Introductory Chapter: Cardiac Disease - Plague in the Modern World

Abstract

Medicine has been recognized as an art of understanding and healing human illnesses and injuries for thousands of years. Warfare, economic turmoils, and all kinds of socioeconomic factors affect medical knowledge and practice in cardiac diseases, mostly prominent in the last centuries. After 1960s, breakthrough changes and innovations in cardiac biomarkers, electrocardiographic monitoring, defibrillation, therapeutic temperature management (TTM), capnography, and some other instruments have been launched, and these have been thought to mitigate the burden of cardiac diseases. Nowadays, it is obvious that electrocardiography, defibrillation, and cardiopulmonary resuscitation (CPR) are far from its current format in the 1950’s and 1960’s world. Out-of-hospital cardiac arrest (OHCA) remains a major death scenario in the middle-aged population all over the world. Despite all new major advances, survival for OHCA is, on average, approximately 10%, but substantial variability is visible among emergency medical services systems even in the most developed countries. Four kinds of fatal arrhythmias (ventricular fibrillation-VF, pulseless ventricular tachycardia, asystole, and pulseless electrical activity) result in a loss of cardiac function and sudden cardiac death. VF is one of the most deadly cardiac arrhythmias and certainly the most common one. It can be described as erratic, disorganized firing of impulses from the ventricles, producing no palpable pulses in the periphery. Literature data have shown that the earlier defibrillation and bystander CPR have been commenced, the lower is the patient mortality. Since considerable differences can affect people’s lives in this context, the role of medical command bears utmost importance to direct these patients to facilities with discrete capabilities [1]. Another aspect of the emergency life-saving interventions in these patients comprises urgent coronary revascularization. Since most patients presenting with OHCA and refractory VF suffer from an acute thrombotic coronary artery lesion, urgent coronary angiography with revascularization is critical.