What is cardiac arrest ?

The sudden collapse from cardiac arrest of Bolton soccer star Fabrice Muamba two weeks ago shocked the nation.

But it has also given rise to confusion as to what exactly happened to the 23-year-old.

For many people the term ‘cardiac arrest’ is interchangeable with ‘heart attack’. But the truth is that the two conditions are very different. So what are those differences and how can you tell one from the other?

As the British Heart Foundation puts it, “most heart attacks are caused by coronary heart disease, which is when your coronary arteries narrow due to a… build-up of fatty material within their walls”.

A piece of the fatty material – or atheroma – can then break off and lead to the formation of a blood clot, which in turn can block the coronary artery “starving your heart of blood and oxygen and causing damage to your heart muscle – a heart attack”.

Symptoms can range from severe pain – or ‘heaviness’ and ‘tightness’ – in the centre of the chest to only mild chest discomfort that makes you feel generally unwell.

Sometimes the pain can affect the neck, jaw, arms, back or stomach, while someone suffering a heart attack may sweat, feel light-headed, nauseous or be short of breath.

Cardiac arrest, on the other hand, is “totally different”. It happens when the heart suddenly stops pumping blood around the body. The victim falls unconscious and their breathing is abnormal or stops completely.

The only chance of survival is immediate CPR (cardiopulmonary resuscitation) – or so-called ‘mouth-to-mouth’ and manual ‘pumping’ of the chest – and defibrillation, or the use of a device to deliver electrical energy to the heart.

So if a build-up of fatty material commonly causes heart attack, what can lead to cardiac arrest in a young, fit and outwardly healthy person such as Fabrice Muamba?

Cardiac arrest can occur for a variety of different reasons, one of which is, in fact, heart attack. Other causes include electrocution or choking, losing a large amount of blood, your body being extremely hot or cold, or a lack of oxygen.

But in cases such as that of Muamba, undiagnosed cardiac conditions are usually to blame. In fact, Dr Steve Fox, director of screening at the UK charity Cardiac Risk in the Young (CRY), says: “Every week in the UK, 12 apparently fit and healthy young people, under the age of 35, die from undiagnosed cardiac conditions.”

The human heart
The human heart

Eighty per cent of these deaths occur with no prior symptoms. So CRY runs a nationwide screening programme to try to identify those at risk. Adds Dr Fox: “One in every 300 of the young people that CRY tests will be identified with a potentially life threatening condition.”

It is particularly important to test those who are involved in organised sport, as while sport does not cause cardiac arrest it can “significantly increase a person’s risk if they have an underlying condition”.

These conditions often involve abnormal, or irregular, heart rhythms (arrhythmias), the most common of which is ventricular fibrillation – when the electrical activity of the heart becomes so chaotic that the heart stops pumping and quivers or ‘fibrillates’ instead.

Another is hypertrophic cardiomyopathy, or a thickening of the heart muscle, which is a leading cause of sudden cardiac death in young athletes.

So what should you do if you suspect someone has had a heart attack or cardiac arrest? For suspected heart attack, the British Heart Foundation advices three first steps:

*Get help immediately

*Get the person to sit in a comfortable position

*Phone 999 for an ambulance (911 in the USA)

If the person is unconscious and you fear cardiac arrest you should first of all approach with care. Then, to find out if they are conscious, gently shake him or her and shout loudly: “Are you all right?” If there is no response, shout for help. Then remember ABC – airway, breathing, CPR:


Open the person’s airway by tilting their head back and lifting the chin.


Look, listen and feel for signs of normal breathing for no more than 10 seconds. Ring 999 if the person is unconscious and not breathing normally.


Start chest compressions by placing the heel of one hand in the centre of their chest, placing the heel of the other hand on top of that first hand and interlocking fingers. Press down firmly and smoothly 30 times – at a rate of a little less than two per second.

After 30 compressions, open the airway again by tilting the head back and lifting the chin, and give two ‘rescue breaths’ by pinching the person’s nostrils closed using your index finger and thumb and blowing into the person’s mouth. Make sure that no air can leak out and that the chest rises and falls with each breath.

Give another 30 chest compressions and then two rescue breaths. Continue until you see signs of life, professional help arrives or you become exhausted.

If you can’t bring yourself to administer rescue breaths, then give chest compressions only.

Heart attack rates down by 50% in the UK

NHS data shows mortality rate at half the 2002 level, with fewer people smoking and better NHS care contributing factors.

The number of people dying from a heart attack has halved in the last decade, with falling rates of smoking, greater use of statins to lower cholesterol, and better NHS care thought to be behind the fall.

Fewer people in England are suffering a heart attack, and fewer of those who do are dying as a result, according to research by Oxford University reported in Thursday’s British Medical Journal.

They used official NHS data on hospital admissions and mortality to study 840,175 men and women who between them had 861,134 heart attacks between 2002 and 2010.

Overall, mortality rates among men fell by 50% and among women by 53%.

The steepest falls in heart attacks were noted among middle-aged people. Rising rates of diabetes and obesity among younger people is thought to lie behind their not seeing the same dramatic drop.

The heart
The heart

Professor Peter Weissberg, medical director of the British Heart Foundation, which funded the study, said: “This impressive fall in death rates is due partly to prevention of heart attacks by better management of risk factors such as smoking, high blood pressure and cholesterol and due partly to better treatment of heart attack patients when they reach hospital.”

Despite the welcome downward trend, “far too many heart attack victims still die from a cardiac arrest before medical help arrives. Many of these deaths could be prevented by rapid cardiopulmonary resuscitation,” added Weissberg.

Improvements in the NHS’s ability to prevent heart attacks, and better treatment of those who have one, were identified as key factors by the researchers.