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By Jennifer J Brown, PhD

Men who suffered cardiac arrest often had symptoms that could have tipped them off to their condition a month before their hearts stopped, found a study reported at the American Heart Association meeting this week.

The new study, of 567 men ages 35 to 65 in Portland, Ore., found that just over half had symptoms from one month to one hour before their cardiac arrest. Most of the men had coronary artery disease, but only about half knew it.


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For the men in the study, symptoms prior to cardiac arrest included:

- Chest pain -- 56 percent of the men
- Shortness of breath -- 13 percent
- Dizziness, fainting or heart palpitations -- 4 percent

Lead study author Sumeet S. Chugh, MD, Associate Director of the Heart Institute at Cedars-Sinai Medical Center in Los Angeles, and his team collected information for the study in a unique way that helped them uncover evidence of previous symptoms.

First, they got records of emergency medical responder interactions with family members and witnesses in the field. Second, the researchers tracked down any information related to prior symptoms, doctor visits or hospitalizations during the four weeks before cardiac arrest. In addition they searched lifetime clinical history for the patients, and finally, they looked into coroner's medical records.

"The important message [of the study] is that if middle-aged men have such symptoms, they should seek medical attention as soon as feasible," said Chugh. While this study focused on men, the researchers said they are currently working on a similar study of women's cardiac arrest symptoms.

Why It's Critical to Recognize Early Clues of Cardiac Arrest

As many as 350,000 Americans have cardiac arrests every year outside of a hospital. In these cases, survival rates are only 7 percent to 9 percent even if CPR is performed. Recognizing heart symptoms like chest pain and breathlessness could help people get medical help earlier -- and get the treatment they need to avoid cardiac arrest.

Cardiologist William T. Abraham, MD, who was not involved with the study, said that the majority of cardiac arrests are due to coronary heart disease or heart failure. "Unfortunately," said Dr. Abraham, "the initial presentation of coronary heart disease or heart failure may be cardiac arrest, so many deaths due to cardiac arrest appear to be unavoidable."

But knowledge is power when it comes to cardiac arrest prevention. Abraham, who is Deputy Director of the Davis Heart and Lung Research Institute at the Ohio State University in Columbus, commented on prevention strategies.

"The key to prevention is knowing the risk factors for coronary heart disease -- family history of premature coronary heart disease, high blood pressure, high cholesterol, diabetes, and cigarette smoking -- and the symptoms of coronary heart disease and heart failure," he said.

Heart attack and cardiac arrest symptoms to watch for:

- Chest pain, discomfort, or pressure
- Shortness of breath
- Fatigue
- Exercise intolerance

If you have any of these, seek medical attention as soon as possible. Abraham pointed out that if coronary heart disease or heart failure is diagnosed and treated, your risk for cardiac arrest can be substantially reduced.

What to Do if You Have Chest Pain

Cardiologist Kevin Campbell MD, from Wake Heart and Vascular in Raleigh, N.C. said, "If a person has chest pain he should be evaluated in the emergency room. At that time an EKG and some blood work will determine if there is any active heart damage occurring."

After the ER visit, "If the patient does have risk factors for heart disease he should undergo stress testing with a qualified cardiologist. Stress testing is a noninvasive way to determine if a person is at risk for having a heart attack. Specific to cardiac arrest, patients who have an abnormal stress test and reduced heart function may be at increased risk," said Dr. Campbell.

Campbell described the next steps in care, "If a patient is determined to be at increased risk for cardiac arrest several steps can be taken. First of all, if the stress test is abnormal, a heart catheterization should be performed in order to determine the nature of any potential blockages in the coronary arteries. In patients who have known heart blockages and reduced heart function they should consider the implantation of an implantable cardioverter defibrillator, ICD, if certain criteria are met such as an ejection fraction less than 35 percent."

This can lower risks significantly, explained Campbell, "ICDs have been shown to reduce risk of sudden cardiac death or cardiac arrest by 30 percent when implanted in appropriate patients."

What can patients do on their own to lower risks? Campbell noted, "Patients can modify their own risk by modifying risk factors for heart disease such as high blood pressure, high cholesterol, tobacco abuse, diabetes and high cholesterol. Adopting a healthy lifestyle including regular exercise and healthy diet is paramount in the reduction of cardiac events in at-risk patients."

"Chest Pain and Other Cardiac Arrest Risks Often Ignored" originally appeared on Everyday Health.