Ventricular Fibrillation

Ventricular fibrillation is life-threatening

Ventricular fibrillation (v-fib for short) is the most serious cardiac rhythm
disturbance. The lower chambers quiver and the heart can't pump any blood,
causing cardiac arrest.
How it works
The heart's electrical activity becomes disordered. When this happens, the
heart's lower (pumping) chambers contract in a rapid, unsynchronized way. (The
ventricles "fibrillate" rather than beat.) The heart pumps little or no blood.
Collapse and sudden cardiac arrest follows -- this is a medical emergency! Watch
an animation of v-fib.

Some causes of Ventricular fibrillation

Lack of proper blood flow to the heart muscle or damage to the heart
muscle from a heart attack.
Cardiomyopathy
Problems with the aorta
Drug toxicity
Sepsis (severe body infection

Signs of cardiac arrest

Sudden loss of responsiveness (no response to tapping on shoulders)

No normal breathing (the victim is not breathing or is only gasping)
This is sudden cardiac arrest (SCA) -- which requires immediate medical
help (CPR and defibrillation)!

Treatment for cardiac arrest caused by ventricular fibrillation

Ventricular fibrillation can be stopped with a defibrillator, which gives an electrical
shock to the heart. If you see someone experiencing the signs of cardiac arrest:

Yell for help. Tell someone to call 9-1-1 and get an automated external
defibrillator (AED) if one is available. You begin CPR immediately.
 If you are alone with an adult who has these signs of cardiac arrest, call 9-
1-1 and get an AED (if one is available) before you begin CPR.
When doing CPR, push down on the chest at least 2 inches at a rate of at
least 100 compressions a minute. After each compression, let the chest
come back up to its normal position.
Use an AED as soon as it arrives.
Continue CPR until the person starts to respond or trained emergency
medical help arrives and takes over.
While Hands-Only CPR (giving chest compressions alone) may be
effective for teens or adults who suddenly collapse, the AHA
recommends CPR with a combination of compressions and breaths
(given as sets of 30 compressions and 2 breaths) for: all infants, children
up to puberty, anyone found already unconscious and not breathing
normally, and any victim of drowning, drug overdose, collapse due to
breathing problems, or prolonged cardiac arrest.

Learn more about defibrillation

Reducing risk of ventricular fibrillation

Arrhythmia medications may help control rhythm disturbances.

Implantable cardioverter defibrillators (ICDs) can correct life-threatening
rhythms in high-risk patients.

What Is a Heart Attack?

A heart attack happens when the flow of oxygen-rich blood to a section
of heart muscle suddenly becomes blocked and the heart cant get
oxygen. If blood flow isnt restored quickly, the section of heart muscle
begins to die.

Heart attack treatment works best when its given right after
symptoms occur. If you think you or someone else is having a heart
attack, even if youre not sure, call 911 right away.

Overview

Heart attacks most often occur as a result of coronary heart

disease (CHD), also called coronary artery disease. CHD is a condition
in which a waxy substance called plaque builds up inside the coronary
arteries. These arteries supply oxygen-rich blood to your heart.

When plaque builds up in the arteries, the condition is

called atherosclerosis. The buildup of plaque occurs over many years.
 Eventually, an area of plaque can rupture (break open) inside of an
artery. This causes a blood clot to form on the plaque's surface. If the
clot becomes large enough, it can mostly or completely block blood
flow through a coronary artery.

If the blockage isn't treated quickly, the portion of heart muscle fed by
the artery begins to die. Healthy heart tissue is replaced with scar
tissue. This heart damage may not be obvious, or it may cause severe
or long-lasting problems.

Heart With Muscle Damage and a Blocked Artery

Figure A is an overview of a heart and coronary artery showing damage (dead heart
muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery
with plaque buildup and a blood clot.

A less common cause of heart attack is a severe spasm (tightening) of

a coronary artery. The spasm cuts off blood flow through the artery.
Spasms can occur in coronary arteries that aren't affected by
atherosclerosis.

Heart attacks can be associated with or lead to severe health

problems, such as heart failureand life-threatening arrhythmias.

Heart failure is a condition in which the heart can't pump enough blood
to meet the body's needs. Arrhythmias are irregular heartbeats.
Ventricular fibrillation is a life-threatening arrhythmia that can cause
death if not treated right away.

Don't Wait--Get Help Quickly

Acting fast at the first sign of heart attack symptoms can save your life
and limit damage to your heart. Treatment works best when it's given
right after symptoms occur.

