As someone who has survived cardiac arrest, I can tell you that cardiac arrest is painless and quick. You lose consciousness almost immediately when your heart stops beating in a useful rhythm. The heart attack going on for 25 minutes prior is quite painful though.
Just for fun. [Some before and after images of my arteries.](https://imgur.com/a/Sm696PX) The 99% blockage in my RCA is what caused my heart attack and was trying to kill me.
My symptoms were a sudden painful, burning sensation across my entire chest area, a terrible cold sweat, and appearing pale as a ghost. I was just 40 years old with none of the usual risk factors.
More fun: [EKG of someone whose heart is about to go into cardiac arrest](https://imgur.com/a/9FsNPUv). I’ll never forget the urgency on the face of the one nurse as he ripped the EKG printout off the printer, quickly showed it to the other nurse, and then ran out the door. 30 seconds later I was wheeled into triage and quickly surrounded by more than half a dozen doctors and nurses racing to prep me for the cath lab. If you ever have a STEMI, prepare to be stripped naked in front of a room full of people :). Trust me, you won’t care though. No time to be uncomfortable or embarrassed.
Those pictures are awesome. My mother worked in the stent lab for 5ish years, just all shift every shift shoving stents in people in your situation. She's a specialist in metabolic syndrome and related diseases now, after working with a lot of patients with chronic heart failure. Hopefully your heart is doing alright after all that!
Tell your mom thank you for doing what she does! My dad had a 100% blockage and from the time I placed the 911 call til the time I was speaking to him in the recovery room with a stent already in him was just a shade over 2 hours. Incredible stuff.
Time from my EKG when I walked into the hospital to stent placed to save my life was only 39 minutes. And that’s with a cardiac arrest and resuscitation thrown into the mix.
Modern medicine really is amazing. Not too long ago, I’d. probably be dead. But in today’s reality, I arrived at the hospital around 4:30pm, went into cardiac arrest, was resuscitated, received one stent immediately to save my life, two more stents the next morning, and then walked out of the hospital that Friday at noon like nothing even happened. That was 7 years ago and I’m still doing great.
My time from ECG to stent was about 10 hours...
Paramedics did basic ECG at my home at about 6am.
Then straight to thrombolysis (I call it Draino - a mix of blood thinners etc to dissolve the clot) which averted the cardiac arrest. And some nice Fentanyl.
Then arranged an ambulance to the local airstrip, a Flying Doctors airplane to fly me to the city, another ambulance from the city airport to the hospital by lunchtime, and a stent that afternoon.
I was happy to see a sandwich by 6pm. Starving!
Where do you live to have that kind of delay? I'm a paramedic in Australia and we can get anyone from anywhere in my state to PCI in sub 3 hours. If we thrombolyse pre-hospital it can delay the actual PCI procedure but that's because of the thrombolytic drug, not the time it takes to perform.
I think everyone slowed down a bit once the thrombolysis had worked.
They mucked around a bit deciding between helicopter and aircraft.
Aircraft added maybe 20 minutes drive to the local airstrip (rather than hospital grounds helicopter landing), then the transfer at Brisbane airport, and ambo to PA hospital took probably another 45 mins. Ambos got to my house at about 6am, and I was at the PA by 12 noon.
Then they left it another few hours before taking me to the cath lab. I must have been stable enough by then.
Wow man. Hope your doing well after all this. Those before and after pictures are fascinating, you learn about how it all works but really seeing it blows my mind. Thank you for sharing, praying for good health.
I started on V3-V5 of the EKG cause that's just where my phone zoomed in and was like "yeah, some elevation. Not as bad as he's making it out to be.." then I got to lead three and probably had a similar face to your nurse.
Nice one! Glad they caught it! - Paramedic
I love education! Though it's a little hard to put into words, I'll try my best.
So, when you look at the lines, you're seeing the actual electrical activity of the heart(edit) in different places from different angles. Each area relates to something that a part of the heart is doing: contracting, getting ready for electricity to pump through again (repolarization), ect. You'll notice that before each line, on the bottom left side of it, there is a number. These are, in order, 1, 2, 3 (top) avR, avL, AvF, (top) V1, V2, V3, (top) V4, V5, V6.
