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Answers of FAQ

1. What is Sudden Cardiac Arrest (SCA)?
(SCA) is a condition in which the heartbeat stops abruptly and unexpectedly. This usually is caused by ventricular fibrillation (VF), an abnormality in the heart's electrical system. When this happens, blood stops flowing to the brain the heart and the rest of the body, and the person collapses. Early emergency treatment with cardiopulmonary resuscitation (CPR) or an automated external defibrillator (AED) can help restart a stopped heart and allow the return of a normal heartbeat to help prevent sudden cardiac death (SCD). 

2. Is SCA the same as a “heart attack”?
No. People often use these terms interchangeably, but they are not synonyms. A heart attack is when blood flow to the heart is blocked, and sudden cardiac arrest is when the heart malfunctions and suddenly stops beating unexpectedly. A heart attack is a “circulation” problem and sudden cardiac arrest is an “electrical” problem. 

3. What causes SCA in young people?
There are three common causes:

1) Long QT syndrome is an often unrecognized congenital condition that predisposes the child to an abnormality in the heart's electrical system, which can lead to SCA. This is a genetic disease that affects 1 in 7,000 young people. Episodes are most commonly triggered by physical exertion or emotional stress;

2) Commotiocordis is an electrical disturbance cases by a blow to the chest. It occurs most often in baseball, but has been reported in other sports and situations in which there is a blow to the chest. Researchers at the U.S. Commotiocordis Registry studied 124 cases and found the average age is 14. Only 18 victims (14%) survived; most who survived received prompt CPR and defibrillation; and

3) Hypertrophic cardiomyopathy is a congenital heart muscle disease. The walls of the heart's left ventricle become abnormally thickened (hypertrophy). The structural abnormality can lead to obstruction of blood flow from the heart, causing loss of consciousness and irregular heartbeat, leading to SCA. About 1 in 500 to 1000 young people have this condition.

4. Who is at risk for SCA?
Everyone is at risk for SCA, however, it occurs more frequently in males than females, and, in children, most commonly occurs between 10-19 years of age. Still, it’s important to note that SCA may occur in children of all ages, even infants.

Some other risk factors include:

 •Athletic activity: Two-thirds of the deaths caused by SCA in children occur during exercise or activity. SCA is the leading cause of death in young athletes, accounting for 75 percent of all athlete-related deaths; 

 • Known congenital heart disease or structural heart abnormalities; 

 • Known abnormal heart rhythms associated with congenital heart disease. Most commonly, these include ventricular arrhythmias or atrial arrhythmias, especially the post-operative state or in the presence of a weakened heart; 

 • Known abnormal heart rhythms that are very rapid, even with a normal heart. For example, rapid ventricular tachycardia or atrial fibrillation with a rapid ventricular response. 
 • Undiagnosed cardiac conditions, especially those known to be associated with sudden cardiac arrest; • Obesity and hypertension; 
 • Exposure to drugs, medications, toxins and infectious, agents, including cocaine, inhalants, recreational or club drugs, and some prescription medications; 

 • Sudden blow to the chest directly over the heart (commotiocordis); 

 • Family history of: 
    *Known heart abnormalities 
    *Sudden death before 50 years of age 
    *Conditions known to cause SCA, such as long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia (CPVT), hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC) or other familial cardiomyopathies 
    *Unexplained fainting or seizures 

 If you have a family history of any of these conditions, immediate family members should be checked out for those conditions known to be inherited or caused by a genetic mutation. This can help you identify a condition early and possibly prevent SCA or SCD.  

5. What are the warning signs/symptoms of SCA?
Warning signs and symptoms do exist in 30-50 percent of cases of SCA/SCD, but are often ignored or misunderstood.

If your child has any of the warning signs or symptoms of SCA, make an immediate appointment with your pediatrician or take your child to the ER if they appear distressed in any way.

