Sudden cardiac death (SCD), also called cardiac arrest, is used to describe a situation in which the heart abruptly and without warning stops working, so no blood can be pumped to the rest of the body. It is responsible for half of all heart disease deaths.

Click here for basic facts on Sudden Cardiac Death

Sudden cardiac death occurs when the heart’s electrical system malfunctions. It is not a heart attack (also known as a myocardial infarcation). A heart attack is when a blockage in a blood vessel interrupts the flow of oxygen-rich blood to the heart, causing heart muscle to die. So if the heart can be compared to a house, SCD occurs when there is an electrical problem and a heart attack – when the problem is the plumbing.

The most common cause of cardiac arrest is a heart rhythm disorder or arrhythmia called ventricular fibrillation (VF). The heart has a built-in electrical system. In a healthy heart, a “pace- maker” triggers the heartbeat, then electrical impulses run along pathways in the heart, causing it to contract in a regular, rhythmic way. When a con- traction happens, blood is pumped. But in ventricular fibrillation, the elec- trical signals that control the pumping of the heart suddenly become rapid and chaotic. As a result, the lower chambers of the heart, the ventricles, begin to quiver (fibrillate) instead of contract, and they can no longer pump blood from the heart to the rest of the body. If blood cannot flow to the brain, it becomes starved of oxygen, and the person loses consciousness in seconds. Unless an emergency shock is delivered to the heart to restore its regular rhythm, using a machine called a defibrillator, death can occur within minutes. It’s estimated that more than 70% of ventricular fibrillation victims die before reaching the hospital.

Who Is At Risk?
SCD often occurs in active, outwardly healthy people with no known heart disease or other health problems. But the truth is that sudden cardiac death is not a random event. Most victims do have heart diseases or other health problems, although they may not know it.

There are numerous contributors to cardiac arrest, but two of the most important ones are:

* A previous heart attack: 75% of the people who die of SCD show signs of a previous heart attack.
* Coronary artery disease: 80% of SCD’s victims have signs of coronary artery disease. This is a condition in which the arteries that supply blood to the heart are narrowed or blocked.

There are also a number of symptoms and signs that may indicate that a person is at increased risk for SCD. These include:

* An abnormal heart rate or rhythm (arrhythmia) of unknown cause
* An unusually rapid heart rate (tachycardia) that comes and goes, even when the person is at rest
* Episodes of fainting (called syncope) of unknown cause
* A low ejection fraction (EF): The ejection fraction is a measurement of how much blood is pumped by the ventricles with each heart beat. A healthy heart pumps 55% or more of its blood with each beat. People at highest risk for SCD have ejection fractions of less than 40%, combined with ventricular tachycardia, an abnormally fast heart rate in the lower chambers of the heart.

Are You At Risk?

Tests That Predict Risk
There are a number of tests that can be performed to determine if someone is in a group that is at high risk for cardiac arrest. These include:

Echocardiogram – a painless test in which sound waves are used to create a moving picture of the heart. The test can measure the pumping ability of the heart and identify other problems that may increase a person’s risk for SCD.

Electrocardiogram – A painless test in which electrodes are attached to the patient’s chest to record the electrical activity of the heart in order to identify abnormal heart rhythms. Certain arrhythmias could point to an increased risk of SCD.

Holter monitor – A Walkman-size recorder that patients attach to their chest for one to two days, recording a longer sampling of their heart rhythm. After the recorder is removed, the tape is analyzed for signs of arrhythmia.

Event recorder – a pager-sized device that also records the electrical activity of the heart over a longer period of time. Unlike a holter monitor, it does not operate continuously. Instead, patients turn on the device whenever they feel their heart beating too quickly or chaotically.

Electrophysiology study (EPS) – This test is performed at a hospital or clinic. A local anesthetic is used to numb areas in the groin or neck and thin flexible wires called catheters are snaked up to the heart to record its electrical signals. During the study, the electrophysiologist studies the speed and flow of electrical signals through the heart, identifies rhythm problems and pinpoints areas in the heart that may be the sources of abnormal electrical signals that trigger arrhythmias. The physician can also determine if a patient has had a prior heart attack or evidence of prior heart damage without knowing it. All of this information can help determine whether the patient is in a group at higher risk for SCD.

