Cardiac Arrest: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate cardiac arrest:

Leading symptoms

  • Respiratory arrest
  • Unconsciousness
  • Drop in blood pressure
  • Pulselessness
  • Pale skin, bluish lips
  • Wide non-reactive pupils

Prodromal symptoms (precursor symptoms)

One in two patients had precursor symptoms four weeks earlier (in half, in the days before the event; 93% also had symptoms the day before their sudden cardiac arrest), suggesting transient cardiac dysfunction:

  • Thoracic pain (chest pain); usually in the form of intermittent angina (“chest tightness”; sudden onset of pain in the cardiac region)
  • Dyspnea (shortness of breath)
  • Vertigo (dizziness)
  • Syncope (momentary loss of consciousness)
  • Palpitations (heart actions perceived by the affected person himself as unusually fast, forceful or irregular).

Men were more likely to complain of chest pain (chest pain), and women were significantly more likely to experience dyspnea (shortness of breath).

Caution. Underlying disease in most cases is coronary artery disease (CAD).

Note: More than one-sixth of all out-of-hospital sudden cardiac deaths (OHCA) could be attributed to drug overdose according to a prospective cohort study: Opioids (68.4% and 48.1%), sedative-hypnotics (49.4% and 51.9%), and stimulants (48.1% and 51.9%) were most commonly detected in the blood.

Sure Signs of Death

Notice: Neither lack of pulse nor lack of respiration is a sure sign of death. This also applies to the zero line on the ECG (= unsafe sign of death).

Safe signs of death are:

  • Early changes
    • Death spots (livor mortis) – The first death spots appear about 20-30 minutes after circulatory arrest.
    • Rigor mortis (Rigor mortis; rigor mortis) – Rigor mortis occurs sequentially according to the Nysten rule:
      • After about 1-2 hours on the eyelids,
      • After 1-2 hours on jaw / chewing muscles small joints.
      • Neck/neck
      • Upper extremity
      • Lower extremity
      • At room temperature, rigor mortis is fully developed after about 6-12 hours (faster in heat, slower in cold).
    • Injuries incompatible with life (eg, separation of head and torso).
  • Late changes
    • Putrefaction (synonyms: putrescence, putrefaction) onset of decay: discoloration, odor change and liquefaction) and putrefaction.
    • Colonization of most of the body by fly and beetle maggots, ants, etc.
    • Adipocire (= corpse or fat wax formation in the absence of air).
    • Mummification of the body (eg, dry environment).

To narrow down the time of death, it is necessary to determine the core body temperature and the ambient temperature.

Note: If there are no definite signs of death, immediate resuscitation must be started!