Warning signs and symptoms may include:

• Exercise related chest pain or discomfort; • Unexplained fainting (syncope) or near fainting, especially with or just after activity;

• Repeated episodes of unexplained fainting (syncope); • History of recurrent fainting or unusual seizures/seizure-like activity, especially with or just after activity;

• Dizziness or lightheadedness; • Racing heart rate, palpitations; • Excessive fatigue or unexplained shortness of breath with exercise;

• Recent viral infection with chest pain or change in exercise tolerance; • History of a heart murmur whose cause has not been determined with certainty; • History of high blood pressure;

• Prior evaluation or treatment for a cardiac condition; and • Restriction from activity because of a cardiac issue.

In more than half of the cases of SCA in children, death was completely unexpected. Young people are often unaware of the risk factors and don’t tell adults when they experience the symptoms. 

They may be frightened, embarrassed or simply unaware that what they are feeling indicates a potentially fatal problem. Educating parents, children and teenagers about the symptoms and risk factors of SCA is one way to help prevent it.

6. How can you prevent SCA?
Primary prevention includes evaluation of those with warning signs and symptoms or a positive family history. Identifying a heart condition or other risk factors allows for early intervention with medication, lifestyle alterations, and defibrillation devices.

Heart Screenings reduce the risk of sudden cardiac arrest by identifying young people with potentially serious heart problems that had not been previously diagnosed, and then provide them with heart health education as well as recommendations for clinical evaluation and follow-up. 

7. How should SCA be treated? 
SCA requires immediate attention. If your child suddenly collapses and does not immediately awaken, call 911 and start CPR. If an AED is available, it should be applied. The best chance of SCA survival is prompt recognition, and a planned emergency response with CPR and AED use. If sudden cardiac arrest is not treated within minutes to establish a normal heart rhythm, a person will die. The heart is either quivering or has stopped completely, and cannot pump blood effectively. Blood flow to the brain and body stops, death will result if life-sustaining care is not provided. 

8. What role does CPR play in an SCA event?
CPR manually pumps blood around the body and maintains the circulation, allowing blood with oxygen to reach the body organs and brain, until a normal heart beat can be restored. Hands-only CPR is most effective when performed right after the collapse and when an AED is also applied quickly. CPR should continue until emergency medical services (EMS) arrives and takes over, unless the affected person has a return of normal circulation (either spontaneously or after AED shock) and is awake (moving/breathing), alert and talking. Rescue breathing as part of CPR is recommended to be used by trained health professionals.

9. How does an Automatic External Defibrillator (AED) work?
A computer inside the defibrillator analyzes the victim's heart rhythm. The device decides whether a shock is needed. Some devices shock the victim automatically if a shock is needed. Other devices require that the operator press a button to deliver the shock. The shock is delivered through pads stuck to the victim's bare chest. The shock stuns the heart, stopping abnormal heart activity, and allowing a normal heart rhythm to resume. 

10. Who can use an AED?
Most AEDs are designed for use by non-medical personnel such as police, flight attendants, security guards, and other lay rescuers who have been properly trained. Having more people in the community who can respond to a medical emergency by providing defibrillation will greatly increase sudden cardiac arrest survival rates.

11. Where should AED's be placed?
Logical locations for AED placement include police cars, airports, train and bus stations, highway rest stops, sports arenas, doctor and dentist offices, health clinics and fitness clubs. They can also be placed at shopping malls, large grocery stores, theatres, workplaces, schools, churches and retirement communities. Increasingly, consumers are choosing to purchase AEDs for their homes and vehicles. All locations frequented by the general public should have an accessible AED. Source 1

12. What is the Chain of Survival?
The chain of survival concept represents the sequence of five events that must occur quickly to optimize a person's chance of surviving a cardiac arrest. 

The five links of the chain:

1. Immediate recognition of cardiac arrest and activation of the emergency response system;
2. Early cardiopulmonary resuscitation (CPR) with emphasis on chest compressions;
3. Rapid defibrillation using an AED can establish a normal heart rhythm to a person suffering a cardiac arrest. It is most effective when it is performed in the first few minutes of a cardiac arrest;
4. Effective advanced life support; and
5. Integrated post-cardiac arrest care.

1. Parent Heart Watch 2. American Heart Association 3. 4. Children’s Hospital of Philadelphia

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