#136 The 6 Warning Symptoms Before a Cardiac Arrest

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The 6 Warning Symptoms Before a Cardiac Arrest

Cardiac arrests are the number one killer in the U.S.  Each year up to 550,000 Americans will suffer a cardiac arrest.  Only 7% will survive and even less will be lucky enough to survive without permanent brain damage.  What are the warning symptoms before a cardiac arrest?

A new study released this week showed that most people who die suddenly had symptoms up to a month prior to their cardiac arrest.  These warning symptoms before a cardiac arrest were generally ignored by either the victim or their doctor.

In this article, I will share with you the 6 warning symptoms before a cardiac arrest so that you can protect yourself and loved ones from tragically having your life cut short.

A Typical Cardiac Arrest Story

“Looking back, there were warning symptoms before the cardiac arrest,” Kristin’s husband said.

“What were these symptoms?” I asked as we spoke at Kristin’s bedside in the intensive care unit.  Kristin was still in a coma and on a breathing machine.

“I remember her telling me that she had a hard time breathing and felt as if she was going to pass out.  The same thing happened with her father before he died suddenly.  I took her to the doctor and he didn’t think much of it.  He thought she was dehydrated and was maybe coming down with the flu.”

“Then what happened?”  I asked.

“Later that night as she was putting our kids to bed she told me that she didn’t feel right.  Just then she fell to the floor unconscious.  Our oldest child called 911 as I started CPR.”

Kristin’s husband had to stop as tears were streaming down his face.  He continued, “I’ll never forget the fear on my 4-year old’s face when she asked, ‘Is mommy going to die?'”

In the end, the paramedics arrived in time and shocked her heart back to normal rhythm.  Fortunately, she survived her cardiac arrest and eventually got out of the ICU.  Before going home, I performed an implantable defibrillator surgery for her so that this would not happen again.  However, despite beating the odds, Kristin was left with life-long short term memory challenges.

What is the difference between a cardiac arrest and a heart attack?

A cardiac arrest is complete electrical failure of the heart.  When this happens, cardiac arrest victims immediately pass out and cannot be aroused.  The heart is not beating at all and, unless the heart can be shocked back into rhythm fast, permanent brain damage or death will happen in minutes.  CPR can keep the victim “alive” a few extra minutes while waiting for the paramedics to arrive with a defibrillator.

Whereas a cardiac arrest is an “electrical problem” of the heart, a heart attack is a “plumbing problem.”  In other words, one of the arteries feeding blood to the heart suddenly plugs up and the heart muscle fed by the artery starves for blood and dies.  As portions of the heart muscle die with a heart attack, this can cause heart failure as the surviving muscle has to work harder to compensate.

Heart attack victims don’t usually lose consciousness.  For these people, time is also critical.  The faster the artery can be opened the less heart muscle dies.

The confusion is that heart attacks can trigger a cardiac arrest.  However, cardiac arrests often occur in people with absolutely no blockages in the arteries of their heart.

The Warning Symptoms Before a Cardiac Arrest Study

This past week a study was published on the warning symptoms before a cardiac arrest.  This study was published by my friend, Dr. Sumeet S. Chugh, from the Cedars-Sinai Medical Center, Heart Institute in Los Angeles, California.

In this study, Dr. Chugh and his colleagues carefully analyzed the medical records of 839 cardiac arrest victims from 16 Oregon hospitals.  Here is what they found:

1. The average age for a cardiac arrest was 52.

2. Warning symptoms before a cardiac arrest were often ignored by the victim or their doctor.

3. The main symptom for men was chest pain.

4. The main symptom for women was shortness of breath.

5. Most victims had a family history of heart problems or a heart condition themselves.

What are the warning symptoms before a cardiac arrest?

Here are the top 6 symptoms, in order, prior to a cardiac arrest from Dr. Chugh’s study.  As victims can have more than one symptom, these numbers add up to more than 100.

1. Chest pain prior to 46% of cardiac arrests.

2. Abdominal symptoms before 20% of cardiac arrests.

3. Shortness of breath at the time of 18% of cardiac arrests.

4. Flu-like symptoms preceding 10% of cardiac arrests.

5. Fainting prior to 5% of cardiac arrests.

6. Palpitations before 5% of cardiac arrests.

Making Sense of the Symptoms

The most difficult part of this study is how do you make sense of these symptoms?  Everyone gets a little chest pain, abdominal pain, shortness of breath, palpitations, or flu-like symptoms from time to time.  Do you dial 911 every time this happens?