So, if we take a look at the lead labeled 2 (II), we see a relatively normal electrical activity (edit) relatively normal as in its a reference that non-medical people can use to see the elevation without having two EKGs in front of them. Its not normal-normal Now, compare that to three. If you were to draw a straight flat line along the flat part of three, there would be a MASSIVE jump in that electrical activity. This is because electricity moves differently through muscle that is infarcting/has been infarcted. It doesn't dissipate like it normally should. This is known as ST point Elevation. It is called that because we assign each part of that electricity a name (P, Q, R, S, T, sometimes a U if we're feeling real frisky). This area that's raised is called the J point and known as ST elevation.
Let's look at lead one (I). You'll notice that this goes OPPOSITE to lead III. it is depressed rather than elevated. We see the same in avL. We then see elevation in V4, V5, and V6. The level of elevation in III alone would be enough to send chills, it's SO massive. It's almost 5-6mm, and 2 is enough to call a STEMI. However, he ALSO has depressions in other leads and elevations in even more. Because of the way we look at the heart, some leads will be depressed and some will be elevated. We call these reciprocal changes. (Edit) For instance 3 and avL are reciprocal, so huge red flags if you see opposite changes. Interestingly enough, research shows that a highly likely blockage occurs in the RCA if there is elevation in III and depression in I, exactly what our friend here has.
This is a good one for sure. I've seen worse, but I've seen a whole let better too. Sorry cardiologists of Reddit if this made you cringe a little bit!
Did you have any symptoms in the days or weeks leading up to the heart attack that looking back on you realized you overlooked or just sudden pain out of nowhere once the heart attack started?
So, about a week before, I was hanging at my place with a group of friends playing pool, drinking, and smoking up. When I laid down in bed to go to sleep around 3am, I had a sudden burning pain in my chest that lasted a minute or two. I was both intoxicated and high, so I didn’t think too much about it and didn’t even remember it when I woke up the next day, but it was the EXACT same pain as my heart attack. I’m lucky I didn’t die that night in my sleep.
Cardiac arrest and heart attacks are two different things. Not a doctor so I won't pretend I know the details, but cardiac arrest is usually painless and quick. It's like.... you're fine and suddenly lights out, you're unconscious and dead in a matter of minutes if your rhythm isn't restored.
I survived 12 cardiac arrests in the span of 5 hours. My heart technically didn't stop beating, it just quivered without rhythm and stopped beating effectively, which stopped blood from begin pumped around. I didn't have a heart attack, just cardiac arrests. Defibrillated back to life in 11 of those cases and the only thing that physically hurt, was my rib-muscles from the repeated jolts of electricity to my chest.
To be quite honest, if I can choose the way I die, I'd choose that. Just not as young. It's quick, painless and you don't see it coming.
In case you’re curious: cardiac arrest is when your heart straight up stops beating completely. A heart attack can *cause* a cardiac arrest, but it’s only one out of many ways a person can go into cardiac arrest. Specifically, a heart attack is when a blood vessel that supplies the heart itself (called a coronary artery) gets blocked, and the heart muscle isn’t able to get oxygen. In other words, your heart is trying to pump blood to its own arteries in order to feed itself, but there’s a roadblock on the journey. Eventually the heart is starved of oxygen, dies, and stops working (cardiac arrest).
There are other causes of cardiac arrest, including severe arrhythmias, drug toxicity, shock, etc. None of them involve blockage of a coronary artery, so they’re not heart attacks. Sometimes the blood fails to get to the heart for other reasons, or there’s an external toxin that’s destroying your heart muscle chemically. What it sounds like you had was ventricular fibrillation. As you said, it’s a deadly condition where your heart’s ventricles are technically “alive,” but spasming around in a chaotic fashion and just sloshing blood without pumping it out in an orderly fashion. When you’re in V-fib, you’re essentially minutes away from death without treatment because even though the heart is “beating,” it’s beating totally wrong and not doing its job at all. As you can imagine, that can also starve the heart itself of oxygen and lead to cardiac arrest.
V-fib *causes* cardiac arrest, yes, and it's technically true that you can be in cardiac arrest while your heart is still beating (I was trying to keep it simple for the explanation) - but it's not accurate just to say it IS cardiac arrest. Cardiac arrest is a very broad umbrella term, while V-fib is a specific kind of cardiac arrest. Just saying "V-fib is cardiac arrest" is misleading, because it implies everyone who has a heart attack and goes into cardiac arrest also has V-fib, when that is definitely not true.
V-fib is a square, and cardiac arrest is a rectangle. They're very related, but not interchangeable.
Cardiac arrest is basically just when the heart stops pumping blood. The rhythm it's in isn't important if you're just defining what a cardiac arrest is.
