Sudden chest pain isn’t something you’re likely to ignore. This symptom—along with breathlessness, cold sweats and other classic heart attack symptoms—is a clear sign that you need to call 911.

While a possible heart attack is scary enough, the reality actually could be even worse. With sudden cardiac arrest (SCA), brain damage is almost certain unless you are treated within just a few minutes. And unlike a heart attack, which many people survive, SCA is almost always fatal. But what if that grim picture could be improved?

A chance of survival: Research suggests that paying close attention to early signs that may precede SCA—as well as being prepared in your home, where this killer condition most often strikes—could mean the difference between life and death.

What you need to know…


A heart attack occurs when a blood clot interrupts blood flow to a section of the heart. In contrast, with SCA, an electrical malfunction in the heart triggers a dangerous abnormality in the heart rhythm (arrhythmia) that disrupts blood flow to the brain and other organs.

Only about 10% of people who suffer SCA live long enough to get to a hospital. Most—such as newsman Tim Russert who succumbed to SCA in 2008—collapse and then die within minutes.


About 356,000 Americans (not including hospitalized patients) suffer SCA each year. If your doctor has warned you about elevated cholesterol, high blood pressure or other cardiovascular risk factors, you know that you could be setting yourself up for a heart attack. But the same conditions also mean that you’re at risk for SCA.

For certain other people, SCA is truly a stealth killer. It sometimes occurs in those who have “silent” (often congenital) cardiovascular disease. Abusing drugs or alcohol also increases risk for SCA.


When someone suffers cardiac arrest, the only symptoms that occur simultaneously tend to be sudden collapse and a loss of consciousness. The victim also will have stopped breathing and won’t have a detectable pulse.

What’s new: Many individuals do have advance warning of SCA—even if they choose to ignore it.

In fact, when researchers recently looked into this, they found that 53% of SCA patients had prior -symptoms, including chest pain, shortness of breath, heart palpitations and/or fainting. The symptoms—identical to those that often accompany heart attacks—occurred anywhere from one hour to four weeks before the SCA. Since SCA is so closely tied to heart disease, it makes sense that many victims will have heart disease symptoms before they suffer from SCA. If you have any of these symptoms, consult a doctor!


Most of the same approaches that will protect you from a heart attack—such as maintaining a healthy weight and not smoking—will help you avoid SCA. Also useful for people concerned about SCA…

    • Consider buying an automated external defibrillator (AED). It can triple the likelihood of survival when used within the first minute or two of SCA. An AED is about the size of a laptop computer. The cost ranges from $1,200 to $2,500 but might be covered by insurance or Medicare if you have a high-risk arrhythmia or another heart condition. The device is easy to operate. Once it’s turned on, a voice and screen explain where to attach the electrodes and when to push the buttons.

Be sure to act quickly: If someone collapses, use the device immediately. It won’t prompt you to deliver a shock unless the person is experiencing SCA. For each one-minute delay, the chance of survival from SCA drops about 10%.

Important: I advise everyone who has heart disease or heart disease risk factors to talk to his/her doctor about owning one of these devices (or sharing one with close neighbors)—and to watch an online video or take an in-person class on how to use it. AEDs are available online.

  • Chest compressions. Even if an AED is available, give chest compressions until it is ready to be placed on the victim’s chest. If the heartbeat hasn’t started after following AED voice prompts, do chest compressions for two minutes and use the AED again. Or if there’s no AED, do chest compressions alone. Don’t waste time checking for a pulse or giving mouth-to-mouth breathing—it’s the chest compressions that are needed to restart the victim’s heart. If someone collapses and is unresponsive and you suspect it’s SCA, call 911 first. Then give the compressions, and don’t stop (it’s hard work, so you may need help from a bystander) until the emergency medical service arrives.

How to do compressions: Put the heel of one hand on the center of the chest (between the nipples)…place the heel of your other hand on top of the first hand for strength…position your body over your hands…and press hard about two inches into the chest. Try to give at least 100 compressions per minute (almost two per second).

For a hands-only CPR video: Go to For more detailed instruction, sign up for in-person training at your local hospital or fire department.


If you suffer SCA in the hospital (or if you get to an ER in time), you’ll be given treatments to restart the heart and re-establish heart, brain and lung functions.

Induced hypothermia , a promising therapy to reduce the damage from SCA, is available at many hospitals. This therapy involves rapid cooling of the body to about 89°F for about 24 hours. Cooling the body as soon as the heart has been restarted lowers the metabolic requirements of the brain and reduces the risk for long-term neurological problems, such as coma.

People who survive SCA may need additional treatments to prevent a second cardiac arrest.

Examples: Some are given an implantable cardioverter defibrillator (ICD), a surgically implanted device that analyzes the heartbeat and administers shocks to treat ventricular fibrillation. Another approach, radio-frequency ablation, uses radio-frequency energy to destroy abnormal heart cells that can cause irregular rhythms.