What are the immediate treatments for cardiac arrest vs heart attack?

Immediate Treatments for Cardiac Arrest vs. Heart Attack

In cardiac arrest, immediate high-quality CPR with chest compressions and early defibrillation are essential life-saving interventions, while heart attacks (myocardial infarction) require rapid medical attention focused on restoring blood flow through medications and possible cardiac catheterization.

Cardiac Arrest Treatment

Cardiac arrest is characterized by sudden loss of heart function where the heart stops pumping effectively, resulting in unconsciousness and absence of normal breathing.

Immediate Actions for Cardiac Arrest:

• Check for responsiveness by tapping the victim and shouting "Are you all right?" If unresponsive with no breathing or only gasping, assume cardiac arrest 1
• Activate emergency response system immediately 1
• Begin high-quality chest compressions as soon as possible 1
• Push hard (at least 2 inches/5 cm deep) at a rate of 100-120 compressions per minute 1
• Allow complete chest recoil after each compression 1
• Minimize interruptions in chest compressions 1

For Lay Rescuers:

• Perform chest compressions at minimum; if trained, add rescue breaths in a 30:2 ratio 1
• Continue CPR until an AED arrives or EMS providers take over 1
• If an AED is available, use it as soon as possible following the device prompts 1
• Resume chest compressions immediately after shock delivery 1

For Healthcare Providers:

• Provide chest compressions and rescue breaths in a 30:2 ratio until advanced airway placement 1
• After advanced airway placement, provide continuous chest compressions with ventilations at 1 breath every 6 seconds (10 breaths/minute) 1
• Avoid excessive ventilation as it decreases venous return and cardiac output 2
• For patients on mechanical ventilation who develop cardiac arrest, disconnect from the ventilator and ventilate manually 2
• Consider administration of medications per ACLS protocols:
  • Amiodarone (First dose: 300 mg bolus; Second dose: 150 mg) or Lidocaine (First dose: 1-1.5 mg/kg; Second dose: 0.5-0.75 mg/kg) for shock-refractory VF/pVT 1

Heart Attack (Myocardial Infarction) Treatment

Heart attack occurs when blood flow to part of the heart is blocked, causing damage to heart muscle but the heart continues to beat.

Immediate Actions for Heart Attack:

• Activate emergency response system immediately 1
• Administer aspirin if not contraindicated 1
• Provide supplemental oxygen if oxygen saturation is low 1
• Obtain 12-lead ECG as soon as possible 1
• Establish IV access 1
• Consider early reperfusion therapy (thrombolysis or percutaneous coronary intervention) 1
• Monitor vital signs and cardiac rhythm continuously 1

Medications for Heart Attack:

• Antiplatelet agents (aspirin, P2Y12 inhibitors) 1
• Anticoagulants (heparin, low molecular weight heparin) 1
• Nitrates for chest pain relief if blood pressure allows 1
• Beta-blockers (such as metoprolol) if not contraindicated 3
• Pain management with opioid analgesics if needed 1

Key Differences in Treatment Approach

• Cardiac arrest requires immediate CPR and defibrillation (if shockable rhythm), while heart attack requires medical therapy focused on restoring coronary blood flow 1
• Cardiac arrest is a true "code" situation requiring resuscitation, while heart attack patients are typically conscious but require urgent care 1
• Public access defibrillation is recommended at sites where cardiac arrest is relatively common, as early defibrillation significantly improves survival 1
• For cardiac arrest, high-quality CPR with minimal interruptions is critical; for heart attack, rapid transport to a facility capable of coronary intervention is essential 1

Common Pitfalls to Avoid

• Delaying chest compressions to check for pulse in suspected cardiac arrest - healthcare providers should not delay CPR if a pulse is not immediately found 1
• Interrupting chest compressions unnecessarily during cardiac arrest resuscitation 1
• Excessive ventilation during CPR, which can decrease venous return and cardiac output 2
• Failure to recognize cardiac arrest due to misinterpretation of gasping as normal breathing 1
• Confusing cardiac arrest with other conditions - EMS dispatchers should be specifically trained to identify cardiac arrest through focused questions about consciousness and breathing quality 1

Remember that time is critical in both conditions - every minute counts for survival and neurological outcomes 4, 5.