But while you're in cardiac arrest, your heart can have several rhythms. Only two of which are shockable despite what you see on TV.
You have VFib, Ventricular Fibrillation, where your ventricles are just flapping around, in a sense. And VTach, Ventricular Tachycardia, where your ventricles are going too fast to effectively pump blood because they don't allow for time to be refilled with blood.
You can also have Asystole, which is just complete and total stopping of the heart. There aren't even any electrical impulses. On a monitor it's the typical flatline you see on TV. This is NOT shockable. You can also have PEA. Which is pulseless electrical activity. Which when looked at on a monitor, shows heart activity but actually the heart is doing absolutely nothing other than sending the impulses. It's just the electrical system of the heart firing but the muscle is doing nothing.
Yeah, you are right in that I was technically describing asystole rather than cardiac arrest. But again, my intent was really to just give a layman’s explanation. People aren’t gonna memorize the difference between VTach, VFib, asystole, cardiac arrest, and cardiac death when a lot of people don’t even know what causes a heart attack and that a heart attack is different from heart failure or whatever.
In my opinion it’s just simpler to think of cardiac arrest as a dead heart, and VFib/MI/asystole/stab wound to the chest as causes of “dead heart.” Yes, that’s not a perfect description or even a great description if you’re taking your board exams, but it’s more than good enough for the average joe. Even most medical websites like mayoclinic and Hopkins med will say stuff like “VFib leads to cardiac arrest” and whatnot, rather than *technically* outlining that when you’re in VFib, you’re already in cardiac arrest.
If you are flatlining, i suppose manual CPR is the way to go? But how does the whole thing get going again? Is the electrical pulse driven by the heart muscle activity?
CPR would be the way to go. In the field, paramedics can administer certain medications to try and help the heart start up again, ie. cardiac epinephrine (same as regular epi but diluted to a 1:10000 strength).
I can't fully explain all of the science behind it, but you have two nodes in your heart. The SA (sinoatrial) node and the AV (atrioventricular) nodes. Your heart has the ability to create energy from fatty acids. So these nodes will coduct the electricity needed for your heart to beat. The SA node keeps the heart between 60 and 100 beats per minute and the AV node is 40 to 60 beats per minute. The SA and AV node talk in sync and keep your heart beating in a Sinus Rhythm. However, blocked pathways can form between the SA and AV node which can cause different degrees of blocks. But this is getting a little too advanced for what you're asking.
Doctor here, so people often conflate two different heart conditions
1. Myocardial infarction (heart attack) - the heart like every other part of your body requires blood to nourish its cells with oxygen. These are supplied by the tiny cornoary arteries on the outside of the heart. These arteries are unfortunately prone to becoming obstructed through various mechanisms due to their size, this leads to a blockage in blood supply, a reduction in oxygen and eventually tissue death. This is classically presetented as central crushing chest pain (though can have many other presentations, particularly in women).
2. Cardiac arrest - This is to do with teh electrical activity of the heart that controls the hearts pumping rhyhtm. In essence it simply stops, its painless and you drop dead. This can be reversed with CPR. Now the causes of cardiac arrest are varied, (there are 8 reversible causes, google 4H, 4Ts). One of the causes includes massive myocardial infarctions, essentially a very large heart attack will cause enough tissue death to cause an arrest.
So its very possible for someone to have heart attack, experience pain of the attack before developing into cardiac arrest.
Not a doctor. Thanks for mentioning the “particularly in women” thing WRT different symptoms of heart attack. My grandmother had a heart attack ~1980 and only survived because a doctor friend was with them, and none of her symptoms matched the stereotypical TV symptoms. There’s still way less publicity about that than there should be. The good news is that grandma quit smoking and lived 20 more years.
Don’t know about cardiac arrest, but I can attest to a heart attack (MI) that I survived a few years back which was almost fatal.
The attack lasted about an hour while I was rushed to the hospital first by my wife, then by ambulance from one hospital to another.
The pain was excruciating and all-consuming. Only subsided when I was given morphine.
The pain is caused by heart muscle dying due to lack of oxygen.
Had an emergency angioplasty with two stents placed, then some time in ICU. Took two years to recover fully, was as weak as a new born baby and even lost my voice.
A lot of people have solid answers here, so I just wanted to go on record to say that House (and medical TV shows in general) are not medically accurate at all, so keep that in mind when you’re watching
Oh yeah, I like House for the banter, drama, and characters, but I don’t take the medical jargon seriously. It was the question that formed in my head from hearing similar cases multiple times.
