Sudden Cardiac Arrest

What is sudden cardiac arrest (SCA)?

Sudden cardiac arrest (SCA) is a condition in which the heart suddenly stops beating. When that happens, blood stops flowing to the brain and other vital organs. If it is not treated, SCA usually causes death within minutes. But quick treatment with cardiopulmonary resuscitation (CPR) and a defibrillator may be lifesaving.

A heart attack is different from an SCA. A heart attack happens when blood flow to the heart is blocked. During a heart attack, the heart usually doesn't suddenly stop beating. With an SCA, the heart stops beating.

Sometimes an SCA can happen after or during recovery from a heart attack.

Your heart has an electrical system that controls the rate and rhythm of your heartbeat. An SCA can happen when the heart's electrical system is not working right and causes irregular heartbeats. Irregular heartbeats are called arrhythmias. There are different types. They may cause the heart to beat too fast, too slow, or with an irregular rhythm. Some can cause the heart to stop pumping blood to the body; this is the type that causes SCA.

Certain diseases and conditions can cause the electrical problems that lead to SCA. They include:

• Ventricular fibrillation, a type of arrhythmia where the ventricles (the heart's lower chambers) don't beat normally. Instead, they beat very fast and very irregularly. They can't pump blood to the body. This causes most SCAs.
• Coronary artery disease (CAD), also called ischemic heart disease. CAD happens when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart. It is often caused by the buildup of plaque, a waxy substance, inside the lining of larger coronary arteries. The plaque blocks some or all of the blood flow to the heart.
• Some types of physical stress can cause your heart's electrical system to fail, such as:
  • Intense physical activity in which your body releases the hormone adrenaline. This hormone can trigger SCA in people who have heart problems.
  • Very low blood levels of potassium or magnesium. These minerals play an important role in your heart's electrical system.
  • Major blood loss.
  • Severe lack of oxygen.
• Certain inherited disorders which can cause arrhythmias or problems with the structure of your heart.
• Structural changes in the heart, such as an enlarged heart due to high blood pressure or advanced heart disease. Heart infections can also cause changes to the structure of the heart.

You are at higher risk for SCA if you:

• Have coronary artery disease (CAD). Most people with SCA have CAD. But CAD usually doesn't cause symptoms, so they may not know that they have it.
• Are older; your risk increases with age.
• Are a man; it is more common in men than women.
• Are Black or African American, especially if you have other conditions such as diabetes, high blood pressure, heart failure, or chronic kidney disease.
• Have a personal history of heartbeats that aren't regular (arrhythmia).
• Have a personal or family history of SCA or inherited disorders that can cause arrhythmia.
• Have a problem with drug or alcohol use.
• Have had a heart attack.
• Have heart failure.

Usually, the first sign of SCA is loss of consciousness (fainting). This happens when the heart stops beating.

Some people may have a racing heartbeat or feel dizzy or light-headed just before they faint. And sometimes people have chest pain, shortness of breath, nausea, or vomiting in the hour before they have an SCA.

SCA happens without warning and requires emergency treatment. Health care providers rarely diagnose SCA with medical tests as it's happening. Instead, it is usually diagnosed after it happens. Providers do this by ruling out other causes of a person's sudden collapse.

If you are at high risk for SCA, your provider may refer you to a cardiologist, a doctor who specializes in heart diseases. The cardiologist may ask you to get various heart health tests to see how well your heart is working. They'll work with you to decide whether you need treatment to prevent SCA.

SCA is an emergency. A person having SCA needs to be treated with a defibrillator right away. A defibrillator is a device that sends an electric shock to the heart. The electric shock can restore a normal rhythm to a heart that's stopped beating. To work well, it needs to be done within minutes of the SCA. CPR should be started right away and continued until a defibrillator is ready to use. CPR helps keep blood flowing to the brain and other organs until the heart's rhythm can be restored.

Most police officers, emergency medical technicians, and other first responders are trained and equipped to use a defibrillator. Call 9-1-1 right away if someone has signs or symptoms of SCA. The sooner you call for help, the sooner lifesaving treatment can begin.

Many public places such as schools, businesses, and airports have automated external defibrillators (AEDs). AEDs are special defibrillators that untrained people can use if they think that someone has had SCA. They give step-by-step voice instructions. AEDs are programmed to give an electric shock if they detect a dangerous arrhythmia. This prevents giving a shock to someone who may have fainted but isn't having SCA.