Prevention
There are a number of things people can do to decrease the likelihood of becoming a victim of sudden cardiac death. To begin with, living a “heart healthy” life can help reduce the chances of dying of cardiac arrest or other heart conditions. This includes exercising regularly, eating healthful foods, maintaining a reasonable weight and avoiding smoking. Treating and monitoring diseases and conditions that can contribute to heart problems, including high blood pressure, high cholesterol and diabetes, is also important.

Finally, for some patients, preventing sudden cardiac death means controlling or stopping the abnormal heart rhythms that may trigger ventricular fibrillation. Treating arrhythmias is done in three ways:

Medications – Medications, including ACE inhibitors, beta blockers, calcium channel blockers and other antiarrhythmics, can control abnormal heart rhythms or treat other conditions that may contribute to heart disease or SCD. But taking medication alone has not proved to be very effective in reducing cardiac arrest. These medications are sometimes taken by patients who also have an ICD, in order to reduce how often it fires.

Implantable cardioverter defibrillators (ICDs) – These devices have been very successful in preventing sudden cardiac death in certain high-risk patients. Like a pacemaker, ICDs are implanted under the skin. Wires called leads run from the ICD to the heart, and the device monitors the heart to detect any abnormal rhythms. If a dangerous arrhythmia is detected, the ICD delivers an electrical shock to restore the heart’s normal rhythm and prevent sudden cardiac death. The ICD can also act like a pacemaker if the heart is beating too slowly.

Catheter Ablation – In this tech- nique, radiofrequency energy (heat), cryotherapy (freezing), or other energy forms are used to destroy small areas of heart muscle that give rise to the abnormal electrical signals that cause rapid or irregular heart rhythms. The energy is delivered through catheters that are snaked through the veins or arteries to the heart. Catheter ablation is sometimes done in patients who have an ICD to decrease the frequency of abnormal heart rhythms, and again, to reduce how often the device fires.

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Monday, December 4th, 2006

Somes v. United Airlines, Inc.

In 1995, 39 year old Steven Somes died of a cardiac arrest on a United Airlines flight from Boston to San Francisco. The claim against United was based on the failure to have an automatic external defibrillator (”AED”) on board Mr. Somes’ plane, which would have saved his life. Several obstacles stood in the way of successful resolution: AEDs had not been required by the federal government in 1995; no major U.S. airline carried them in 1995; and the extensive regulation of airlines by the federal government gave basis to a defense that federal law preempted state law, such that no claim was available.

Paul, John, and Ronald Kidd and John Sikorski of Robinson Donovan made extensive investigation into the medical aspects of cardiac arrest, the technological history of AEDs, the U.S. passenger airline industry, and use of AEDs by foreign airlines beginning in the early 1990s. On behalf of Steven Somes’s widow Jamie, a wrongful death action was filed against United in January 1998.

The memorandum of law against preemption was prepared by John and Paul. Federal District Court Judge Morris Lasker largely adopted its reasoning in his lengthy written opinion. Pre-trial discovery included extensive motion practice and depositions in England and France. In the course of obtaining complete records of the airline industry’s internal deliberations on the subject of AEDs, Paul and John obtained substantial sanctions against the principal lobby group of the U.S. domestic airline industry, the Washington D.C.-based Airline Transport Association. Somes’ lawyers were prepared to prove that United - like most other major U.S. airlines - was well aware in 1995 of the inexpensive, reliable, and proven life-saving capacity of AEDs, but refused to install them on grounds of cost. United settled the case before trial, the terms of which remain confidential.

According to a recent New York Times assessment, the Somes case was instrumental in prompting the U.S. airline industry to carry AEDs on passenger planes. The case has also been recognized as a milestone in the cause of Public Access Defibrillation (”PAD”), countering the wide-spread but misguided perception that supposed liabilities associated with AEDs outweigh the benefits of installing them. Paul and John, in collaboration with Robinson Donovan, continue to handle wrongful death claims against airlines for failure to have an AED, including suits filed in Chicago against Continental Airlines, which was settled in the summer of 2002, and against Frontier Airlines, which settled shortly before trial.

