Cardiac arrest, heart attack and stroke: What’s the difference?

Manasi Y Mastakar speaks to experts and tries to distinguish the differences between cardiac arrest, heart attack and stroke, terms which are many a times either used synonymously or interchangeably

The initial reports of actress Sridevi’s death said it was cardiac arrest that claimed her life. Of course, later it was clarified that the cause of death was accidental drowning. But the initial reports did give rise to a vital question: Are heart attack and cardiac arrest the one and the same? Or is there a difference. The terms, heart attack and cardiac arrest, are used by the public either synonymously or inter-changeably. But they are not the same.

What’s the difference?

“A heart attack occurs when blood flow to the heart getss blocked.  The heart muscle is deprived of its vital blood supply carrying oxygen and nutrition to the heart muscle. If the blocked artery (tube carrying blood) to the heart muscle is not reopened quickly, the part of the heart normally nourished by that artery begins to die,” says Interventional Cardiologist Dr Nimit Shah.

Cardiac arrest should not be confused with heart attack, because in cardiac arrest the heart suddenly stops functioning. “Cardiac arrest occurs suddenly and often without warning. It is triggered by an electrical malfunction in the heart that causes an irregular heart beat or very slow heart beat before it completely stops beating. This causes disruption in pumping of the heart. With its pumping action is disrupted, the heart cannot pump blood to the brain, lungs and other organs. Seconds later, a person becomes unresponsive, is not breathing or is only gasping. Death occurs within minutes if the victim does not receive treatment,” cautions Dr Shah.

Cardiac arrest, heart attack and stroke: What’s the difference?

Apart from electrical malfunction in the heart, cardiac arrest also has several other causes; some related to the heart, some not directly related to the heart. “But it’s mainly ventricular fibrillation, heart attack, heart valve stenosis, blood clots in the lung vessels, etc.; sometimes sudden fright leading to vasovagal attack can cause cardiac arrest,” says doctor Dr Bipeenchandra Bhamre, Cardiac Surgeon, Sir Harkisandas Narrottumdas, Reliance Foundation Hospital.

“Electrocution, drowning, drug overdose, severe hemorrhage, any illness in the body which causes electrolyte abnormalities (abnormal level of sodium and potassium) or a critical illness can also cause cardiac arrest,” adds Dr Shah.

While we aren’t doctors, and in most cases heart attacks and cardiac arrests occur at homes or in public places, telling the difference between the two also becomes important. Because at that time, a person going to the situation is at the mercy of the people around him/her. So how to tell the difference between the two and what to do in such cases?

“For common people the difference between cardiac arrest and heart attack in simple words is whether the person experiencing this is conscious or not. If you are having a heart attack you will have chest pain, sweating, but you will be conscious and anxious. But if you develop cardiac arrest, you will not be alert or conscious, you will fall down on floor, and there will no pulse. Blood pressure will not be recordable, because the motor (heart) has stopped working. But in a heart attack, pulse and blood pressure, although variable, are recordable,” enlightens Dr Bhamre.

The symptoms

In any illness or physical ailments, it is the symptoms that prompt us seek medical help and understand the problems. In heart attack, the common symptoms are chest pain, pressure or discomfort that suddenly occurs and doesn’t go away, a pain that spreads to the left or right arm, neck, jaw, back or stomach, shortness of breath. In some cases people may also have a choking sensation in the throat. “Sometimes, a person may get a heart attack without any symptoms (silent heart attack) or very atypical symptoms like extreme tiredness and lethargy.  This is more common in the elderly, women, or those with diabetes,” says Dr Shah.

Though cardiac arrest occurs suddenly, and without any warnings or symptoms, if cardiac arrest is due heart attack, a person will likely feel the above mentioned symptoms, says Dr Bhamre. “I always insist people to walk. You if have chest pain while walking, it is a tell-tale sign that something is wrong, and that you should consult a doctor rather than waiting for the heart attack to strike,” Dr Bhamre cautions.

It becomes utmost important that a person suffering cardiac arrest receive immediate medical help. “Call for help from standby persons and seek immediate medical help. By the team the medical help arrives, immediate resuscitation can be life saving. If the person isn’t breathing or is only gasping, give CPR (chest compression and artificial breathing) if the person is trained to do so,” says DR Shah.

While in heart attack too, immediate help is required to avoid further damage to the heart muscle, till the time medical help arrives, “Get the person to sit in a comfortable position, stay with them and keep them calm. If the person is not allergic to aspirin, give them an adult aspirin tablet (300mg) to chew if there is one easily available. If you don’t have an aspirin to hand, or if you don’t know if the person is allergic to them, just get the person to stay resting until the ambulance arrives,” Dr Shah adds.

Minutes matter

Any kind of heart problem shouldn’t be ignored. After all, it is the most important organ, responsible for the well-being of the other organs in the body. If a person is experiencing heart attack one shouldn’t waste time in getting the person to the hospital. According to Dr Bhamre, survival post-attack depends on the time that lapses between the person getting an attack and receiving treatment. The earlier the treatment received the better chances of survival and less damage to the heart muscle.

In cases of cardiac arrest, it is even more difficult, because arrests occur suddenly and in most cases without prior warning. After receiving the heart attack, a sufferer has something called as a Golden Hour – if this hour passes, survival becomes difficult. But in cardiac arrest, it’s only a matter of minutes. “Survival will depend on the cause of the cardiac arrest, patient’s condition and other co-existing disease and time lag between the cardiac arrest and resuscitation performed. If the patient survives the cardiac arrest his treatment will depend on the cause of the cardiac arrest and outcome of the cardiac arrest. If the cardiac arrest is due to the heart attack and patient survives after immediate resuscitation without any brain damage, emergency treatment of heart attack by opening up the block artery will be life saving and reduce the risk of further cardiac arrest and complications.” adds Dr Shah.

Treatment post-heart attack depends on what is best for you. “After having undergone angiography, doctor may suggest if you need angioplasty or bypass surgery. It is important to take a long-term health decision,” says Dr Bhamre.

It is possible to avoid heart problems by leading healthy lifestyle, controlling and treating any risk factors like diabetes, blood pressure, cholesterol, etc. If heart problems run in the family, a regular screening of immediate family is advisable to avoid developing any kind of life-threatening complications.

Stroke is different

While we have seen in detail the difference between heart attack and cardiac arrest, another term that is misunderstood and many a times confused with these two is stroke. The most important factor in stroke is, it is related to the brain and occurs in the brain. Though it arises from lack of proper blood supply to the brain, which can also originate from blockage in heart. Symptoms of stroke include trouble walking, speaking and understanding, as well as paralysis or numbness of the face, arm or leg.

Shedding light on it, Dr Ramesh Patankar, Neurologist, Zen Hospital says, “Stroke is a neurological problem which involves one of one of the blood vessels that supply blood to the brain. Not all strokes are heart related, but in heart-related strokes, clots can travel to the brain through heart. There are two types of strokes: Ischemic, which is lack of oxygenated blood supply to the brain, and hemorrhaging that occurs when a blood vessel ruptures. Immediate treatment is necessary as delay can cause further damage and permanent brain damage. These days, there is a new drug that helps dissolve clot immediately if the person is taken to hospital within three hours after getting a stroke.” Treatment will also be centred around limiting further complications and causing additional strokes.

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