In this study, a key thing to remember is that most cardiac arrest victims had a history of heart problems or a close family member with a heart condition.  Thus, if you fit either of these two categories then you need to pay more attention to these symptoms.  Also, other studies show that if you have an unhealthy lifestyle you are far more likely to suffer from a cardiac arrest.

New chest pain, shortness of breath, fainting, or palpitations should always be evaluated.  “Classic” cardiac chest pain is pain that happens with physical activity or mental stress and is relieved with rest.  In this study, the chest pain never went away prior to the cardiac arrest.

For women, the symptoms are more likely to be new shortness of breath, abdominal pain, or flu-like symptoms.  New abdominal discomfort or flu-like symptoms can be much more challenging in deciding whether or not to go into the emergency room.

Why Warning Symptoms Before a Cardiac Arrest Matter

One of the key take away messages of this study is that symptoms matter.  For example, if someone called 911 before the actual cardiac arrest, 32% of these people lived in this study.  However, if 911 was not called until the victim became unconscious, then only 6% of these people survived.

Thus, recognizing the symptoms of a cardiac arrest increased survival more than 5-fold!

81% of Cardiac Arrests are Totally Preventable

No one wants to die suddenly in front of family members.  This trauma could scar them for life.

Rather than watching for the warning symptoms before a cardiac arrest, a much better approach is to make the right lifestyle changes now so that a cardiac arrest never happens.

Fortunately, studies show that at least 81% of cardiac arrests are totally preventable by doing just 4 things.  In a study by my friend, Dr. Christine Albert at Harvard University, of 81,722 women, she identified 4 healthy lifestyles than can prevent 81% of cardiac arrests.

1. Don’t smoke.

2. Maintain a healthy weight.

3. Exercise 30 minutes a day.

4. Eat a diet high in fruit, vegetables, nuts, legumes, whole grains, and fish

Take Home Message

The take home message from this study is that a cardiac arrest can strike anyone, most people had warning symptoms before a cardiac arrest, and those that heeded their symptoms were 5 times more likely to survive.  I was pleased to see that this message was covered by the news reports of this study that I was interviewed for–However, not smoking, maintaining a healthy weight, daily exercise, and a healthy diet can prevent 81% of cardiac arrests!

If you have been diagnosed with a heart condition, have a family history of heart problems, or live an unhealthy lifestyle, you are at significant risk of a cardiac arrest.  For you, knowing what warning symptoms to look out for and changing your lifestyle is critically important.  Regardless of your age, it is never too late to change!

Please leave a comment below if you have had a loved one who has died suddenly or have made changes to decrease your risk of a cardiac arrest.  Also, please feel free to leave your questions about this article and I will do my best to answer every question.

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14 Comments
  1. Another excellent article! Question: Do the abdominal pain symptoms described occur immediately precede an arrest or can they occur on a random basis over time? Why I ask is because I’ve experienced random pain in the lower right quadrant the past two months. My PCP diagnosed a cracked rib on my lower right side last month. How much does an EKG lend itself to identifying cardiac arrest risk?

    • Hi Jim,

      Abdominal pain is a very difficult symptom to use in predicting a cardiac arrest. In the study, the abdominal pain was typically right before the cardiac arrest. If the abdominal pain is not getting better, I would suggest following up with your regular doctor or even a gastrointestinal specialist.

      EKG’s can sometimes predict a cardiac arrest. The most classic example of this would be a long QT interval on an EKG. Also, signs of “ischemia” or inadequate blood flow to the heart can also predict risk.

      Hope this helps!

      John

  2. I was diagnosed with atrial fibrillation in 2006 after collapsing in the street while running for a bus. Three ablations over the next two years helped for a time, but the fibrillation was always there, periodically, sometimes a bout of AF a few hours every couple of weeks. Then in September this year I was part of a support crew at the Lotoja bike race, with hundreds of athletes competing over a 205-mile course. It was inspirational, as I saw men in their sixties complete the demanding physical challenge. I decided there and then that I had imposed artificial limits on myself, so I immediately began stepping up my exercise, gradually at first, but never missing a day. I cut out as much sugar from my diet as possible, increased fruits and vegetables, nuts and grains, cut way back on red meat and increased fish consumption. My diet change is permanent, not a fad. I also moved bedtime 30-60 minutes earlier. In three months and a half months I dropped 12 Lbs and am now at my optimal weight. I have had only one very short bout of AF in that time, and it lasted only an hour instead of 6-10 hours every couple of weeks. I’m convinced the consistent exercise of 30 minutes daily and a good diet has made the difference. I read Dr. Day’s blog faithfully, and every week there is something in that blog to remind me I’m on the right course. Thanks for all the great advice!