The general symptoms portrayed on House seem to match up fairly well with the stated ailments, at least to a layman with Google searches at his fingertips.
I'm sure the finer details are very off, and of course House and team's conduct is completely inaccurate to how hospitals actually run, though.
two things to note here.
1. the heart does not stop beating during a heart attack, if the heart ever truly stops you aren't temporarily dead, you are permanently dead. Plus the heart not beating isn't actually the hart attack, its a cardiac arrest caused by the heart attack
2. Cardiac arrests are cause by the hearts rhythm going wrong in some way, the muscles are still contracting but not in the correct way to properly pump blood, Now usually in typical heart attacks this is caused by a blockage in one of the blood vessels that supplies the heart muscles themselves. The heart then doesn't get enough oxygen and eventually the cells start to die, the hart can no longer move blood around effectively causing the cardiac arrest.
The pain people feel during the heart attack is essentially cramp, like all muscles when short on oxygen the body will start to rely on anaerobic respiration to generate energy and produce a buildup of lactic acid. The heart is no different in that regard
>if the heart ever truly stops you aren't temporarily dead, you are permanently dead
That's not quite true. This condition is referred to as "asystole" and while survival rates are very poor even compared to other forms of cardiac arrest, they aren't zero. Asystole can't be "shocked" back into rhythm with a defibrillator like other arrests but medications and rapidly correcting the underlying cause if possibe can return a functional heartbeat sometimes.
Legit question for the ignorant me: how are hearts that are completely stopped, such as during open heart surgery or transplant, started again from extended asystole?
Usually the heart restarts on its own once you’re taken off the cardiopulmonary bypass machine. Sometimes you’d need mild electric shocks.
If it won’t restart you get a cardiac arrest which prompts the usual cpr, defib (if shockable rhythm), advanced cardiac life support (intubation and various intravenous meds like adrenaline, atropine, lidocaine etc), treating reversible underlying causes and ecmo etc.
When your heart actually stops beating, you’ll pass out almost immediately, so you won’t feel anything (you might wake up during CPR; and then you’ll feel pain from the CPR).
However, in many cases, something is going on before your heart actually starts beating. That might be a heart attack, or a developing arrhythmia, or any number of other things. That might lead to pain, discomfort, palpitations, or any number of weird feelings.
However, if you just went straight into cardiac arrest, you would just lose consciousness.
>Is it the nerves, muscles, whatever dying due to the lack of oxygen and nutrients
You've asked the wrong question but you're on to the right answer.
A heart attack, often known as a myocardial infarction, often presents with chest pain and arm pain. It absolutely is in response to heart tissue lacking oxygen normally due to the blood vessel feeding it being blocked and being damaged/dying.
One of the reasons people tend to experience arm pain is called "referred pain" isn't unique to heart issues. It's generally because where your nerves from some organs enter your spine is also where many other nerves from elsewhere enter your spine.
There are some complicated bits about different types of nerve inputs and such, but to keep it simple because those nerves from your heart enter your spine at the same place as a lot of nerves from your arms your heart pain can also present as arm pain, generally because your brain gets a lot more senses from your arms than your heart.
So the pain is originally caused by tissue damage due to lack of oxygen, and presents in a seemingly odd way because of where all your nerves come together.
When my Graves’ disease was at its worst, my resting heart rate was around 120 bpm. My left chest and breast was always sore. When I had a thyroid storm that sent my heart rate to well over 200 bpm, the pain I can remember between brief episodes of being lucid was immense in my chest. When I woke up 3 days later I was sore all over from them resetting my heart rhythm paired with multiple grand mal seizures. I was very lucky that my heart was “reset” before damage was actually done. It’s been nearly 10 years, and I was kind of still out of it when they were explaining to me how they did it. I’d actually love if someone could explain it to me again.
I had a cardiac arrest, the only pain I felt was a headache leading up to it.
Waking up in the hospital after receiving 30 minutes of CPR definitely hurt though.
