Circulatory arrest or cardiovascular failure can have various causes. Decisive for a good prognosis in circulatory arrest is, above all, rapid intervention.
What is circulatory arrest?
In medicine, the failure of the cardiovascular system in an affected person is called circulatory arrest. If such cardiovascular failure occurs, it is often also defined as clinical death. Circulatory arrest can take several forms. For example, ventricular fibrillation may be present in a circulatory arrest; in this case, the various heart muscle cells do not work in a coordinated manner, so that the heart cannot contract. Another possible form of cardiovascular failure is that the heart beats too fast to be able to fill itself sufficiently with blood between heartbeats. In addition, circulatory failure may be characterized by the fact that although electrical nerve impulses are measurable at the heart, they cannot cause the heart to work. Signs that may indicate circulatory arrest with a high degree of certainty include respiratory arrest, gasping for breath, or even a lack of pulse from major arteries.
Causes
The most common cause of circulatory arrest in people in industrialized nations is sudden cardiac death. Such sudden cardiac death as a cause of cardiovascular failure may occur, for example, as a result of a myocardial infarction. In rarer cases, circulatory arrest may also be due to so-called non-cardiac causes (i.e., causes not related to the heart): Such causes of cardiovascular failure include, for example, respiratory arrest or pulmonary edema (i.e., causes originating in the respiratory tract). Various impairments affecting the brain can also lead to circulatory arrest; for example, a stroke suffered or a traumatic brain injury can result in circulatory arrest. Last but not least, other incidents can also lead to cardiovascular failure; such as electrical accidents or shocks suffered.
Symptoms, complaints, and signs
Circulatory arrest announces itself by pallor, cold sweat, and lightheadedness. Shortly before circulatory arrest, victims are often nervous and anxious. If a heart attack or cardiac arrhythmia is the underlying cause, the typical symptoms of the respective cause appear. Thus, there may be a stabbing of the heart, a feeling of tightness in the chest, dizziness, stiffness of the neck, and a variety of other signs that, taken alone, do not necessarily indicate an impending cardiovascular arrest, but in combination are a clear warning sign. The actual collapse is manifested by the affected person becoming unconscious and unresponsive. Typically, no breathing sound is heard at the mouth and nose anymore. In parallel, the blood pressure drops and the heart stops beating. At this stage, a flatline can already be detected in the ECG. The patient’s life is in acute danger and brain death is imminent. With early treatment using cardiac muscle massage, a pulse can be restored in the best case. However, circulatory arrest has severe after-effects such as confusion, physical and mental exhaustion, and panic attacks. It is not uncommon for a circulatory arrest that has been overcome to be followed by another, usually with more severe symptoms.
Diagnosis and course
With a fairly high degree of certainty, circulatory arrest can be diagnosed when an affected person presents with symptoms such as respiratory failure or pulselessness affecting the major arteries. Symptoms that may indicate circulatory arrest but may also be the result of other conditions include loss of consciousness, onset of convulsions, or dilated pupils that are fixed in light. The course that cardiovascular failure takes in individual cases initially depends to a large extent on how quickly appropriate measures are taken. In principle, cardiovascular failure is reversible, which means that a patient can be resuscitated. Whether such resuscitation is successful and what consequential damage can occur (such as brain damage due to oxygen deficiency) can depend in particular on the immediate measures taken, such as ventilation or cardiac massage by laypersons until the arrival of an emergency physician.If medical intervention is not timely, cardiovascular failure can be fatal.
Complications
Various complications may occur as a result of circulatory arrest. In the acute phase, hyperventilation initially occurs and, subsequently, cardiac distress, convulsions, and gulping of air often occur. Rarely, the gasping breath causes the tongue to be swallowed, but this can then result in asphyxiation. Circulatory arrest can also lead to falls and accidents. This can result, for example, in fractures, contusions or the most serious injuries, which are usually associated with further complications. If treatment for cardiovascular failure is delayed, the lack of oxygen can cause irreversible organ damage. The first organ to be affected is the brain, which suffers severe damage after only a few minutes without oxygen supply and eventually suffers brain death. If treated incorrectly or too late, circulatory arrest can lead to death. In addition, drugs used with epinephrine, lidocaine or amiodarone can cause corresponding side effects and interactions. In the long term, circulatory arrest often results in cardiac insufficiency. Affected persons subsequently have to wear a pacemaker and take medication for the rest of their lives. In addition to the physical consequences, this can also lead to psychological discomfort and a general decline in quality of life.
When should you see a doctor?
