Surviving Sudden Cardiac Arrest

Did you survive Cardiac Arrest?

With advanced technology and medicine more people are surviving episodes of cardiac arrest.  Each month, 10,000 people, including children, have a defibrillator implanted to restore normal heart rhythm and prevent sudden cardiac death. For many survivors and their families, leaving the hospital after experiencing a sudden cardiac arrest can be an unsettling experience.  Patient experiences with surviving cardiac arrest  can be quite different. There are some factors that should be addressed.

One is the chest wall soreness. If you had CPR performed on you it is a brutal assault to the chest wall. Between each layer of ribs is a layer called costal cartilage. This cartilage has a very poor blood supply and when the cartilage is inflamed or injured – such as during CPR it can take a long time to heal. Many patients are concerned as it can be hard to distinguish between heart pain and chest wall pain. A few ways of determining is chest wall pain has a very specific location, often you can point to the location where it hurts. This pain doesn’t travel. It can be brought on by specific movements, a stretch or a compression, where heart pains are more likely to come on with a physical or emotional stress, such as brisk exercise, and lessen when the activity is stopped. It is always recommended you discuss any concerns about chest discomfort with your healthcare practitioner.

Memory: 

Survivors also commonly deal with memory loss or delayed recall. Forgetfulness and/or a reduced ability to comprehend or problem-solve can lead to increased stress, anxiety, anger anddepression.

Medical Care :

  • external defibrillator – a vest worn for approximately 3 months which can deliver shocks when appropriate
  •  internal defibrillator these have their issues including inappropriate shocks, or not shocking when should due to lead issues. They also require batteries to be changed approximately every 5 years.
  •  AED   Some choose to simply have an AED around them at all times, of course you need to have people trained to use it, unless you are James Bond
  •  Ablation The irritable nerves are burned out of the heart, this sometimes requires a permanent pacemaker placed
  •  medications to lessen the chances or arrhythmia

Emotional:

Responses, coping, support, are each critical. Every persons responds differently. Some are extremely grateful and feel like each day is a bonus. Others live in a state of Post traumatic stress and are waiting and fearful for the next arrest to occur. Because depression, anxiety and post-traumatic stress disorder are common among people with implanted cardioverter defibrillators, healthcare providers should provide gender- and age-specific information on the potential psychological impact. Unfortunately these are areas that are rarely addressed or well comprehended by patients, who are in a state of emotional shock already from their recent health event and need time to process it all.

I recommend joining a support group or talking with a therapist to help cope with this. Below is a link to the Sudden Cardiac Arrest Association  and Sudden Cardiac Arrest Foundation which I think are some of the best support groups out there.  These include discussion forums, reflections, survivor stories. I have worked with many patients who have survived sudden cardiac arrest. Each has a unique story to tell, some are good and some are horrifying. A listening ear is one thing, but to get support from others who are living it is probably the best support one can get.

http://www.inspire.com/groups/sudden-cardiac-arrest-association/

http://www.sca-aware.org/about-the-sudden-cardiac-arrest-foundation

Support the Sudden Cardiac Arrest causes

https://www.facebook.com/thehbproject

   

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ICD’s: Resources, Decision Making, and What to Know

An ICD is an implantable cardiac defibrillator. They are used for people who are high risk sudden cardiac death due to heart arrhythmias  of  ventricular tachycardia or ventricular fibrillation. They are often implanted as a preventative measure when the heart has a poor pumping ability as this makes one prone to arrhythmias. If the ejection fraction (pumping ability) is 30% or less and doesn’t show signs of improving your healthcare provider may consider implanting one.

Special care should be placed not to put excessive strain on the shoulder, arm and torso area where the ICD is implanted. Doing so may damage the ICD or the leads going from the unit to the patient’s heart. For this reason strength training with heavy repetitive weights is often discouraged. The exercises which would potentially damage the leads involves exercises with the arms overhead, such as a Military or shoulder press, seated fly’s,overhead triceps press. By heavy weights we are talking about weights upwards of 100 lbs or more with repeated repetitions and multiple sets. The wiring goes under the first rib, repeated bending and stress to the wires in this area can damage the leads. If your work involves this type of activity be sure to discuss this first with your cardiologist.