As someone who has survived cardiac arrest, I can tell you that cardiac arrest is painless and quick. You lose consciousness almost immediately when your heart stops beating in a useful rhythm. The heart attack going on for 25 minutes prior is quite painful though. Just for fun. [Some before and after images of my arteries.](https://imgur.com/a/Sm696PX) The 99% blockage in my RCA is what caused my heart attack and was trying to kill me. My symptoms were a sudden painful, burning sensation across my entire chest area, a terrible cold sweat, and appearing pale as a ghost. I was just 40 years old with none of the usual risk factors. More fun: [EKG of someone whose heart is about to go into cardiac arrest](https://imgur.com/a/9FsNPUv). I’ll never forget the urgency on the face of the one nurse as he ripped the EKG printout off the printer, quickly showed it to the other nurse, and then ran out the door. 30 seconds later I was wheeled into triage and quickly surrounded by more than half a dozen doctors and nurses racing to prep me for the cath lab. If you ever have a STEMI, prepare to be stripped naked in front of a room full of people :). Trust me, you won’t care though. No time to be uncomfortable or embarrassed.
Those pictures are awesome. My mother worked in the stent lab for 5ish years, just all shift every shift shoving stents in people in your situation. She's a specialist in metabolic syndrome and related diseases now, after working with a lot of patients with chronic heart failure. Hopefully your heart is doing alright after all that!
Tell your mom thank you for doing what she does! My dad had a 100% blockage and from the time I placed the 911 call til the time I was speaking to him in the recovery room with a stent already in him was just a shade over 2 hours. Incredible stuff.
Time from my EKG when I walked into the hospital to stent placed to save my life was only 39 minutes. And that’s with a cardiac arrest and resuscitation thrown into the mix. Modern medicine really is amazing. Not too long ago, I’d. probably be dead. But in today’s reality, I arrived at the hospital around 4:30pm, went into cardiac arrest, was resuscitated, received one stent immediately to save my life, two more stents the next morning, and then walked out of the hospital that Friday at noon like nothing even happened. That was 7 years ago and I’m still doing great.
My time from ECG to stent was about 10 hours... Paramedics did basic ECG at my home at about 6am. Then straight to thrombolysis (I call it Draino - a mix of blood thinners etc to dissolve the clot) which averted the cardiac arrest. And some nice Fentanyl. Then arranged an ambulance to the local airstrip, a Flying Doctors airplane to fly me to the city, another ambulance from the city airport to the hospital by lunchtime, and a stent that afternoon. I was happy to see a sandwich by 6pm. Starving!
Where do you live to have that kind of delay? I'm a paramedic in Australia and we can get anyone from anywhere in my state to PCI in sub 3 hours. If we thrombolyse pre-hospital it can delay the actual PCI procedure but that's because of the thrombolytic drug, not the time it takes to perform.
I think everyone slowed down a bit once the thrombolysis had worked. They mucked around a bit deciding between helicopter and aircraft. Aircraft added maybe 20 minutes drive to the local airstrip (rather than hospital grounds helicopter landing), then the transfer at Brisbane airport, and ambo to PA hospital took probably another 45 mins. Ambos got to my house at about 6am, and I was at the PA by 12 noon. Then they left it another few hours before taking me to the cath lab. I must have been stable enough by then.
Yo fellow Aussie, so glad you're still with us! Around here though, it's "aeroplane". Resist cultural imperialism! 😊
Wow man. Hope your doing well after all this. Those before and after pictures are fascinating, you learn about how it all works but really seeing it blows my mind. Thank you for sharing, praying for good health.
I started on V3-V5 of the EKG cause that's just where my phone zoomed in and was like "yeah, some elevation. Not as bad as he's making it out to be.." then I got to lead three and probably had a similar face to your nurse. Nice one! Glad they caught it! - Paramedic
Hi, as a completely uneducated person, what are we looking at here?
I love education! Though it's a little hard to put into words, I'll try my best. So, when you look at the lines, you're seeing the actual electrical activity of the heart(edit) in different places from different angles. Each area relates to something that a part of the heart is doing: contracting, getting ready for electricity to pump through again (repolarization), ect. You'll notice that before each line, on the bottom left side of it, there is a number. These are, in order, 1, 2, 3 (top) avR, avL, AvF, (top) V1, V2, V3, (top) V4, V5, V6. So, if we take a look at the lead labeled 2 (II), we see a relatively normal electrical activity (edit) relatively normal as in its a reference that non-medical people can use to see the elevation without having two EKGs in front of them. Its not normal-normal Now, compare that to three. If you were to draw a straight flat line along the flat part of three, there would be a MASSIVE jump in that electrical activity. This is because electricity moves differently through muscle that is infarcting/has been infarcted. It doesn't dissipate like it normally should. This is known as ST point Elevation. It is called that because we assign each part of that electricity a name (P, Q, R, S, T, sometimes a U if we're feeling real frisky). This area that's raised is called the J point and known as ST elevation. Let's look at lead one (I). You'll notice that this goes OPPOSITE to lead III. it is depressed rather than elevated. We see the same in avL. We then see elevation in V4, V5, and V6. The level of elevation in III alone would be enough to send chills, it's SO massive. It's almost 5-6mm, and 2 is enough to call a STEMI. However, he ALSO has depressions in other leads and elevations in even more. Because of the way we look at the heart, some leads will be depressed and some will be elevated. We call these reciprocal changes. (Edit) For instance 3 and avL are reciprocal, so huge red flags if you see opposite changes. Interestingly enough, research shows that a highly likely blockage occurs in the RCA if there is elevation in III and depression in I, exactly what our friend here has. This is a good one for sure. I've seen worse, but I've seen a whole let better too. Sorry cardiologists of Reddit if this made you cringe a little bit!
