Emergency Medicine Sn Chugh Pdf
Slikk Huisenga
The study, led by sudden cardiac arrest expert Sumeet Chugh, MD, found that 50% of individuals who experienced a sudden cardiac arrest also experienced a telling symptom 24 hours before their loss of heart function.
Smidt Heart Institute investigators also learned that this warning symptom was different for women than it was for men. For women, the most prominent symptom of an impending sudden cardiac arrest was shortness of breath, whereas men experienced chest pain.
"Harnessing warning symptoms to perform effective triage for those who need to make a 911 call could lead to early intervention and prevention of imminent death," said Chugh, director of the Center for Cardiac Arrest Prevention in the Smidt Heart Institute and senior author of the study. "Our findings could lead to a new paradigm for prevention of sudden cardiac death."
For this study, investigators used two established and ongoing community-based studies, each developed by Chugh: the ongoing Prediction of Sudden Death in Multi-Ethnic Communities (PRESTO) Study in Ventura County, California, and the Oregon Sudden Unexpected Death Study (SUDS), based in Portland, Oregon.
"It takes a village to do this work," said Chugh, the Pauline and Harold Price Chair in Cardiac Electrophysiology Research, medical director of the Heart Rhythm Center in the Department of Cardiology, and director of the Division of Artificial Intelligence in Medicine in the Department of Medicine. "We initiated the SUDS study 22 years ago and the PRESTO study eight years ago. These cohorts have provided invaluable lessons along the way. Importantly, none of this work would have been possible without the partnership and support of first responders, medical examiners and the hospital systems that deliver care within these communities."
In both the Ventura and Oregon studies, Smidt Heart Institute investigators evaluated the prevalence of individual symptoms and sets of symptoms prior to sudden cardiac arrest, then compared these findings to control groups that also sought emergency medical care.
The Ventura-based study showed that 50% of the 823 people who had a sudden cardiac arrest witnessed by a bystander or emergency medicine professional, such as an emergency medicine service (EMS) responder, experienced at least one telltale symptom 24 hours previously. The Oregon-based study showed similar results.
"This is the first community-based study to evaluate the association of warning symptoms -- or sets of symptoms -- with imminent sudden cardiac arrest using a comparison group with EMS-documented symptoms recorded as part of routine emergency care," said Eduardo Marbn, MD, PhD, executive director of the Smidt Heart Institute and the Mark Siegel Family Foundation Distinguished Professor.
"Next we will supplement these key sex-specific warning symptoms with additional features -- such as clinical profiles and biometric measures -- for improved prediction of sudden cardiac arrest," said Chugh.
Dr. Sarah Myers is a pharmacist and freelance medical writer and fact checker. With 15 years of experience as a community pharmacist, she is passionate about educating consumers so they may actively participate in their own healthcare. Her professional interests include medication safety, lifestyle medicine, and the mind-body connection.
Cardiac arrest is different from a heart attack. A heart attack happens when a blockage in an artery stops blood from flowing through the different sections of the heart, but it does not cause the heart to completely stop beating as cardiac arrest does.
According to Dr. Sumeet Chugh, a cardiac electrophysiologist and director of the Center for Cardiac Arrest Prevention in the Smidt Heart Institute at Cedars-Sinai Health System and lead author of this study, it is important to have better predictors for sudden cardiac arrest.
This is not the first study to look at new ways of predicting sudden cardiac arrest. Previous studies have used artificial intelligence (AI) and a deep learning algorithm to help predict cardiac arrest.
Upon analysis, researchers found that 50% of people who had a sudden cardiac arrest in the studies that was witnessed by a bystander or an emergency medical professional experienced at least one telltale symptom 24 hours beforehand.
Medical News Today also spoke about this study with Dr. Jennifer Wong, cardiologist and medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA.
As far as a difference in the 24-hour warning symptoms of sudden cardiac arrest, Dr. Wong said there are also gender differences in other cardiovascular diseases, such as a heart attack that could potentially cause cardiac arrest.
image: Heart experts have long believed that weekday mornings -- and especially Mondays -- were the danger zones for unexpected deaths from sudden cardiac arrests. But a new Cedars-Sinai study shows those peak times have disappeared and now, sudden cardiac arrests are more likely to happen on any day at any time. view more
LOS ANGELES - Oct. 2, 2018 - Heart experts have long believed that weekday mornings - and especially Mondays - were the danger zones for unexpected deaths from sudden cardiac arrests. But a new Cedars-Sinai study shows those peak times have disappeared and now, sudden cardiac arrests are more likely to happen on any day at any time.
