In July 2023, rising US basketball star Bronny James collapsed on the court during practice and was sent to hospital. The 18-year-old athlete, son of famous LA Lakers’ veteran LeBron James, had experienced a cardiac arrest.

Many media outlets incorrectly referred to the event as a “heart attack” or used the terms interchangeably.

A cardiac arrest and a heart attack are distinct yet overlapping concepts associated with the heart.

With some background in how the heart works, we can see how they differ and how they’re related.

Understanding the heart

The heart is a muscle that contracts to work as a pump. When it contracts it pushes blood – containing oxygen and nutrients – to all the tissues of our body.

For the heart muscle to work effectively as a pump, it needs to be fed its own blood supply, delivered by the coronary arteries. If these arteries are blocked, the heart muscle doesn’t get the blood it needs.

This can cause the heart muscle to become injured or die, and results in the heart not pumping properly.

Heart attack or cardiac arrest?

Simply put, a heart attack, technically known as a myocardial infarction, describes injury to, or death of, the heart muscle.

A cardiac arrest, sometimes called a sudden cardiac arrest, is when the heart stops beating, or put another way, stops working as an effective pump.

In other words, both relate to the heart not working as it should, but for different reasons. As we’ll see later, one can lead to the other.

Why do they happen? Who’s at risk?

Heart attacks typically result from blockages in the coronary arteries. Sometimes this is called coronary artery disease, but in Australia, we tend to refer to it as ischaemic heart disease.

The underlying cause in about 75% of people is a process called atherosclerosis. This is where fatty and fibrous tissue build up in the walls of the coronary arteries, forming a plaque. The plaque can block the blood vessel or, in some instances, lead to the formation of a blood clot.

Atherosclerosis is a long-term, stealthy process, with a number of risk factors that can sneak up on anyone. High blood pressure, high cholesterol, diet, diabetes, stress, and your genes have all been implicated in this plaque-building process.

Other causes of heart attacks include spasms of the coronary arteries (causing them to constrict), chest trauma, or anything else that reduces blood flow to the heart muscle.

Regardless of the cause, blocking or reducing the flow of blood through these pipes can result in the heart muscle not receiving enough oxygen and nutrients. So cells in the heart muscle can be injured or die.

But a cardiac arrest is the result of heartbeat irregularities, making it harder for the heart to pump blood effectively around the body. These heartbeat irregularities are generally due to electrical malfunctions in the heart. There are four distinct types:

• ventricular tachycardia: a rapid and abnormal heart rhythm in which the heartbeat is more than 100 beats per minute (normal adult, resting heart rate is generally 60-90 beats per minute). This fast heart rate prevents the heart from filling with blood and thus pumping adequately
• ventricular fibrillation: instead of regular beats, the heart quivers or “fibrillates”, resembling a bag of worms, resulting in an irregular heartbeat greater than 300 beats per minute
• pulseless electrical activity: arises when the heart muscle fails to generate sufficient pumping force after electrical stimulation, resulting in no pulse
• asystole: the classic flat-line heart rhythm you see in movies, indicating no electrical activity in the heart.

Cardiac arrest can arise from numerous underlying conditions, both heart-related and not, such as drowning, trauma, asphyxia, electrical shock and drug overdose. James’ cardiac arrest was attributed to a congenital heart defect, a heart condition he was born with.

But among the many causes of a cardiac arrest, ischaemic heart disease, such as a heart attack, stands out as the most common cause, accounting for 70% of all cases.

So how can a heart attack cause a cardiac arrest? You’ll remember that during a heart attack, heart muscle can be damaged or parts of it may die. This damaged or dead tissue can disrupt the heart’s ability to conduct electrical signals, increasing the risk of developing arrhythmias, possibly causing a cardiac arrest.

So while a heart attack is a common cause of cardiac arrest, a cardiac arrest generally does not cause a heart attack.

What do they look like?

Because a cardiac arrest results in the sudden loss of effective heart pumping, the most common signs and symptoms are a sudden loss of consciousness, absence of pulse or heartbeat, stopping of breathing, and pale or blue-tinged skin.

But the common signs and symptoms of a heart attack include chest pain or discomfort, which can show up in other regions of the body such as the arms, back, neck, jaw, or stomach. Also frequent are shortness of breath, nausea, light-headedness, looking pale, and sweating.