If you see someone who you think has had SCA, you should give CPR until defibrillation can be done. If you haven't been trained in CPR, you can still help by giving hands-only CPR. You do this by pushing hard and fast on the center of the chest.

People who are at risk for SCA may want to consider having an AED at home. Ask your cardiologist to help you decide whether having an AED in your home might help you.

If you survive SCA, you'll likely be admitted to a hospital for ongoing care and treatment. In the hospital, your medical team will closely watch your heart. They may give you medicines to try to reduce the risk of another SCA.

They will also try to find out what caused your SCA. If you're diagnosed with coronary artery disease, you may have an angioplasty or coronary artery bypass surgery. These procedures help restore blood flow through narrowed or blocked coronary arteries.

Often, people who have had SCA get a device called an implantable cardioverter defibrillator (ICD). This small device is surgically placed under the skin in your chest or abdomen (belly). An ICD uses electric pulses or shocks to help control dangerous arrhythmias.

You may be able to lower your risk of SCA by following a heart-healthy lifestyle. If you have coronary artery disease or another heart disease, treating that disease can also lower your risk of SCA. If you have had an SCA, getting an implantable cardioverter defibrillator (ICD) can lower your chance of having another SCA.

NIH: National Heart, Lung, and Blood Institute

Surgery

There are many reasons to have surgery. Some operations can relieve or prevent pain. Others can reduce a symptom of a problem or improve some body function. Some surgeries are done to find a problem. For example, a surgeon may do a biopsy, which involves removing a piece of tissue to examine under a microscope. Some surgeries, like heart surgery, can save your life.

Some operations that once needed large incisions (cuts in the body) can now be done using much smaller cuts. This is called laparoscopic surgery. Surgeons insert a thin tube with a camera to see, and use small tools to do the surgery.

After surgery there can be a risk of complications, including infection, too much bleeding, reaction to anesthesia, or accidental injury. There is almost always some pain with surgery.

Agency for Healthcare Research and Quality

Teen Depression

What is depression in teens?

Depression in teens (ages 13-17) is a serious medical illness. It's more than just a feeling of being sad or "blue" for a few days. It is an intense feeling of sadness, hopelessness, and anger or frustration that lasts much longer. These feelings make it hard for you to function normally and do your usual activities. You may also have trouble focusing and have no motivation or energy. Depression can make you feel like it is hard to enjoy life or even get through the day.

Many factors may play a role in depression, including:

• Genetics. Depression can run in families.
• Brain biology and chemistry.
• Hormones. Hormone changes can contribute to depression.
• Stressful childhood events such as trauma, the death of a loved one, bullying, and abuse.

Depression can happen at any age, but often begins in the teens or early adulthood. Certain teens are at higher risk of depression, such as those who:

• Have other mental health conditions, such as anxiety, eating disorders, and substance use
• Have other diseases, such as diabetes, cancer, and heart disease
• Have family members with mental illness
• Have a dysfunctional family/family conflict
• Have problems with friends or other kids at school
• Have learning disabilities or attention deficit hyperactivity disorder (ADHD)
• Have had trauma in childhood
• Have low self-esteem, a pessimistic outlook, or poor coping skills

If you have depression, you have one or more of these symptoms most of the time:

• Sadness
• Feeling of emptiness
• Hopelessness
• Being angry, irritable, or frustrated, even at minor things

You also may also have other symptoms, such as:

• No longer caring about things you used to enjoy
• Changes in weight, such as losing weight when you are not dieting or gaining weight from eating too much
• Changes in sleep, such as having trouble falling asleep or staying asleep, or sleeping much more than usual
• Feeling restless or having trouble sitting still
• Feeling very tired or not having energy
• Feeling worthless or very guilty
• Having trouble concentrating, remembering information, or making decisions
• Thinking about dying or suicide

If you think you might be depressed, tell someone that you trust, such as your:

• Parents or guardian
• Teacher or counselor
• Doctor

The next step is to see your doctor for a checkup. Your doctor can first make sure that you do not have another health problem that is causing your depression. To do this, you may have a physical exam and lab tests.

If you don't have another health problem, you will get a psychological evaluation. Your doctor may do it, or you may be referred to a mental health professional to get one. You may be asked about things such as:

• Your thoughts and feelings
• How you are doing at school
• Any changes in your eating, sleeping, or energy level
• Whether you are suicidal
• Whether you use alcohol or drugs

Effective treatments for depression in teens include talk therapy, or a combination of talk therapy and medicines:

Talk therapy

Talk therapy, also called psychotherapy or counseling, can help you understand and manage your moods and feelings. It involves going to see a therapist, such as a psychiatrist, a psychologist, a social worker, or counselor. You can talk out your emotions to someone who understands and supports you. You can also learn how to stop thinking negatively and start to look at the positives in life. This will help you build confidence and feel better about yourself.

