Even if you’re not a soccer fan — or sports fan for that matter — chances are you heard about Danish professional soccer player Christian Eriksen’s collapse on the field during the recent European Championship games. Eriksen was administered CPR and defibrillation on the field, restarting his heart. But even after Eriksen was resuscitated and taken to a hospital for treatment, many were left wondering how a healthy 29-year-old professional athlete with no underlying conditions could collapse unexpectedly.
It was later revealed that Eriksen suffered a condition called cardiac arrest. Unlike a heart attack or stroke, cardiac arrest is a lesser-known heart condition for most, and how quickly it strikes — and how elusive it can be — just adds to the mystery and confusion that can often surround the condition for the everyday person.
That’s why we spoke with Ashesh Parikh, D.O., a non-interventional cardiologist at Texas Health Heart & Vascular Specialists, a Texas Health Physicians Group practice in Plano, to lift the veil of mystery on cardiac arrest.
Understanding What Cardiac Arrest Is
“Heart attack” and “stroke” are well-known words in most people’s lexicons, simply because they happen more frequently and therefore there is more information out there about the conditions. You probably know someone or know of someone who has suffered from a heart attack or stroke. But you may not be able to say the same for cardiac arrest.
That’s because it’s so rare, occurring in only about .01% of the population, Parikh says.
So what is cardiac arrest and how does it differ from a heart attack or stroke?
“Cardiac arrest is caused by the sudden stop and lack of blood flow leaving from the heart. So essentially, you’re beating 80 beats a minute, a normal heart rate, and then all of a sudden you lose your pulse,” Parikh explains. “When that occurs, obviously there’s no blood flow reaching your brain or your heart, and that’s why it’s called a cardiac arrest.”
Cardiac arrest is triggered by an electrical malfunction in the heart that causes an irregular heartbeat, or an arrhythmia. We have two heart rhythms: ventricular tachycardia (v-tach) or ventricular fibrillation (vfib).
“In v-tach, the bottom chamber of the heart goes into arrhythmia where the heart rate shoots up to well over 220 to 280 beats per minute,” Parikh explains. “In VFIB, it shoots up to more than 300 beats per minute. And the only effective treatment for that is to shock the heart to essentially reset the electrical circuit. That’s why they used a defibrillator on field for Eriksen.”
But while a heart attack can cause cardiac arrest, the two are not the same. A heart attack occurs in your arteries. We have three main arteries: the aorta, the left coronary artery, and the right coronary artery. When these arteries get clogged up from cholesterol, calcium or a blood clot, and that’s what causes the heart attack. Think of it in terms of a heart attack stops blood flow to the heart while cardiac arrest stops blood flow to the whole body.
A stroke is similar to a heart attack, but instead of affecting the heart, it affects the brain. It can occur for similar reasons, such as cholesterol or a blood clot. But unlike a heart attack, you most likely won’t present with any pain, you’ll have those classic F.A.S.T. symptoms of facial drooping, arm weakness, speech difficulty and a headache.
So to recap, a heart attack stops blood flow to the heart, a stroke stops blood flow to the brain, and cardiac arrest stops blood flow to the entire body.
Prevention & Treatment
After a cardiac arrest, Parikh says doctors go into detective mode trying to find the cause of the event. For most young people, Parikh says cardiac arrest is usually caused by a structural abnormality or an underlying genetic abnormality that’s gone undetected over the years. But as of right now, doctors are still unsure what caused Eriksen’s cardiac arrest.
“I looked up to see what the doctors said ended up happening to him, out of curiosity, but there’s still no clear answer which is definitely not usual,” Parikh says. “I’m sure there are more tests they’ll do, but there’s always an answer. As of right now though, they did allow him to leave the hospital after implanting an internal defibrillator to protect him from it happening again.”
Testing is typically done after a cardiac event, which brings up the question of why we don’t test prior to an event as a means of prevention. But Parikh says it’s a bit of a loaded question.
