Important lessons from the collapse of NHL player Rich Peverley

Last night my Twitter stream lit up with the news that NHL player Rich Peverley collapsed from a heart arrhythmia. Fortunately, he was successfully treated, and is reported to be in good condition.

Here is a link to the best story I could find. It sounds awfully significant.

[Dr.] Salazar said of the treatment, “We provided oxygen for him. We started an IV. We did chest compressions on him and defibrillated him, provided some electricity to bring a rhythm back to his heart, and that was successful with one attempt, which is very reassuring.”

A couple of things to clarify about this matter. First, cardiac arrest is different from heart attack. The term “heart attack” is used to mean myocardial infarction. This more common scenario occurs when a blood vessel, called a coronary artery, on the outside of the heart becomes blocked, usually with clot. The obstruction leads first to starvation of downstream heart muscle (ischemia), then, if not reversed within 90 minutes, death of the downstream heart muscle (infarction). Sometimes an abrupt loss of nutrients to the heart can cause electrical instability and ventricular (not atrial) fibrillation. So some heart attacks can cause cardiac arrest.

This is not likely what happened to Mr. Peverley. Previous reports tell us that Mr. Peverley had been treated for heart rhythm problems in the preseason. A video taken during the game last night seems to show he collapsed abruptly on the bench. Given his young age and prior history, it is likely he had a “primary” electrical disorder of some sort.

Remember the break point on age. Athletes over the age of 35 who suffer cardiac arrest usually do so because of blockage of an artery. Athletes under the age of 35 with cardiac arrest usually have heart muscle disease, such as hypertrophic cardiomyopathy or right ventricular dysplasia, or they have electrical disease, such as long QT syndrome. (The caveat here is what’s called an anomalous coronary artery–the Pete Maravich cause of death.)

Image from Wikipedia
Image from Wikipedia

The most important point about the Peverley story is that he survived not because of anything that was done before the event, (e.g. ECG screening) but rather by early resuscitation and early defibrillation with an AED.

I can’t stress the point of early intervention enough. This group of researchers from France found major regional disparities in survival from cardiac arrest. The authors concluded: “SCA [Sudden Cardiac Arrest] cases from regions with the highest levels of bystander resuscitation had the best survival rates to hospital admission and discharge.”

It is not hard to learn how to help others survive cardiac arrest. Last November at the AHA meeting, I did this report on how a one-minute video could save lives.

My colleague Dr. William Dillon (@wmdillion) is leading a local effort here in Louisville to improve our city’s dismal survival rate from cardiac arrest. It’s going to be about education of fellow human beings. One of the most interesting stats Dr. Dillon promotes is that those who learn CPR techniques are most likely to use them on a loved one.

Heart disease is the leading cause of death in the US. Treatment wise, early and effective intervention for cardiac arrest is low-hanging fruit.

One can hope that increased efforts in public education and AED availability will make successes like Mr. Peverley’s more common.

JMM

10 comments

  1. How gratifying that prompt resuscitation efforts saved Rich Peverly last night. Although the medical staff “provided oxygen – started an IV – and did chest compressions” – what they did that counted was defibrillate Rich Peverly with an available AED (Automatic External Defibrillator). Early electricity to potentially lethal arrhythmia = saving the patient’s life. Hopefully the cause of the arrhythmia can be elucidated (sounds like he’s had some problems before) – and there should be excellent potential for longterm treatment or prevention of recurrence. It could have ended very differently. THANKS for posting!

  2. Why did give the guy not have a pacemaker? When he was found to suffer from an iirregular heartrythm and playing active top Level hockey? My gathering is he would have been ok and this would not be in the News and the game would be history.. Maybe he would have felt a slam in the chest as the pacemaker hit him and that would be all. The specifics in Peverleys situation I know nothing about, but I do have general knowledge and from what I have read it seems a bit odd he was not equipped With a pacemaker before the incident that easily couod have cost him his life. I presume he will have the operation within a week. The question is, will he continue playing pro hockey after this? I hope it Works out and he can play another 4-5 years and be well through his final Seasons and life thereafter.

  3. The below website said he was treated for afib:

    http://bleacherreport.com/articles/1988472-scary-scene-for-dallas-stars-as-rich-peverley-has-heart-stop-on-bench

    EXCERPT:

    “Peverley had just returned to the Stars after an episode of atrial fibrillation, a heart condition characterized by a rapid and irregular heartbeat.

    According to the Associated Press (via ESPN), Peverley had an episode last week where he felt his heart flutter before a flight. He was checked by doctors and had been cleared to return, playing in two games before his collapse.

    Peverley’s condition had been discovered during preseason physicals. An unusual EKG led to more tests, leading to Peverley undergoing a cardiac procedure called ablation, where part of the heart is damaged to stop the unusual and potentially dangerous arrhythmia. This common procedure does not preclude return to play and has a very short recovery time.”

  4. John,
    Wonderful piece on Rich Peverley and cardiac arrests. A couple of critical points that make this case unusual and much more survivable. His cardiac arrest was witnessed and in a public location. Only 20% of cardiac arrests happen in public. Having a witnessed arrest and receiving CPR doubles or triples your survival during a cardiac arrest. He received prompt defibrillation with an automated external defibrillator (AED). Less than 3% of cardiac arrest victims receive a shock with an AED. The main difficulty is in locating an AED and also a fear of AEDs. AEDs are very safe and easy to use. I am very happy for this young man. However, for most cardiac arrest victims, their best chance of survival is promptly calling 911 and starting hands-only CPR. CPR extends the amount of time that the heart and brain can survive until the heart can be restarted with an electrical shock by EMS. Sadly only 25% of cardiac arrest victims receive CPR. Hands only CPR is a simple easy to learn technique that does not involve mouth breathing. This is the current recommend CPR technique for lay people to perform CPR. You can see more posts about cardiac arrest @starttheheart2

  5. Thank you for elucidating this. And Eirick, it’s not a pacemaker even though it can do that. It’s an implantable cardioversion defibrillator.

  6. The team physician at the press conference today said it appears his afib degenerated into vfib.

  7. I see he is “shackled” to the wcd…..why would anyone utilize a noninvasive, effective, safe, cost-effective, insurance-covered, well-reviewed, life-saving device in an evaluation period?

    prompt defibrillation is the key dr. M……when are you going to learn?

      1. Yes Dr. M, I am reading your stuff and I completely/respectfully disagree with the way you discount and undeserevedly describe the wcd.

        You completely contradict yourself in this review regarding prompt defibrillation. I commend you on promoting a plan of action and promoting the reasons behind “prompt defibrillation”; those phrases are indeed what make the wcd unique.

        One day you will utilize the wcd and rely on it to get your patient from point A to point B. “When”, I guess, is the question. As I rarely disagree with your reviews/articles, you have the wcd all wrong and with this high profile case supposedly “shackled” to the wcd in in your mind, your credibility loses significant steam.

        Your credibility exhales a close resemblence to HOT AIR.

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