There are many different types of talk therapy. Certain types have been shown to help teens deal with depression, including:

• Cognitive behavioral therapy (CBT), which helps you to identify and change negative and unhelpful thoughts. It also helps you build coping skills and change behavioral patterns.
• Interpersonal therapy (IPT), which focuses on improving your relationships. It helps you understand and work through troubled relationships that may contribute to your depression. IPT may help you change behaviors that are causing problems. You also explore major issues that may add to your depression, such as grief or life changes.

Medicines

In some cases, your doctor will suggest medicines along with talk therapy. There are a few antidepressants that have been widely studied and proven to help teens. If you are taking medicine for depression, it is important to see your doctor regularly.

It is also important to know that it will take some time for you to get relief from antidepressants:

• It can take 3 to 4 weeks until an antidepressant takes effect
• You may have to try more than one antidepressant to find one that works for you
• It can also take some time to find the right dose of an antidepressant

In some cases, teenagers may have an increase in suicidal thoughts or behavior when taking antidepressants. This risk is higher in the first few weeks after starting the medicine and when the dose is changed. Make sure to tell your parents or guardian if you start feeling worse or have thoughts of hurting yourself.

You should not stop taking the antidepressants on your own. You need to work with your doctor to slowly and safely decrease the dose before you stop.

Programs for severe depression

Some teens who have severe depression or are at risk of hurting themselves may need more intensive treatment. They may go into a psychiatric hospital or do a day program. Both offer counseling, group discussions, and activities with mental health professionals and other patients. Day programs may be full-day or half-day, and they often last for several weeks.

Teen Health

As a teenager, you go through many changes. Your body is on its way to becoming its adult size. You may notice that you can't fit into your old shoes or that your jeans are now 3 inches too short. Along with these changes, you are probably becoming more independent and making more of your own choices. Some of the biggest choices you face are about your health.

Healthy habits, including eating a healthy diet and being physically active, can help you feel good, look good, and do your best in school, work, or sports. They might also prevent diseases such as diabetes, high blood pressure, heart disease, osteoporosis, stroke, and some cancers when you are older.

Telehealth

What is telehealth?

Telehealth is the use of communications technologies to provide health care from a distance. These technologies may include computers, cameras, videoconferencing, the Internet, and satellite and wireless communications. Some examples of telehealth include:

• A "virtual visit" with a health care provider, through a phone call or video chat
• Remote patient monitoring, which lets your provider check on you while you are at home. For example, you might wear a device that measures your heart rate and sends that information to your provider.
• A surgeon using robotic technology to do surgery from a different location
• Sensors that can alert caregivers if a person with dementia leaves the house
• Sending your provider a message through your electronic health record (EHR)
• Watching an online video that your provider sent you about how to use an inhaler
• Getting an email, phone, or text reminder that it's time for a cancer screening

Sometimes people use the term telemedicine to mean the same thing as telehealth. Telehealth is a broader term. It includes telemedicine. But it also includes things like training for health care providers, health care administrative meetings, and services provided by pharmacists and social workers.

Some of the benefits of telehealth include:

• Getting care at home, especially for people who can't easily get to their providers' offices
• Getting care from a specialist who is not close by
• Getting care after office hours
• More communication with your providers
• Better communication and coordination between health care providers
• More support for people who are managing their health conditions, especially chronic conditions such as diabetes
• Lower cost, since virtual visits may be cheaper than in-person visits

Some of the problems with telehealth include:

• If your virtual visit is with someone who is not your regular provider, he or she may not have all of your medical history
• After a virtual visit, it may be up to you to coordinate your care with your regular provider
• In some cases, the provider may not be able to make the right diagnosis without examining you in person. Or your provider may need you to come in for a lab test.
• There may be problems with the technology, for example, if you lose the connection, there is a problem with the software, etc.
• Some insurance companies may not cover telehealth visits

The types of care that you can get using telehealth may include:

• General health care, like wellness visits
• Prescriptions for medicine
• Dermatology (skin care)
• Eye exams
• Nutrition counseling
• Mental health counseling
• Urgent care conditions, such as sinusitis, urinary tract infections, common rashes, etc.

For telehealth visits, just like with an in-person visit, it is important to be prepared and have good communication with the provider.