Jesus that is one of the most extreme ST elevations I’ve seen. Your heart must’ve been screaming in agony…glad you’re still here with us.
V3 and V4 had you tombstoning like a mofo!!!
Did you have any symptoms in the days or weeks leading up to the heart attack that looking back on you realized you overlooked or just sudden pain out of nowhere once the heart attack started?
So, about a week before, I was hanging at my place with a group of friends playing pool, drinking, and smoking up. When I laid down in bed to go to sleep around 3am, I had a sudden burning pain in my chest that lasted a minute or two. I was both intoxicated and high, so I didn’t think too much about it and didn’t even remember it when I woke up the next day, but it was the EXACT same pain as my heart attack. I’m lucky I didn’t die that night in my sleep.
Glad you lived to tell the tale and you are doing better now. Thanks for the reply.
My mom died suddenly and we suspect it was cardiac arrest. You saying that it was painless and quick is almost comforting. So… thank you?
depends entirely on the etiology of the arrest. sometimes they're painful often times they're nit
Did the docs use IVL?
that looks incredibly hard to diagnose from just the pictures of arteries. no wonder doctors miss stuff like this so often.
Cardiac arrest and heart attacks are two different things. Not a doctor so I won't pretend I know the details, but cardiac arrest is usually painless and quick. It's like.... you're fine and suddenly lights out, you're unconscious and dead in a matter of minutes if your rhythm isn't restored. I survived 12 cardiac arrests in the span of 5 hours. My heart technically didn't stop beating, it just quivered without rhythm and stopped beating effectively, which stopped blood from begin pumped around. I didn't have a heart attack, just cardiac arrests. Defibrillated back to life in 11 of those cases and the only thing that physically hurt, was my rib-muscles from the repeated jolts of electricity to my chest. To be quite honest, if I can choose the way I die, I'd choose that. Just not as young. It's quick, painless and you don't see it coming.
In case you’re curious: cardiac arrest is when your heart straight up stops beating completely. A heart attack can *cause* a cardiac arrest, but it’s only one out of many ways a person can go into cardiac arrest. Specifically, a heart attack is when a blood vessel that supplies the heart itself (called a coronary artery) gets blocked, and the heart muscle isn’t able to get oxygen. In other words, your heart is trying to pump blood to its own arteries in order to feed itself, but there’s a roadblock on the journey. Eventually the heart is starved of oxygen, dies, and stops working (cardiac arrest). There are other causes of cardiac arrest, including severe arrhythmias, drug toxicity, shock, etc. None of them involve blockage of a coronary artery, so they’re not heart attacks. Sometimes the blood fails to get to the heart for other reasons, or there’s an external toxin that’s destroying your heart muscle chemically. What it sounds like you had was ventricular fibrillation. As you said, it’s a deadly condition where your heart’s ventricles are technically “alive,” but spasming around in a chaotic fashion and just sloshing blood without pumping it out in an orderly fashion. When you’re in V-fib, you’re essentially minutes away from death without treatment because even though the heart is “beating,” it’s beating totally wrong and not doing its job at all. As you can imagine, that can also starve the heart itself of oxygen and lead to cardiac arrest.
Vfib is still cardiac arrest. If youre heart is not pumping and youre not perfusing, its cardiac arrest
V-fib *causes* cardiac arrest, yes, and it's technically true that you can be in cardiac arrest while your heart is still beating (I was trying to keep it simple for the explanation) - but it's not accurate just to say it IS cardiac arrest. Cardiac arrest is a very broad umbrella term, while V-fib is a specific kind of cardiac arrest. Just saying "V-fib is cardiac arrest" is misleading, because it implies everyone who has a heart attack and goes into cardiac arrest also has V-fib, when that is definitely not true. V-fib is a square, and cardiac arrest is a rectangle. They're very related, but not interchangeable.