“That’s been a huge debate in the pediatric community, the cardiology community, and just the health community in general. Because there’s no one answer for what causes cardiac arrest and who it happens to, there’s also no one test we can perform that will 100% say, ‘ok everything looks good, you won’t have a cardiac rest in your lifetime,’” he explains “There are so many causes for a cardiac arrest so it requires multiple tests and you really have to hunt for what caused a cardiac arrest pretty much after the fact. So in terms of knowing if you’re at risk, it’s extremely difficult. I wish I could say that’s there’s one test you can take as a child or a teen and it will predict if you’re going to have a cardiac arrest or not, but I can’t.”
However, a lot of school physicals require an EKG, because an EKG can detect any abnormal heart rhythms that may interfere with your ability to exercise safely. But Parikh adds that if you’re not an athlete or your child isn’t in something that requires a sports physical, then you’re losing out on this test and the clarity it could provide since it’s not typically done during an annual exam unless your doctor has good reason to perform the test.
But recently, the UIL started requiring high school students in marching band or color guard to also have a sports physical in order to perform, just as a student athlete would. Some districts already required physicals prior to this new rule. For instance, the Fort Worth school district has required physicals for marching band participants every year since 2006.
For the rest of us, though, Parikh says regular testing isn’t standard simply because cardiac arrest will occur in such a small incidence of the population.
“Yes, you heard about Christian Eriksen because it was broadcast live on TV, or you may read about a local high school athlete who the same thing happened to, but if you compare that to all other 20-year-olds or 16-year-olds, or even 30-year-olds, etc., the incidence of cardiac arrest is less than .01 percent of the population. That’s why testing isn’t really recommended for everyone.”
Additionally, Parikh says that cardiac arrests typically occur in those who are 40-years-old or younger.
“You see it less in those above 40, I’m not saying it doesn’t occur, but you see it more in those under the age of 40,” he says. Actually, it’s a bit easier to identify the source of a cardiac arrest in those over 40 because you most likely have some risk factors by that time, whether it be high cholesterol or high blood pressure, diabetes, smoking, etc.”
What to Do if Cardiac Arrest Strikes
First things first, call 911 for emergency medical services. Next, ask for or get an automated external defibrillator (AED) if one is available and use it as soon as it arrives.
Texas requires all schools, dental offices, nursing homes and extended care facilities to have an AED on site, and an employee trained in AED must be available as well. You may also see AEDs in malls, hotels or in sporting venues.
“The faster you have access to a defibrillator, the higher your chances for survival because you have to shock the patient’s system and restore cardiac rhythm to restore blood flow throughout their body,” Parikh explains.
If there is no AED nearby, you can administer CPR until medical personnel arrive. You will also perform CPR after defibrillation until medical personnel arrive. If two people are available to help, one should begin CPR immediately while the other calls 911 and finds an AED.
“Your greatest odds of surviving honestly is being in the right place at the right time with the right people. Unfortunately, it doesn’t always happen that way, though,” Parikh adds. “Christian Eriksen was fortunate to have medical staff nearby and a defibrillator on site.”
If you’re going to suffer from a cardiac arrest, the highest probability of it striking is when you’re exercising at a high intensity, because there’s usually something structurally wrong with the heart and as you’re exerting a lot of energy, that will restrict your ability to do so and you’ll go into cardiac arrest. But, unfortunately, you can also suffer from cardiac arrest when you’re just at rest watching a movie or taking a light walk.
While that may give you a bit of anxiety, Parikh wants everyone to remember how rare cardiac arrests are.
“If you’re worried, please remember that 99.9% of people will not have a cardiac arrest event. But if you’re an athlete or parent of one, definitely get that physical and get the EKG to rule out any abnormalities that may already be there,” he explains. “Even if you’re not a teenager or college athlete, and you’re just an average person who works out regularly, if you’re concerned, you can definitely bring it up to your physician.
“I would say that’s especially important if you want to heavily increase the intensity of your workouts or maybe you want to run a marathon or do an Iron Man, something of that nature — go get a baseline EKG with your provider just to rule out anything. There’s nothing wrong with being proactive with your health and advocating for yourself.”