Many people aren't sure what's wrong when they are having symptoms
of a heart attack. Some of the most common warning symptoms of a
heart attack for both men and women are:

Chest pain or discomfort. Most heart attacks involve discomfort in

the center or left side of the chest. The discomfort usually lasts more
than a few minutes or goes away and comes back. It can feel like
pressure, squeezing, fullness, or pain. It also can feel like heartburn or
indigestion.
 Upper body discomfort. You may feel pain or discomfort in one or
both arms, the back, shoulders, neck, jaw, or upper part of the
stomach (above the belly button).
Shortness of breath. This may be your only symptom, or it may
occur before or along with chest pain or discomfort. It can occur when
you are resting or doing a little bit of physical activity.

Other possible symptoms of a heart attack include:

Breaking out in a cold sweat

Feeling unusually tired for no reason, sometimes for days (especially if
you are a woman)
Nausea (feeling sick to the stomach) and vomiting
Light-headedness or sudden dizziness
Any sudden, new symptom or a change in the pattern of symptoms
you already have (for example, if your symptoms become stronger or
last longer than usual)

Not all heart attacks begin with the sudden, crushing chest pain that
often is shown on TV or in the movies, or other common symptoms
such as chest discomfort. The symptoms of a heart attack can vary
from person to person. Some people can have few symptoms and are
surprised to learn they've had a heart attack. If you've already had a
heart attack, your symptoms may not be the same for another one.

Quick Action Can Save Your Life: Call 911

If you think you or someone else may be having heart attack

symptoms or a heart attack, don't ignore it or feel embarrassed to call
for help. Call 911 for emergency medical care. Acting fast can
save your life.

Do not drive to the hospital or let someone else drive you. Call an
ambulance so that medical personnel can begin life-saving treatment
on the way to the emergency room. Take a nitroglycerin pill if your
doctor has prescribed this type of treatment.

Other Names for a Heart Attack

Myocardial infarction (MI)
Acute myocardial infarction (AMI)
Acute coronary syndrome
Coronary thrombosis
Coronary occlusion
Myocardial Infarction (Heart
Attack)
A heart attack occurs if the flow of oxygen-rich blood to a
section of heart muscle suddenly becomes blocked. If blood
flow isn't restored quickly, the section of heart muscle begins to
die.
PubMed Health Glossary
(Source: NIH - National Heart, Lung, and Blood Institute)

SymptomsTestsTreatmentsPrevention
About the Heart

About Heart Attack

A heart attack happens when the flow of oxygen-rich blood to a section
of heart musclesuddenly becomes blocked and the heart can't get oxygen.
If blood flow isn't restored quickly, the section of heart muscle begins to die.
Heart attack treatment works best when it's given right after symptoms
occur. If you think you or someone else is having a heart attack, even if
you're not sure, call 9-1-1 right away.
 Ventricular Fibrillation in Emergency
Medicine Treatment & Management
Updated: Dec 30, 2015 (medscape)

Author: Keith A Marill, MD; Chief Editor: Erik D Schraga, MD more...

Prehospital Care
Because of the critical importance of early defibrillation, prehospital care is
vital for arrests due to ventricular fibrillation (VF) that occur outside the
hospital.
Interventions that impact survival and outcome of resuscitation include the
following:
Witnessed or early recognition of an arrest
Early activation of emergency medical services (EMS) system
Bystander CPR slows the degeneration of VF and improves survival.
Automated external defibrillator (AED) application and defibrillation
by trained personnel in the field
Early access to trained EMS personnel capable of performing CPR,
defibrillation, and advanced cardiac life support (ACLS)
Bystander CPR

Traditionally, CPR consists of artificial respirations and chest

compressions. Mounting evidence demonstrates that high quality chest
compressions are the critical action to provide some cardiac perfusion
during CPR, and artificial respirations are less
important. [12, 13, 14, 15] Interruption of chest compressions to perform artificial
respirations by a single resuscitator causes a loss of cardiac perfusion
pressure, and even after restarting compressions, it may take some time
before the previously obtained perfusion pressure is restored.
Other concerns exist regarding the recommendation of artificial ventilations
routinely for VF arrest. Rescuers may be prone to hyperventilate the victim,
which may lead to increased intrathoracic pressure, and resulting
decreased coronary perfusion and survival. [16] Bystanders may be more
likely to perform CPR that involves only chest compressions and no
artificial respirations.
Current American Heart Association (AHA) guidelines recommend
immediate treatment with 30 chest compressions prior to any artificial
ventilations.
Untrained lay rescuers should continue to provide chest compressions only
with an emphasis on "push hard and fast." This should continue until an
AED arrives or healthcare providers are ready to take over care.
Trained lay rescuers should provide 30 compressions to 2 artificial breaths.
Healthcare providers should perform cycles of 30 chest compressions to 2
ventilations until an advanced airway is placed. After that, chest
compressions can be performed continuously along with provision of one
breath every 6 to 8 seconds.
AHA guidelines reflect developments in this ongoing area of research,
including the "cardiocerebral resuscitation" approach, also summarized
below after the AHA algorithm. [17] This approach emphasizes minimal
interruption of continuous chest compressions (CCC) for victims of
witnessed cardiac arrest. More recent data do not suggest a difference in
outcome between performance of CPR by EMS providers with chest
compressions that are continuous or interrupted by artificial ventilations. [18]
It is important to note the arguments above apply to the use of artificial
respirations for initial resuscitation of VF circulatory arrest. Future research
may confirm the importance of artificial respirations for respiratory,
drowning, traumatic, or other causes of arrest. It is becoming clear that the
optimal treatment for these conditions with grossly different etiologies will
differ and "one size will not fit all."
Automated external defibrillator (AED) application and defibrillation by trained personnel in
the field