If a person becomes unconscious, the emergency physician must be called. Sudden drop in blood pressure and sweating may be the first signs of impending circulatory arrest. If these symptoms are noticed, do not wait to seek medical attention. Cramps or dilated pupils also require examination and treatment. At the latest, if gasping, neurological disorders or cardiac arrhythmias are noticed, this must be clarified. People who have already suffered cardiovascular failure or respiratory arrest are among the risk groups. Likewise, people with a history of pulmonary edema or another condition that could cause circulatory arrest. If cardiovascular failure occurs in conjunction with a stroke or traumatic brain injury, emergency medical services should also be called. Further therapy takes place in a general clinic or in a specialist center for cardiovascular diseases. Possible contacts are the family doctor, a cardiologist or an internist. Children and adolescents should be taken to a pediatrician when the aforementioned complaints occur, who can make a diagnosis and prepare further therapy.
Treatment and therapy
Circulatory arrest is always considered a medical emergency. An important immediate measure for cardiovascular failure is first immediate cardiopulmonary resuscitation to save a victim’s life. Although first aid measures such as cardiac massage can be successful in the short term in the event of circulatory arrest, rapid further medical measures are often also necessary, such as defibrillation or the administration of medication. Defibrillation describes a treatment method in which an affected person receives electric shocks to stimulate the heart’s activity. Defibrillation can be used, for example, for cardiovascular failure caused by ventricular fibrillation or ventricular flutter – in other words, for various forms of cardiac-related cardiovascular failure. The administration of medication in the event of cardiovascular failure may be necessary, for example, if cardiovascular failure is caused by an accelerated heartbeat, an impaired pacemaker or other causes that do not originate in the heart. Defibrillation is usually an ineffective measure for medical treatment of cardiovascular failure in the latter cases.
Outlook and prognosis
Cardiovascular arrest is a medical emergency. The affected person is in acute danger of death and must be treated immediately by an emergency physician. If the necessary resuscitation measures are initiated immediately, there is a relatively high chance of recovery. The chances of survival also depend on the cause of the circulatory arrest and the patient’s constitution. According to the German Resuscitation Register, around 10 to 15 percent of those affected survive a circulatory arrest.The association also states that immediate resuscitation measures can double to triple patients’ chances of survival. In the long term, about 75 percent of all survivors are able to return to work after circulatory arrest. In the first few months, accompanying symptoms such as exhaustion and circulatory problems occur, which can significantly reduce well-being and quality of life. Comprehensive medical monitoring is necessary in any case. The prognosis can be improved by strictly adhering to the doctor’s instructions regarding diet, exercise and so on. Then, if necessary, even a complete recovery is possible. The prognosis after circulatory arrest thus depends on various factors, but is in principle relatively good, insofar as the affected person survives the actual circulatory arrest.
Prevention
To prevent circulatory arrest, it is generally important above all to prevent the various possible causes of circulatory arrest. For example, cardiac arrhythmias, myocardial infarction and stroke as causes of circulatory arrest are mainly favored by obesity and high blood pressure. The latter factors can be prevented, for example, by regular exercise, a balanced diet, and a conscious approach to nicotine and alcohol.
Aftercare
In the case of circulatory arrest, there are usually no special aftercare options available to those affected. At the same time, circulatory arrest also leads to death in most cases if it is not detected in time. Therefore, a doctor should be consulted at the first signs or symptoms of this complaint to prevent this complication from occurring. An emergency physician should be called immediately or a hospital should be visited directly so that the affected person can receive emergency care. Further measures of aftercare are usually not available to the patient. Since circulatory arrest in many cases leads to the death of the patient, the parents, family or other relatives are dependent on psychological support and counseling. In this case, loving conversations and intensive care for those affected have a very positive effect on the further course of these complaints. Depression or other psychological upsets can also be prevented as a result. If the circulatory arrest is treated, the affected person should take care of his heart after the treatment and not expose himself to stressful or physical activities, as these would unnecessarily stress the heart.
Here’s what you can do yourself
Circulatory arrest is a life-threatening situation in which every second counts. Relatives or first responders should first immediately alert the emergency physician. First aid measures must be administered until medical help arrives. It is very important not to lay the victim down, but to keep the upper part of the body upright to relieve the pressure on the heart. Tight clothing should also be loosened so that the victim can breathe. Resuscitation measures must then be started immediately. If available, a defibrillator can be used. Otherwise, cardiac massage or mouth-mouth/nose resuscitation must be performed. If the patient is conscious, he or she must be calmed and stress and excitement avoided until the emergency physician arrives. The patient will then have to spend several days in hospital. First and foremost, rest and bed rest are indicated. As soon as the cause of the circulatory arrest is known, therapeutic measures can be started. In general, light exercise such as physiotherapy or yoga, dietary measures and the avoidance of stress are recommended. In short: a healthy and conscious lifestyle. Additional support from relatives can help to consistently follow the new lifestyle habits and avoid another circulatory arrest.