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Automated external defibrillators
Monday, December 4th, 2006

Every Houston Independent School District campus will soon be equipped with an automated external defibrillator. The device is used to shock a heart and restore its normal beating rhythm.
The school board is expected to accept 300 donated defibrillators from the Texas Arrhythmia Institute next week. The total value is about $650,000. The campuses need to send their nurses and other key personnel to training sessions beginning next month.
In the past few years, several student athletes have died suddenly of cardiac arrest, according to Dr. Nadim Nasir Jr., a cardiologist and senior researcher for the Houston-based Texas Arrhythmia Institute. The device’s life-saving potential can be important not only for students, but also for staff members and visitors.
Officials believe the donation will make HISD the largest American school district to outfit all of its schools with defibrillators.
STRATFORD —I’ll Take Manhattan, a deli, celebrated its grand opening on Friday at 955 Ferry Blvd. The owners were giving away samples from its menu to raise money to buy defibrillators.The defibrillators are used to restore cardiac function when people suffering from a heart attack. Each device costs $2,500.

When a person has a sudden heart attack, these defibrillators can be the difference between life and death, according to Stratford’s EMS Chief Donna Best.

Don Czaplinski, co-owner of I’ll Take Manhattan, said the business would donate a portion of its weekend sales to the effort.

Mayor James R. Miron is now trying to raise enough money to install the defibrillators in all town buildings and schools, because there is no such device in Town Hall and other municipal or school buildings.

Medtronic’s 13 percent drop biggest since ‘84

Fear that the market for implantable defibrillators might be shrinking, makes the device stocks continue freefall.

Medtronic Inc.’s shares fell by $6.61 or 13 percent in New York Stock Exchange composite trading. The decline was the biggest in 22 years. Many companies such as Natick, Mass.-based Boston Scientific Corp., Little Canada-based St. Jude Medical suffered a great loss in stock market.

According to Medtronic, U.S. sales of the devices declined 6 percent in the quarter ended July 28. Surgeons are implanting fewer of the $30,000 defibrillators than last year.

Sales of implantable defibrillators have slowed from a 25 percent growth rate in 2004 and 2005, partly because of the product recalls. Medtronic and St. Jude. Boston Scientific and Guidant collectively have recalled 136,200 defibrillators since June 2005.

The slowdown in defibrillator sales suggests a larger problem and a bigger market development challenge, according to Bruce Nudell, an analyst with Sanford Bernstein & Co. in New York.

Provides sheriff’s department with fund for 3 defibrillators

Exelon Nuclear donated $4,000 to help Grundy County sheriff get three additional defibrillators. Each device was approximately $1,300.

Automatic External Defibrillators send electric charge or shock to restore normal heart rhythm, when the heartbeat is fatally fast due to ventricular tachycardia or ventricular fibrillation.

Between 1999 and 2004, the sheriff’s department responded to ambulance calls 332 times on the average, according to Grundy County Sheriff’s Sergeant Jeff Cole. In 2001, on more than 70 percent occasions that the department responded to, the sheriff’s deputy arrived first on the scene.

The sheriff’s goal is to eventually own 18 AEDs to complete all squad cars, 12 more than the department’s current six.

For now, they’ve equipped the cars they send out to the rural areas, because often in those cases the sheriff’s department will beat the ambulance service to the scene.

The sheriff’s office received the AEDs in June and they are already available in the patrol unit.
U.S. Food and Drug Administration sent much less warning letters to drug and medical device companies in 2005 from five years earlier, according to New York Times.Seizures of mislabeled, defective, or dangerous products fell 44 percent over the span. And enforcement actions over medical devices fell 65 percent.

This was not because companies were in greater compliance with government regulations, but because top FDA officials increasingly overruled subordinates’ desire to enforce regulations, according to the newspaper.

Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group, noted that the FDA receives some $380 million a year from drug companies and device makers.
DeMarco Anderson-Turner, the fifth grader, drowned when celebrating the end of the school year with classmates at a pool party.There were adult chaperones and three lifeguards at the party at Portage Central Middle School. But no adults noticed that Demarco was at the bottom of the pool.

When the child was pulled from the water, he was unconscious and had no pulse. Rescuers tried to use a rescue breathing mask to resuscitate him, but it didn’t work.

Poolside rescuers looked for a defibrillator, but there wasn’t one in the pool area. Michigan law doesn’t require defibrillators around pools. Emergency medical personnel arrived, but by then it was too late.

The American Red Cross has recommended that automated external defibrillators be widely distributed in schools, workplaces, malls, airports, and any place where people gather and where someone might suffer a sudden cardiac arrest.

Starting next year, the state of Michigan will mandate that health clubs and gyms have defibrillators and staff will be trained to use them.

According to University of Michigan Health System, any place where a defibrillator is used at least once every seven years makes sense. And lawmakers should go a step further and require defibrillators at public pools.
After much research, the West Liberty School Board decided to install defibrillators for the school district during a June 19 meeting.The defibrillators will be donated by the Lions Club, local Girl Scouts and the West Liberty Fire Department. Each defibrillator will cost around $1,500.

The equipment can be used during school hours and during after-school activities, such as sporting events, meetings or musical performances. They will not only benefit students, faculty and staff of West Liberty, but also benefit any parent, grandparent or visitor on the school grounds.

The idea was presented to the board two years ago by Mercy Hospital representative Kelly Garvin. The board wanted time to research the equipment before making the purchase. Liability and issues regarding the difficulty of using the equipment were also raised.

Each school building, elementary school, middle school, high school and administrative building will have a defibrillator available.

The board will also decide where it makes the most sense to place the defibrillators within the schools.
Heart attack - During strenuous training in May, the officer went into cardiac arrestDefibrillator saved Lt. Michael Shults’ life, the official of the Multnomah County Sheriff’s office.

On May 21, Shults was at the end of a challenging, two-week Oregon Marine Board course for public safety officials at Camp Rilea. The stress of the exercise and a blockage in an artery near his heart had sent him into cardiac arrest.

Shults was lucky that day. A defibrillator was nearby, and several paramedics were part of the class. He was shocked back to life and returned to work last week.

Sudden cardiac arrest is like an electrical storm in the heart, and the machine delivers a shock that’s like hitting control-alt-delete on a computer, rebooting the heart, according to Shaun Lisenby, the district manager of Philips Medical Systems, manufacturer of the Heart Start FRX defibrillator.

Defibrillators have gotten smaller and smaller, they’ve also gotten easier to use. Current models are made to stand up under rugged use.

Weighing about five pounds, the device has three buttons and a gentle voice that can lead anyone through restarting a heart. “We’ve made it so easy anyone can do it,” Lisenby said.

Gov. Jeb Bush has signed two new laws that will put heart defibrillators in most of Florida’s 159 state parks. The laws increase chances that a life-saving device will be within reach if park visitors and young athletes suffer a cardiac arrest.

The new laws in Florida follow the death last year of Matthew Miulli, a Tampa high school baseball player. Miulli died of cardiac arrest during a preseason practice. He might have been saved if a defibrillator had been nearby.

The resulting law, the Gordon & Miulli Act, is named for Miulli and a South Florida teen who also died. It allows nonprofit groups like Little League baseball and community football teams to apply for grant money from the state and from county commissioners in each county.

More than 200,000 Americans die each year of cardiac arrest. But up to 50,000 deaths — one in four — could be prevented if a defibrillator was immediately available, according to the American Red Cross.

Small portable defibrillators can shock a heart back into normal rhythm. They have been put in offices, airplanes and public buildings across the nation for years. Advocates now want to place them in as many places as possible, because they boost survival rates by 50 percent if used quickly.

Automated external defibrillators are dropping in price, however, many local school officials, especially in small counties, say they can’t afford the costs. But in the wake of Miulli’s death, the Florida High School Athletic Association last year made it mandatory for every school in the state to have defibrillators at all district, state and regional sports events.