Sudden cardiac arrest is caused by an electrical malfunction that disrupts the heart's pumping action. It can result from coronary artery abnormalities, ventricular hypertrophy, myocardial diseases, inflammatory or infiltrative processes, valve diseases, congenital heart defects, electrophysiological abnormalities, or neurological influences. Treatment involves CPR, defibrillation in the emergency room, and may require procedures like angioplasty, bypass surgery, ablation, or implanting a defibrillator depending on the underlying cause. Nursing care focuses on monitoring for arrhythmias, fluid balance, anxiety, and providing patient education.

2. CARDIAC ARREST Sudden cardiac arrest is the sudden, unexpected loss of heart function, breathing and consciousness usually results from an electrical disturbance in heart that disrupts its pumping action, stopping blood flow to the rest of the body.

3. ETIOLOGICAL FACTORS I. CORONARY ARTERY ABNORMALITIES A. Coronary atherosclerosis Acute or transient myocardial ischemia Acute myocardial infarction Chronic atherosclerosis

4. B. Congenital abnormalities of coronary arteries Anomalous origin from pulmonary artery Other coronary arteriovenous fistula Origin of a left coronary branch from right or noncoronary sinus of Valsalva Origin of right coronary artery from left sinus of Valsalva Hypoplastic or aplastic coronary arteries Coronary-intracardiac shunt

5. C. Coronary artery embolism Aortic or mitral endocarditis Prosthetic aortic or mitral valves Abnormal native valves or left ventricular mural thrombus Platelet embolism

6. D. Coronary arteritis progressive systemic sclerosis, giant cell arteritis Mucocutaneous lymph node syndrome (Kawasaki disease) Syphilitic coronary ostialstenosis

7. E. Miscellaneous mechanical obstruction of coronary arteries Coronary artery dissection in Marfan syndrome Coronary artery dissection in pregnancy Prolapse of aortic valve myxomatous polyps into coronary ostia Dissection or rupture of sinus of Valsalva

8. F. Functional obstruction of coronary arteries Coronary artery spasm with or without atherosclerosis Myocardial bridges

9. II. HYPERTROPHY OF VENTRICULAR MYOCARDIUM Left ventricular hypertrophy associated with coronary heart disease Hypertensive heart disease without significant coronary atherosclerosis Hypertrophic myocardium secondary to valvular heart disease Hypertrophic cardiomyopathy Primary or secondary pulmonary hypertension

10. III. MYOCARDIAL DISEASES AND HEART FAILURE A. Chronic congestive heart failure Ischemic cardiomyopathy Idiopathic dilated cardiomyopathy Alcoholic cardiomyopathy Hypertensive cardiomyopathy Postmyocarditis cardiomyopathy Peripartum cardiomyopathy

11. B. Acute and subacute cardiac failure Massive acute myocardial infarction Acute myocarditis Acute alcoholic cardiac dysfunction Takotsubo syndrome (uncertain sudden death risk) Bail-valve embolism in aortic stenosis or prosthesis Mechanical disruptions of cardiac structures Acute pulmonary edema in noncompliant ventricles

12. IV. INFLAMMATORY, INFILTRATIVE, NEOPLASTIC, AND DEGENERATIVE PROCESSES A. Viral myocarditis, with or without ventricular dysfunction B. Myocarditis associated with the vasculitides C. Sarcoidosis D. Progressive systemic sclerosis E. Amyloidosis

13. F. Hemochromatosis G. Idiopathic giant cell myocarditis H. Chagas' disease I. Cardiac ganglionitis J. Arrhythmogenic right ventricular dysplasia; right ventricular cardiomyopathy K, Neuromuscular diseases M. Obstructive intracavitary tumors

14. V DISEASES OF THE CARDIAC VALVES Valvular aortic stenosis/insufficiency Mitral valve disruption Mitral valve prolapse Endocarditis Prosthetic valve dysfunction

15. VI. CONGENITAL HEART DISEASE A. Congenital aortic or pulmonic valve stenosis B. Right-to-left shunts with Eisenmenger physiology C. Late after surgical repair of congenital lesions (e.g., tetralogyof Fallot)

16. VII. ELECTROPHYSIOLOGICAL ABNORMALITIES A. Abnormalities of the conducting system 1. Fibrosis of the His-Purkinje system Primary degeneration Secondary to fibrosis and calcification of the "cardiac skeleton" Postviral conducting system fibrosis Hereditary conducting system disease 2. Anomalous pathways of conduction

17. B. Abnormalities of repolarization 1. Congenital abnormalities of QT interval duration a. Congenital long-QT interval syndromes b.Congenital short QT interval syndrome

18. 2.Acquired (or provoked) long QT interval syndromes a. Drug effect b. Electrolyte abnormality c. Toxic substances d. Hypothermia e. Central nervous system injury; subarachnoid hemorrhage Brugada syndrome- right bundle branch block and ST segment elevations in the absence of ischemia

19. C. Ventricular fibrillation of unknown or uncertain cause 1. Absence of identifiable structural or functional causes "Idiopathic" ventricular fibrillation polymorphicventricular tachycardia Nonspecific fibrofatty infiltration in previously healthyvictim