"While there are likely several reasons to explain why more cardiac arrests happen outside of previously identified peak times, stress is likely a major factor," said Sumeet Chugh, MD, professor of medicine and associate director of the Smidt Heart Institute at Cedars-Sinai. "We now live in a fast-paced, 'always on' era that causes increased psycho-social stress and possibly, an increase in the likelihood of sudden cardiac arrest," said Chugh, the primary investigator on the study, published in the peer-reviewed journal Heart Rhythm.
Chugh's team of investigators analyzed data from the community-based Oregon Sudden Unexpected Death Study between 2004 to 2014. All reported cases were based on emergency medical service reports containing detailed information regarding the cause of the cardiac arrest.
- Of the 1,535 patients who died from sudden cardiac arrest, only 13.9 percent died in the early morning hours between 6 - 10 a.m.
- There was no evidence that more sudden cardiac arrests occurred on Mondays.
- Aside from stress, other contributing factors may be a shift in how high-risk patients are being treated, as well as inadequacies in how past studies have measured time of death caused by sudden cardiac arrest (such as using time of death found on a death certificate versus time of death when sudden cardiac arrest actually occurred).
Although "sudden cardiac arrest" and "heart attack" often are used interchangeably, the terms are not synonymous. Unlike heart attacks (myocardial infarctions), which are typically caused by clogged coronary arteries reducing blood flow to the heart muscle, sudden cardiac arrest is the result of defective electrical activity of the heart. Patients may have little or no warning, and the disorder usually causes instantaneous death. Sudden cardiac arrest accounts for approximately 300,000 deaths each year in the U.S.
The Oregon Sudden Unexpected Death Study is a comprehensive, 16-hospital, multiyear assessment of cardiac deaths in the 1 million population Portland, Oregon, metropolitan area. Led by Chugh, the project - now ongoing for more than 15 years - provides researchers with unique, community-based information to help determine the causes of sudden cardiac arrest.
"Because sudden cardiac arrest is usually fatal, we have to prevent it before it strikes," said Chugh, the Pauline and Harold Price Professor of Cardiac Electrophysiology Research. "This is just another piece to the puzzle. Our next steps are to conclusively determine the underlying reasons behind this shift, then identify public health implications as a result."###
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Hometown: Greenwood, Indiana
Undergrad: Indiana University, Bloomington, IN
Medical School: Indiana University School of Medicine, Indianapolis, IN
Career/Research Interests: Adolescents, kiddos living with varying abilities, service dog assistance, mental health, SDOH, nutrition/exercise
After Residency: General Outpatient Pediatrics
Hobbies/Interests: Family, dogs, college basketball (go Hoosiers!), Cincinnati Reds, Indianapolis Colts
Bio: I grew up in Greenwood, Indiana, a suburb of Indianapolis, and completed my Biology BS and Psychology minor at Indiana University. As a medical student, I found a sense of peace when working with children. Their contagious laughter and incredible resilience are simply unparalleled. The field of pediatrics offers the special opportunity to build relationships with and provide education and empowerment to both children and their families. There is nothing more rewarding than sitting down with a family and developing a plan that meets their specific needs and goals. When I interviewed at Mizzou, I knew that they valued the physician-patient-family relationship in this same way. I felt the genuine interest that the staff and residents here have in helping both their patients and each other succeed. I am beyond grateful for the opportunity to expand my pediatrics knowledge and get to know the Columbia community here at Mizzou.
Hometown: Green Bay, WI
Medical School: University of Wisconsin School of Medicine & Public Health
Career/Research Interests: Primary Care, Rural Health
After Residency: Rural General Pediatrics
Hobbies/Interests: Baking bagels, reading, game nights, Lego, craft beer, the Packers, and spoiling my cat Robin
Bio: I grew up in Green Bay, WI (Go Pack!) and completed undergrad at Marquette University with a major in biomedical sciences and minors in chemistry and history. I went to UWSMPH for medical school where I was in the rural health and public health programs. As part of the rural health program, I completed my clinical rotations at a community hospital in Green Bay and several outlying clinics. As part of the public health program, I completed a public health field course in Thailand and worked on several community projects in Green Bay. I chose pediatrics because the rotations that involved child health were my favorite in med school. Children brighten any day and I enjoy the unique opportunity pediatrics provides to form impactful relationships with patients and their families. It is incredibly rewarding to watch patients grow up and support them and their families along the way. I chose Mizzou for residency because being a smaller-sized program at a large university creates a program with a family feel and plenty of learning opportunity. Columbia, as a smaller midwestern city with minimal traffic and lots of local restaurants and bars to explore, also felt a lot like home.