in the heart suddenly blocks, depriving the heart muscle of oxygen. Typically, a heart attack produces severe, central, crushing chest pain. How much heart muscle dies depends on the extent of the blockage and how quickly the blood flow can be restored through medical intervention. </p>
<p>An oxygen-starved heart is unstable and prone to rhythm abnormalities, so a heart attack is one of the common triggers of a “sudden cardiac arrest” which means the heart suddenly and unexpectedly stops.</p>
<p>The vast majority of people who have a heart attack do not suffer a sudden cardiac arrest but many will subsequently develop heart failure if sufficient muscle has been damaged. </p>
<h2>So if not heart failure, what do they really mean?</h2>
<p>Heart failure is a major public health problem. It affects <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737418530">approximately 300,000 Australians</a> and, as it is a disease mainly of older people, numbers will significantly rise as the population ages. </p>
<p>The condition increases your risk of dying from a sudden cardiac arrest. Around 50% of people will be dead five years after they receive a heart failure diagnosis, probably from sudden cardiac arrest but other complications are often implicated. This makes the illness <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa020265">as deadly as many cancers</a>.</p>
<p>Many of the celebrity deaths, especially the middle aged ones, reported as being due to heart failure were probably the result of a sudden cardiac arrest caused by underlying coronary artery disease. </p>
<p>But sudden death can have other causes: these include a clot of blood that travels to the lungs (pulmonary embolism), rupture of the aorta (main artery of the body), intentional or unintentional poisoning or brain haemorrhage. George Michael’s post mortem was “inconclusive” and failed to reveal a specific reason for his death, a surprisingly common finding in this context. </p>
<p>On the other hand, 93 year old Christopher Lee had been unwell for some time before he died. He had been admitted to hospital with “respiratory problems and heart failure”, a diagnosis in keeping with his advanced age and reported symptoms. Unlike the others, Saruman the White’s end would have been slower and, hopefully peaceful.</p><img src="https://counter.theconversation.com/content/71151/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Frank Bowden does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>When George Michael passed away last year news reports all over the world announced the cause as heart failure. It’s unlikely this really was the cause.Frank Bowden, Professor at ANU Medical School; Senior Staff Specialist Infectious Diseases; General Physician, ACT HealthLicensed as Creative Commons – attribution, no derivatives.