AEDs have revolutionized prehospital VF management because they

decrease the time to defibrillation. This is accomplished by having the units
prepositioned in the field where cardiac arrests are likely to occur (eg,
airports, casinos, jails, malls, stadiums, industrial parks), eliminating the
need for rhythm-recognition training and increasing the number of trained
personnel and laypeople that can defibrillate at the scene.
Unfortunately, even for a group of patients at high risk for VF/VT,
placement of an AED in the home was not associated with improved
mortality. [19] AEDs were also unhelpful in the hospital setting where early
access to a manual defibrillator and trained personnel are available. They
may even be detrimental to the resuscitation and survival of patients with
nonshockable rhythms such as pulseless electrical activity and
asystole. [20, 21]
AEDs are programmed to recognize 3 shockable rhythms: coarse
ventricular fibrillation, fine ventricular fibrillation, and rapid ventricular
tachycardia. Modern units have a sensitivity greater than 95% and
specificity approaching 100% for the 3 shockable rhythms. The greatest
difficulty is in distinguishing fine ventricular fibrillation from asystole.
AEDs can also be used for children. A pediatric dose-attenuating system
should be used, if available, for children up to the age of 8 years, and a
conventional AED can be used for children at or older than 8 years or with
a corresponding weight of at least 25 kg (55 lb).
Emergency Department Care
Defibrillation

Electrical external defibrillation remains the most successful treatment of

ventricular fibrillation (VF). A shock is delivered to the heart to uniformly
and simultaneously depolarize a critical mass of the excitable myocardium.
The objective is to interfere with all reentrant arrhythmia and to allow any
intrinsic cardiac pacemakers to assume the role of primary pacemaker. [22]
Successful defibrillation largely depends on the following 2 key factors:
duration between onset of VF and defibrillation, and metabolic condition of
the myocardium. VF begins with a coarse waveform and decays to a fine
tracing and eventual asystole. These electrical changes that occur over
minutes are associated with a depletion of the heart's energy reserves.
CPR slows the progression of these events, but defibrillation is the primary
treatment to interrupt the process and return the heart to a perfusing
rhythm.
Defibrillation success rates decrease 5-10% for each minute after onset of
VF. The likelihood of defibrillation success can also be predicted based on
the smoothness of the VF tracing. In strictly monitored settings where
defibrillation was most rapid, 85% success rates have been reported.
Factors that affect the energy required for successful defibrillation include
the following:
Paddle size: Larger paddles result in lower impedance, which allows
the use of lower energy shocks. Approximate optimal sizes are 8-
12.5 cm for an adult, 8-10 cm for a child, and 4.5-5 cm for an infant.
Paddle-to-myocardium distance (eg, obesity, mechanical ventilation):
Position one paddle below the outer half of the right clavicle and one
over the apex (V4-V5). Artificial pacemakers or implantable
defibrillators mandate use of anterior-posterior paddle placement.
Use of conduction fluid (eg, disposable pads, electrode paste/jelly)
Contact pressure
Elimination of stray conductive pathways (eg, electrode jelly bridges
on skin)
Previous shocks may lower the chest wall impedance and decrease
the defibrillation threshold.
Biphasic defibrillation
Biphasic defibrillation has a number of advantages over monophasic
defibrillation including increased likelihood of defibrillation success for a
given shocking energy.[23] While this has not translated into a proven
survival benefit thus far, if less shocks are required, there may be less
interruption of CPR. Lower energy shocks associated with biphasic
defibrillation may lead to less myocardial stunning after repeated
defibrillation attempts. Furthermore, smaller and lighter defibrillation units
are required to produce a biphasic waveform, and this is an important
advantage for portable AED units.
The optimal energy for first and subsequent defibrillation attempts with a
biphasic pulse remains unproven. Escalating energy levels have been
associated with increased VF conversion and termination. Unfortunately,
no improvement in survival was noted. [24]
Operators are advised to use the energy protocols associated with
individual devices, or to begin with 200 J and consider escalating energy
dose with subsequent shocks, if necessary.