20. VIII. ELECTRICAL INSTABILITY RELATED TO NEUROHUMORAL AND CENTRA! NERVOUS SYSTEM INFLUENCES Catecholamine-dependent lethal arrhythmias Central nervous system related Psychic stress, emotional extremes Auditory related "Voodoo death" in primitive cultures Diseases of the cardiac nerves Arrhythmia expression in congenital long-QT interval syndrome

21. IX. SUDDEN INFANT DEATH SYNDROME AND SUDDEN DEATH IN CHILDREN A. Sudden infant death syndrome Immature respiratory control functions Long-QT interval syndrome Congenital heart disease B. Sudden death in children Eisenmenger syndrome, aortic stenosis, hypertrophic cardiomyopathy, pulmonary atresia After corrective surgery for congenital heart disease Genetic disorders of electrical function

22. X. MISCELLANEOUS A. Sudden death during extreme physical activity B. Commotiocordis—blunt chest trauma C. Mechanical interference with venous return D. Dissecting aneurysm of the aorta E. Toxic and metabolic disturbances F. Mimics sudden cardiac death

23. Risk factor A family history Smoking High blood pressure High blood cholesterol Obesity Diabetes A sedentary lifestyle Drinking too much alcohol

24. Other factors : A previous episode of cardiac arrest A previous heart attack A personal or family history of other forms of heart disease Age Being male Using illegal drugs Nutritional imbalance

25. Symptoms Sudden collapse No pulse No breathing Loss of consciousness

26. Warning signs fatigue, fainting, blackouts, dizziness, chest pain, shortness of breath, weakness, palpitations or vomiting

27. Pathophysiology Contributing factors Brady arrythmias Tachyarrythmias End of cascade Cardiac arrest

29. Electrolyte test.

31. Nuclear scan.

33. Ejection fraction testing.

35. Emergency room management Airway: Endotracheal intubation. Combitube Laryngeal mask airway Breathing:

36. Circulation: intravenous(I/V) access , attachment of monitors, electrodes/leads, rhythm identification, blood pressure and medication administration.

37. VF and pulse less VT: Pulseless electrical activity Asystole: Symptomatic bradycardia Unstable tachycardia

38. Defibrillation: delivery of an electrical current to the heart through the chest wall by the use of external paddles, connected to cablesworksby completely depolarizing the heart disrupting the impulses causing dysrrythmia

39. Automated external defibrillation AED is an external defibrillator with rhythm analysis capabilities ,analyses patients rhythm and give counter shock.

40. Implantable Cardioverter defibrillator ICD is a device consist of a generator and at least one lead that can sense an intrinsic electrical activity and deliver an electrical impulse and terminates life threatening episodes of VT and VF.

41. Cardio Version Cardio version is the delivery of a counter shock that is synchronized with patient's cardiac rhythm and is mainly used in atrial fibrillation and atrial flutter.

42. Drugs Diltiazem Dopamine: Lidocaine; Sodium bicarbonate Norepinephrine (Noradrenalin): Atropine Verapamil Vasopressin procainamide

43. SURGICAL MANAGEMENT Coronary angioplasty. Coronary bypass surgery. Radiofrequency catheter ablation. Corrective heart surgery. Heart transplantation.

44. Therapeutic hypothermia Therapeutic hypothermia is the act of cooling a patient to 32 to 34 degrees Celsius (89.6 to 93.2 degrees Fahrenheit) in order to minimize the brain injury that often occurs after a cardiac arrest.

45. NURSING MANAGEMENT potential for Arrhythmias Fluid Volume Excess Anxiety related to fear of death Activity intolerance Risk for infection Knowledge deficit

46. BIBLIOGRAPHY smeltzer,S.C and Bare,B.G (2011),Brunner and suddarth's text book of medical surgical nursing VOL I ,(12th edition).Philadelphia:lippincot Williams and wilkins publishers Pp 843- 845 . Field,M.JandSoderberg,S.E ;(2006).Advanced cardiovascular life support-provider's manual.American heart association(lst edition)Pp 25-130. Libby , Bonow,Ziper ,Braunwalds Heart Diseases,A Text book of cardiovascular Medicine,eighth edition ,saunders publishers ,pp 933-970 sole,D.G and Klein.G; (2001).Introduction to critical care nursing (4 edition).philadelphia:ElsevierpublishersPp 223-225.

47. Keen,J.H(1995).mannual of critical care nursing.st.Louis company. Black,J.M and hawks,J.K.(2005).medical surgical nursing:clinical management for positive outcomes(7th edition).st.Louis:W.B Saunders company.Pp 345-348 Lewis ,Heitkemper ,Dirksen ,Medical Surgical Nursing ,6 th edition ,mosby publishers ,pp -834 – 836 E. Brooke Lerner, Michael R. Sayre, Jane H. Brice, Lynn J. White, Amy J. Santin, Anthony J. Billittier IV and Samuel D. Cloud Resuscitation, Online December 26, 2007

48. Then ,with the perfect timing ,he silently leans forward and with a familiar and practiced gesture, offer his arm and smiles Extract from :wise traveller relationships. Thank u…. nidheesha 1styrmsc nursing