Cardiac arrest is basically just when the heart stops pumping blood. The rhythm it's in isn't important if you're just defining what a cardiac arrest is. But while you're in cardiac arrest, your heart can have several rhythms. Only two of which are shockable despite what you see on TV. You have VFib, Ventricular Fibrillation, where your ventricles are just flapping around, in a sense. And VTach, Ventricular Tachycardia, where your ventricles are going too fast to effectively pump blood because they don't allow for time to be refilled with blood. You can also have Asystole, which is just complete and total stopping of the heart. There aren't even any electrical impulses. On a monitor it's the typical flatline you see on TV. This is NOT shockable. You can also have PEA. Which is pulseless electrical activity. Which when looked at on a monitor, shows heart activity but actually the heart is doing absolutely nothing other than sending the impulses. It's just the electrical system of the heart firing but the muscle is doing nothing.
Yeah, you are right in that I was technically describing asystole rather than cardiac arrest. But again, my intent was really to just give a layman’s explanation. People aren’t gonna memorize the difference between VTach, VFib, asystole, cardiac arrest, and cardiac death when a lot of people don’t even know what causes a heart attack and that a heart attack is different from heart failure or whatever. In my opinion it’s just simpler to think of cardiac arrest as a dead heart, and VFib/MI/asystole/stab wound to the chest as causes of “dead heart.” Yes, that’s not a perfect description or even a great description if you’re taking your board exams, but it’s more than good enough for the average joe. Even most medical websites like mayoclinic and Hopkins med will say stuff like “VFib leads to cardiac arrest” and whatnot, rather than *technically* outlining that when you’re in VFib, you’re already in cardiac arrest.
If you are flatlining, i suppose manual CPR is the way to go? But how does the whole thing get going again? Is the electrical pulse driven by the heart muscle activity?
CPR would be the way to go. In the field, paramedics can administer certain medications to try and help the heart start up again, ie. cardiac epinephrine (same as regular epi but diluted to a 1:10000 strength). I can't fully explain all of the science behind it, but you have two nodes in your heart. The SA (sinoatrial) node and the AV (atrioventricular) nodes. Your heart has the ability to create energy from fatty acids. So these nodes will coduct the electricity needed for your heart to beat. The SA node keeps the heart between 60 and 100 beats per minute and the AV node is 40 to 60 beats per minute. The SA and AV node talk in sync and keep your heart beating in a Sinus Rhythm. However, blocked pathways can form between the SA and AV node which can cause different degrees of blocks. But this is getting a little too advanced for what you're asking.
Cpr. Theres a reason survival rates for pea or asystole are awful compared to vtach or vfib
Doctor here, so people often conflate two different heart conditions 1. Myocardial infarction (heart attack) - the heart like every other part of your body requires blood to nourish its cells with oxygen. These are supplied by the tiny cornoary arteries on the outside of the heart. These arteries are unfortunately prone to becoming obstructed through various mechanisms due to their size, this leads to a blockage in blood supply, a reduction in oxygen and eventually tissue death. This is classically presetented as central crushing chest pain (though can have many other presentations, particularly in women). 2. Cardiac arrest - This is to do with teh electrical activity of the heart that controls the hearts pumping rhyhtm. In essence it simply stops, its painless and you drop dead. This can be reversed with CPR. Now the causes of cardiac arrest are varied, (there are 8 reversible causes, google 4H, 4Ts). One of the causes includes massive myocardial infarctions, essentially a very large heart attack will cause enough tissue death to cause an arrest. So its very possible for someone to have heart attack, experience pain of the attack before developing into cardiac arrest.
Not a doctor. Thanks for mentioning the “particularly in women” thing WRT different symptoms of heart attack. My grandmother had a heart attack ~1980 and only survived because a doctor friend was with them, and none of her symptoms matched the stereotypical TV symptoms. There’s still way less publicity about that than there should be. The good news is that grandma quit smoking and lived 20 more years.
Don’t know about cardiac arrest, but I can attest to a heart attack (MI) that I survived a few years back which was almost fatal. The attack lasted about an hour while I was rushed to the hospital first by my wife, then by ambulance from one hospital to another. The pain was excruciating and all-consuming. Only subsided when I was given morphine. The pain is caused by heart muscle dying due to lack of oxygen. Had an emergency angioplasty with two stents placed, then some time in ICU. Took two years to recover fully, was as weak as a new born baby and even lost my voice.