Exercise Advice:

  • Exercise with a friend or family member who is familiar with your condition and knows what to do in the event of an emergency.
  • If you exercise at high intensities, you should make sure you have a specific guideline from your cardiologist about your heart rate range. If the heart rate is too high the ICD may sense it as Ventricular Tachycardia. Wearing a heart rate monitor can help you to watch your heart rate range and avoid exercises that spike the heart rate up into the threshold in which the defibrillator is programmed to respond. Your Cardiologist can adjust your ICD settings to recognize the difference between a normal increase in heart rate from exercise and that associated with an abnormal heart rate or rhythm. You should include a low-level 5 to 10 minute warm-up and cool-down phase for aerobic exercise (i.e., walking, cycling) to allow for a slow and steady increase in heart rate.
  • The ICD can be affected by magnetic or electrical fields. You should avoid this and opt for something simpler such as the sum of skinfolds. Heart rate monitors are unlikely to cause any problems in the gym setting. Avoid Bio electric Impedance devices which are used to measure body fat.
Decision Making:
I came across a New York Times article “A Heart Quandry”  recently with the following information. It is something to consider for anyone with an ICD.         http://newoldage.blogs.nytimes.com/2012/06/07/a-heart-quandary/

Going against strong headwinds in his own community of heart specialists, Dr. Kramer emphasizes three important issues that come about when older patients with ICDs face battery depletion.

First, he asks heart doctors to re-evaluate whether the patient still benefits from the ICD. Perhaps, the original heart problem has improved?

Second, he points out that a patient’s experience living with the device may have changed their mind about keeping it active. Perhaps, a patient with inappropriate shocks no longer wants the device?

Third, since the original implant, a patient may have changed their goals of care. Many patients no longer desire life-sustaining shocks—for whatever reason. It’s their choice; but they aren’t often asked.

You may wonder why such obviousness isn’t the norm?

It’s because our healthcare system imparts significant barriers. Dr. Kramer nicely explains two important hurdles. One is that healthcare in the US is fragmented, especially for the infirmed and elderly. Patients may have many doctors, and care is often not well-coordinated. This means, an installer, a proceduralist like me, is left discussing end-of-life care with patients immediately before ICD surgery. That’s not good. I am married to a hospice doctor, so I sort of know how to manage these conversations. This is not the norm for procedure-oriented heart doctors. The other barrier to getting the elderly the best care is our system’s misguided incentives. In our current fee-for-service system, I am rewarded for doing, not discussing not doing. In fact, not doing stuff is very risky—both legally and professionally (ie. loss of referrals.)

Finally, Dr. Kramer and his colleagues call for heart doctors to take the lead in starting “the conversation” with ICD patients. He wants us to share the decision of using invasive, potentially dangerous or ineffective care with the patient. He also asks the scientific community to study the outcomes of patients who undergo elective ICD generator changes. These should not be controversial recommendations.

It’s a huge mistake to equate this kind of smart thinking to rationing. Aligning evidence-based care, especially potentially burdensome surgery in elderly patients, with the goals of the patient is not rationing.  It’s moral, ethical and obvious.

Resources:

There are issues with ICD that patients struggle with. These include the comfort of the ICD, the cosmetic appearance,the stress of having it fire, frequency of battery replacement, leads wearing out, and it working appropriately. I have included a few great resources to help you in living with an ICD.

Sudden Cardiac Arrest Association                     http://www.suddencardiacarrest.org/aws/SCAA/pt/sp/home_page

Powered by Inspire      https://www.inspire.com/groups/sudden-cardiac-arrest-association/topics/living-with-an-icd/

Boston Scientific       http://www.bostonscientific.com/lifebeat-online/live/icd-patients.html