    • Hi Mike,

      What an inspirational story! I have seen so many cases, just like the one you described, that has really convinced me that the most powerful treatment option we have for this condition is a healthy lifestyle!

      Keep up the great work and please continue to share your successes!!!

      John

  3. Thanks for yet another solid albeit very scary article!

    What exactly falls under the category of ‘heart problems’? Is atrial fibrillation, EF of 49% or cardiomyopathy considered heart problems?

    If I end up in the ER or at the doctor’s because of symptoms, how will I know that the possibility of an impending cardiac arrest has been considered and not that I am possibly dehydrated or ‘just’ coming down with the flu? I.e. what tests would one expect to have done at the doctor’s or ER?

    • Hi Lisa,

      Thank you so much for your question. Yes, this is a difficult question…when is something serious and when is something not serious…

      For starters, atrial fibrillation was one “heart problem” listed in this study that increased the risk of a cardiac arrest. However, other studies have shown that the highest risks of Afib are before it is treated. Once Afib is treated this risk goes way down.

      Certainly, there are new symptoms which should never be ignored in someone with a history of heart challenges–these are new chest discomfort, shortness of breath, palpitations (new palpitations different from what you have experienced with Afib), or fainting/near-fainting. The other symptoms in this study, like new abdominal pain or flu-like symptoms, are nearly impossible, even for a cardiologist, to link to an impending cardiac arrest.

      In my mind, the take home message of my blog article is that 81% of cardiac arrests are totally preventable according to other big medical studies if you can just do 4 things: don’t smoke, exercise daily, eat healthy, and maintain a healthy weight. The goal is to live as healthy as possible and not worry about a cardiac arrest–however, if new chest pain, shortness of breath, passing out/near fainting, or palpitations occur get these checked out.

      Hope this helps!

      John

  4. I think I read the article you were interviewed for this morning, though it was not nearly as complete and helpful as your own actual post. Guess they had to make room for advertising instead of adding your informative warnings and solutions. My problem with the warning symptoms is that I have one or more if them every day AND I’m already doing the suggestions. Guess I’ll just keep on keeping on, including my faithful aerobic efforts at the gym. My question: I’ve had three days of returned Afib this past week, for which I’ve taken a daily flecainide, 100mg, hoping it’s the holiday stresses and will ease off again. This time the flec is working , though makes me sleepy and a bit dizzy sometimes, so I am taking before bed. Seems to work for 24 hours.

    • Hi Maureen,

      The key with these symptoms is that they are new symptoms. Also, please see my previous reply to Lisa for more details on making sense of these symptoms.

      Yes, stress is a powerful trigger of Afib. One study showed that when people are feeling “stressed” there is a 5 times greater risk that they will go out of rhythm while feeling stressed.

      Flecainide taken as needed can be very helpful for people with just occasional episodes of Afib. If it is happening more frequently, most people do better on a regularly scheduled dose of flecainide. If flecainide is causing fatigue and dizziness then this is not the right medication for you.

      Hope this helps!

      John

  5. With regard to the aforementioned crucial criterion of healthy lifestyle, we’re hearing more and more about specific nutritional deficiencies in the population relative to things like Vitamin D and magnesium. Given that body electronics are heavily dependent upon adequate levels of specific minerals, and threatened by not only deficiencies but also imbalances (such as particularly a calcium-magnesium imbalance)–I wonder if anyone has ever researched the relationship between cardiac arrest and mineral imbalances/deficiencies. I know of cardiologists who prescribe specifically magnesium for various arrhythmias, and I’m wondering to what extent this might become a new avenue of not only research, but also common treatment.

    • Hi Joe,

      A great question. Yes, you are absolutely correct–there is a definitely link between nutritional deficiencies and heart issues. As you know, I have previously written blog articles on the importance of magnesium, vitamin D, etc. Personally, I often recommend magnesium for my heart patients. Increasingly, more and more cardiologists are recognizing nutritional deficiencies as a cause of heart problems.

      Best,

      John