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The classic Hollywood heart attack isn’t technically a heart attack. When Marlon Brando as the Godfather playfully chased his young grandson around the garden, then suddenly clutched his chest, keeled over, and died — that’s what doctors call sudden cardiac arrest.

And it turns out that these deadly events often aren’t a complete surprise, according to a report published Monday in the Annals of Internal Medicine.

“Sudden cardiac arrest has long been thought of as a bolt from the blue, but we found that many people get warning signs a day or sometimes more in advance,” said Dr. Sumeet S. Chugh, associate director of the Cedars-Sinai Heart Institute in Los Angeles, who led the new study.


Acting on these warning signs by seeing a doctor or calling 911 could help prevent hundreds of thousands of deaths from sudden cardiac arrests each year in the United States.

The term “heart attack” is used to cover two different medical emergencies. First, there are myocardial infarctions, what doctors call true heart attacks, in which a blood clot stops the flow of oxygen-rich blood to part of the heart. The heart keeps beating, but the blockage generates symptoms such as chest pain, unexpected shortness of breath, arm or jaw pain, and more.


Then there are sudden cardiac arrests, in which the heart’s electrical system goes haywire. Instead of sending steady “beat now” signals to the heart’s lower chambers (the ventricles), the electrical impulses spur fast and chaotic contractions. Circulation to the brain, lungs, and the rest of the body stops. The person collapses. The only hope for survival is to start CPR followed by a jolt of electricity from a defibrillator to shock the heart back into a normal rhythm.

About 90 percent of people die from a sudden cardiac arrest. Only about 5 percent succumb immediately to a myocardial infarction.

Chugh and his colleagues evaluated more than 800 men and women who had sudden cardiac arrests in or around Portland, Ore. They found that about half of the study subjects had experienced chest pain, shortness of breath, a fluttering heartbeat, or sudden flu-like symptoms in the hours before the arrest. The other half had no warning signs.

Most people who have a cardiac arrest have pre-existing heart disease. But “unfortunately, in about half of people, dying from a sudden cardiac arrest is the very first sign of heart disease,” said Dr. Douglas P. Zipes, a cardiologist and cardiac arrest expert at the Indiana University School of Medicine, who was not involved in the new study.

Work is underway to identify individuals at high risk for sudden cardiac arrest using biomarkers in the blood, telltale heart rhythms, and even smartphones that can analyze and store heart rhythms. But these efforts haven’t yet yielded fruit.

In the meantime, both Chugh and Zipes urge anyone who is experiencing chest pangs or other worrisome symptoms that might be signs of a heart problem to call their doctor or 911.

Among those who had warning signs in Chugh’s study, 32 percent who dialed 911 survived the cardiac arrest, compared to just 6 percent who didn’t call for help.

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