Dr. John Day, Cardiologist

Podcast: Play in new window | Download

Subscribe: RSS

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.