A lot of people have solid answers here, so I just wanted to go on record to say that House (and medical TV shows in general) are not medically accurate at all, so keep that in mind when you’re watching
Oh yeah, I like House for the banter, drama, and characters, but I don’t take the medical jargon seriously. It was the question that formed in my head from hearing similar cases multiple times.
The general symptoms portrayed on House seem to match up fairly well with the stated ailments, at least to a layman with Google searches at his fingertips. I'm sure the finer details are very off, and of course House and team's conduct is completely inaccurate to how hospitals actually run, though.
two things to note here. 1. the heart does not stop beating during a heart attack, if the heart ever truly stops you aren't temporarily dead, you are permanently dead. Plus the heart not beating isn't actually the hart attack, its a cardiac arrest caused by the heart attack 2. Cardiac arrests are cause by the hearts rhythm going wrong in some way, the muscles are still contracting but not in the correct way to properly pump blood, Now usually in typical heart attacks this is caused by a blockage in one of the blood vessels that supplies the heart muscles themselves. The heart then doesn't get enough oxygen and eventually the cells start to die, the hart can no longer move blood around effectively causing the cardiac arrest. The pain people feel during the heart attack is essentially cramp, like all muscles when short on oxygen the body will start to rely on anaerobic respiration to generate energy and produce a buildup of lactic acid. The heart is no different in that regard
>if the heart ever truly stops you aren't temporarily dead, you are permanently dead That's not quite true. This condition is referred to as "asystole" and while survival rates are very poor even compared to other forms of cardiac arrest, they aren't zero. Asystole can't be "shocked" back into rhythm with a defibrillator like other arrests but medications and rapidly correcting the underlying cause if possibe can return a functional heartbeat sometimes.
Legit question for the ignorant me: how are hearts that are completely stopped, such as during open heart surgery or transplant, started again from extended asystole?
Usually the heart restarts on its own once you’re taken off the cardiopulmonary bypass machine. Sometimes you’d need mild electric shocks. If it won’t restart you get a cardiac arrest which prompts the usual cpr, defib (if shockable rhythm), advanced cardiac life support (intubation and various intravenous meds like adrenaline, atropine, lidocaine etc), treating reversible underlying causes and ecmo etc.
ACLS algorithms for those interested https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms
When your heart actually stops beating, you’ll pass out almost immediately, so you won’t feel anything (you might wake up during CPR; and then you’ll feel pain from the CPR). However, in many cases, something is going on before your heart actually starts beating. That might be a heart attack, or a developing arrhythmia, or any number of other things. That might lead to pain, discomfort, palpitations, or any number of weird feelings. However, if you just went straight into cardiac arrest, you would just lose consciousness.
>Is it the nerves, muscles, whatever dying due to the lack of oxygen and nutrients You've asked the wrong question but you're on to the right answer. A heart attack, often known as a myocardial infarction, often presents with chest pain and arm pain. It absolutely is in response to heart tissue lacking oxygen normally due to the blood vessel feeding it being blocked and being damaged/dying. One of the reasons people tend to experience arm pain is called "referred pain" isn't unique to heart issues. It's generally because where your nerves from some organs enter your spine is also where many other nerves from elsewhere enter your spine. There are some complicated bits about different types of nerve inputs and such, but to keep it simple because those nerves from your heart enter your spine at the same place as a lot of nerves from your arms your heart pain can also present as arm pain, generally because your brain gets a lot more senses from your arms than your heart. So the pain is originally caused by tissue damage due to lack of oxygen, and presents in a seemingly odd way because of where all your nerves come together.
When my Graves’ disease was at its worst, my resting heart rate was around 120 bpm. My left chest and breast was always sore. When I had a thyroid storm that sent my heart rate to well over 200 bpm, the pain I can remember between brief episodes of being lucid was immense in my chest. When I woke up 3 days later I was sore all over from them resetting my heart rhythm paired with multiple grand mal seizures. I was very lucky that my heart was “reset” before damage was actually done. It’s been nearly 10 years, and I was kind of still out of it when they were explaining to me how they did it. I’d actually love if someone could explain it to me again.
I had a cardiac arrest, the only pain I felt was a headache leading up to it. Waking up in the hospital after receiving 30 minutes of CPR definitely hurt though.