Connections: February 2023 - 5

Q A
&
with Kevin Kwaku, MD, PhD
CARDIAC
ARREST:
How to help
You've probably seen the video of Buffalo
Bills safety Damar Hamlin collapsing in cardiac
arrest on the football field last month. The fact
that it happened on " Monday Night Football "
and the wide media coverage kept Hamlin's
story-and recovery -in the headlines
throughout January. Why the intense interest?
No doubt it's because it's so rare for that to
happen-and, for many of us, so scary.
We talked to Kevin Kwaku, MD, PhD,
director of clinical electrophysiology at
Dartmouth Health's Heart & Vascular Center,
about the incident and what we could do to
assist if we ever witnessed a cardiac arrest.
Q: What caused Hamlin's cardiac arrest?
With the caveat/proviso that I have not
treated him nor have access to his medical
records, the general consensus within both the
cardiology and sports medicine communities
is that he suffered from commotio cordis-a
cardiac arrest resulting from transfer of
mechanical energy from an unfortunately
timed impact to the chest.
Q: What are the chances of that happening?
Very low, since the impact needs to be neither
too light nor too strong, must occur within
a very specific area of the chest, and most
critically, the timing must be within a critical
window of time within the cardiac heartbeat
cycle, just as the heart is relaxing.
Q: What are the major causes of cardiac
arrest?
By far in this country the most common
cause is from ischemic heart disease-disease
resulting from blockages in the coronary arteries
that feed the heart. A cardiac arrest can occur at
the time of an acute blockage, or any time after
a heart attack has caused scarring of the heart.
What's a cardiac electrophysiologist?
Not easy to say, but pretty easy to explain
Often called EPs for short, think of electrophysiologists as
the " electricians of the heart. " If there is a needed repair to the
electrical system that operates the heart, it is experts from this
subspecialty who typically will diagnose and treat the problem.
Though years of advanced training are required to become
an electrophysiologist, the basic science is simple. Electrical
impulses generate heartbeats that pump our blood. Most
of the time, the electrical system does its work efficiently.
But sometimes, because of a malfunction, the heartbeats
Q: That leads to an important question:
What's the difference between cardiac
arrest and a heart attack?
A heart attack is when blood flow to the
heart is blocked, and downstream tissue
becomes injured or dies from that blocked
blood flow. Cardiac arrest occurs when the
heart's regular rhythm malfunctions-an
electrical storm takes place, the result being
that the heart suddenly stops beating
Q: If I'm a passerby and see someone who
has collapsed, would there be a way for
me to know whether it's cardiac arrest or a
heart attack?
If there's no pulse, it's likely a cardiac arrest.
Q: Would that make a difference in how I
respond?
None at all. Call for help and begin CPR. Apply
an AED (automated external defibrillator) if one
is available.
Q: What is the advantage of knowing CPR?
It's really simple: You could save someone's
life.
Q: If I don't know CPR, what can I do other
than call 911?
Two big steps: 1) Learn CPR. 2) Apply an AED.
Q: Is CPR hard to learn?
No, not at all. The American Heart
Association runs courses, and many hospitals
and community organizations regularly
offer first aid courses that teach people how
to use an AED and perform CPR. For lessformal
familiarity, there are a multitude of
instructional videos online.
can be either too fast, too slow or irregular. These are called
arrhythmias, or disorders of the heart rhythm.
Electrophysiology studies-achieved by inserting temporary
catheters into the heart-are sometimes done to determine the
cause of the disorder. Treatments can include ablation therapy,
using heat or cold energy to create tiny scars in the heart
tissue to eliminate abnormal electrical signals; implantation
of pacemakers or defibrillators, to help coordinate electrical
impulses; or the use of medication to control the heart's rhythm.
Connections: February 2023

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