But these aren’t merely songs, these are lifesavers. Fast, rhythmic numbers to play in your head when performing CPR (cardiopulmonary resuscitation) for cardiac arrest (CA). Hopefully, reading this will help avoid CA, inform how to spot signs of impending CA, how to learn CPR, and the role of AEDs.
Doctors are privileged to see people in their darkest hour, help many, cure some, and always reassure. But nothing beats resuscitating someone who, without attention, will die 100% of the time. And you can do this too.
Cardiac arrest is the sudden cessation of heartbeats; gas exchange in the lungs stops, organs do not receive required nutrients, and one by one, they die. For etymologists out there, “arrest” originates from Latin, re-stare; to remain, or stop. Stopped hearts kill 300,000–450,000 Americans yearly, more commonly men and older folk.
Risk factor awareness and action, as well as more people learning CPR, can dramatically reduce these deaths. Around 5–10% suffering CA outside the hospital survive; whereas among hospital in-patients, that number climbs to 20 -25%. According to a meta-analysis of 38 studies including 16,933 patients, around 2/3 were still alive after ten years, so CPR has long-term benefits!
When learning to fly, understanding electrical system misbehaviors is always taken seriously by nascent aviators…and those wishing to live long enough to be experienced pilots. The heart merits similar understanding to generate more respect and fewer electrical failures or fires. Our ticker has its own electrical generator, or pacemaker, the sino-atrial node, which sends signals down cellular wires called the Bundle of His, to an electrical substation, the atrioventricular node. These electrical impulses coordinate orchestrated contraction and expansion of the four heart chambers. If disordered, one has an aberrant rhythm (arrhythmia), often foreshadowing ineffective cardiac pumping. That diseased rhythm might be asystole with no contraction, or ventricular fibrillation where the heart looks like a “bag of worms”—wiggly muscle but no blood being pumped; not to be confused with atrial fibrillation, a very common, less serious although often troubling condition.
Eccentric rhythms commonly follow impairment of blood supply to heart muscle due to arteries blocked with gunk (atheroma), or when high blood pressure is associated with a stressed cardiac system. This can be a slow, progressive situation, or a sudden heart attack (myocardial infarction or MI) where an area of heart muscle loses blood supply and dies, either blocking electrical signals or sending out false signals in its death throes.
Avoiding MI is largely achieved by controlling weight, increasing activity, modifying diet, not smoking at all nor drinking to excess, and having blood lipids and pressure checked regularly. Knowing family history risk factors might dictate other helpful steps.
Other causes for CA include structural or functional problems one is born with, dodgy valves, or enlarged heart muscle disease (cardiomyopathy). Just as pilots use memory tricks—IM SAFE and GUMPS come to mind—doctors do the same.
There are the “5 H’s and 5 T’s”
Hypoxia: oxygen shortage due to respiratory disease or a low oxygen environment, perhaps on an airplane. Many commercial aircraft now carry medical equipment and trained personnel in case there isn’t a doctor on board. In one study (Journal of the American Heart Association (AHA) https://www.ahajournals.org/doi/full/10.1161/JAHA.120.021360) of people who suffered CA on an aircraft, 15% survived to hospital discharge, and of those arresting in proximity to a plane, 44% survived. If one has cardiovascular disease, take medical advice before flying.
Hypovolemia: where circulating volume of blood is reduced as in trauma.
Hydrogen ion: where blood becomes more acidic.
Hypo/hyperkalemia/magnesium: reduced (or increased) potassium and
magnesium levels. A colon or rectal tumor can produce large volumes of potassium-rich mucus inducing irregular heart rhythms or arrest. Certain diuretic medications to treat hypertension also deplete potassium.
Hypothermia: cold temperatures can cause CA. “Wild” or cold-water swimming is popular, but carries risks of bad rhythms and pulmonary edema—literally drowning from the inside.
Toxins: poisons and drugs can cause potentially fatal heart rhythms including amiodarone, a medicine ironically used to treat heart conduction problems.
Tamponade: where fluid accumulates in the sac around the heart, preventing full heart expansion.
Tension pneumothorax: where a lung is pierced, trapping air around the organ.
Thrombosis (coronary): blocked heart arteries.
Thrombosis (pulmonary): blocked lung arteries.
Diabetes can be a culprit in several ways; by blocking small cardiac blood vessels, damaging nerves preventing one from experiencing tell-tale symptoms, and throwing body chemistry into disarray. So put that soda down!
Frank, but thankfully rare, electrical abnormalities, likeWolff-Parkinson-White syndrome and Long QT syndrome, may cause CA throughout life. Any sudden mood change—anger, depression, or sadness—can also induce CA; one can truly die of a broken heart. But don’t turn to recreational drug use; cocaine, ecstasy, morphine, and even cannabis kill otherwise healthy people by CA.
Spinal cord injury and a blow to the chest at a specific point in heart rhythm, e.g., by a baseball, can produce CA in an uncommon condition, Commotio cordis.
Based on CA survivor reports, about half experience flu-like symptoms, chest pain, nausea, palpitations, breathlessness, fatigue, and dizziness up to 2 weeks before. If that sounds familiar, seek medical help. Just before an arrest one might feel chest pain, palpitations, dizziness, lightheadedness, weak or faint, then passing out.
If you see someone suddenly collapse, possibly gripping their chest, not breathing, and do not respond if you shout at or shake them, assume this may be a cardiac arrest. In a commanding manner tell someone nearby to call 911, provide the location, and demand paramedics attend and then return to tell you they have done as told. Then have them search for an AED—an automated external defibrillator—that can be a lifesaver. Familiarize yourself with what they look like and how they work; these are intuitive devices that can detect a heart is not beating and shock it into action, but the time to learn about them is not when someone is unconscious before you. Look for a pulse in the neck or groin where arteries are larger and easier to find than the wrist.
This is where performing CPR comes in, but rather than endeavor to teach it here, please find and complete a local course, maybe via AHA’s website (https://cpr.heart.org/en/). Also, if your workplace, sports club, or airport does not have an AED, encourage them to get one. Anybody can save a life, maybe you!
A friend of mine, Glenn Hoddle, a British footballer who has also managed at the highest level, recorded pop songs, and worked as a pundit, was in a London TV studio on his 61st birthday. An otherwise fit guy, he suddenly fell backwards, unconscious. Were it not for Simon Daniels, a sound technician who was CPR trained, Glenn would have died that day in 2018. Now, post–cardiac surgery and implantation of an internal defibrillator, he is well, working, and full of the joys of spring. This problem is real; don’t let it affect you or those you love.
Learn CPR and all about AEDs, and choose your song should you ever need a rhythm to be your resuscitation theme song; maybe the inappropriately named “Heartbreaker” by Mariah Carey and Jay-Z or NSYNC’s “Bye Bye Bye”! Keep that heart pumping and fly well!
I am really excited to announce a new podcast I am doing starting March 12, 2024, with my old medical school colleague, Dr. Nigel Guest. You can register wherever you get your podcasts @jointhedocs. I hope you enjoy!