What’s the take-home message?

While both heart attack and cardiac arrest are disorders related to the heart, they differ in their mechanisms and outcomes.

A heart attack is like a blockage in the plumbing supplying water to a house. But a cardiac arrest is like an electrical malfunction in the house’s wiring.

Despite their different nature both conditions can have severe consequences and require immediate medical attention.

Michael Todorovic, Associate Professor of Medicine, Bond University and Matthew Barton, Senior lecturer, School of Nursing and Midwifery, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

This is the next article in our ‘Light and health’ series, where we look at how light affects our physical and mental health in sometimes surprising ways. Read other articles in the series.

Exposure to light is crucial for our physical and mental health, as this and future articles in the series will show.

But the timing of that light exposure is also crucial. This tells our body to wake up in the morning, when to poo and the time of day to best focus or be alert. When we’re exposed to light also controls our body temperature, blood pressure and even chemical reactions in our body.

But how does our body know when it’s time to do all this? And what’s light got to do with it?

What is the body clock, actually?

One of the key roles of light is to re-set our body clock, also known as the circadian clock. This works like an internal oscillator, similar to an actual clock, ticking away as you read this article.

But rather than ticking you can hear, the body clock is a network of genes and proteins that regulate each other. This network sends signals to organs via hormones and the nervous system. These complex loops of interactions and communications have a rhythm of about 24 hours.

In fact, we don’t have one clock, we have trillions of body clocks throughout the body. The central clock is in the hypothalamus region of the brain, and each cell in every organ has its own. These clocks work in concert to help us adapt to the daily cycle of light and dark, aligning our body’s functions with the time of day.

However, our body clock is not precise and works to a rhythm of about 24 hours (24 hours 30 minutes on average). So every morning, the central clock needs to be reset, signalling the start of a new day. This is why light is so important.

The central clock is directly connected to light-sensing cells in our retinas (the back of the eye). This daily re-setting of the body clock with morning light is essential for ensuring our body works well, in sync with our environment.

In parallel, when we eat food also plays a role in re-setting the body clock, but this time the clock in organs other than the brain, such as the liver, kidneys or the gut.

So it’s easy to see how our daily routines are closely linked with our body clocks. And in turn, our body clocks shape how our body works at set times of the day.

What time of day?

Let’s take a closer look at sleep

The naturally occurring brain hormone melatonin is linked to our central clock and makes us feel sleepy at certain times of day. When it’s light, our body stops making melatonin (its production is inhibited) and we are alert. Closer to bedtime, the hormone is made, then secreted, making us feel drowsy.

Our sleep is also partly controlled by our genes, which are part of our central clock. These genes influence our chronotype – whether we are a “lark” (early riser), “night owl” (late sleeper) or a “dove” (somewhere in between).

But exposure to light at night when we are supposed to be sleeping can have harmful effects. Even dim light from light pollution can impair our heart rate and how we metabolise sugar (glucose), may lead to psychiatric disorders such as depression, anxiety and bipolar disorder, and increases the overall risk of premature death.

The main reason for these harmful effects is that light “at the wrong time” disturbs the body clock, and these effects are more pronounced for “night owls”.

This “misaligned” exposure to light is also connected to the detrimental health effects we often see in people who work night shifts, such as an increased risk of cancer, diabetes and heart disease.

How about the gut?

Digestion also follows a circadian rhythm. Muscles in the colon that help move waste are more active during the day and slow down at night.

The most significant increase in colon movement starts at 6.30am. This is one of the reasons why most people feel the urge to poo in the early morning rather than at night.

The gut’s day-night rhythm is a direct result of the action of the gut’s own clock and the central clock (which synchronises the gut with the rest of the body). It’s also influenced by when we eat.

How about focusing?

Our body clock also helps control our attention and alertness levels by changing how our brain functions at certain times of day. Attention and alertness levels improve in the afternoon and evening but dip during the night and early morning.

Those fluctuations impact performance and can lead to decreased productivity and an increased risk of errors and accidents during the less-alert hours.

So it’s important to perform certain tasks that require our attention at certain times of day. That includes driving. In fact, disruption of the circadian clock at the start of daylight savings – when our body hasn’t had a chance to adapt to the clocks changing – increases the risk of a car accident, particularly in the morning.

What else does our body clock control?

Our body clock influences many other aspects of our biology, including:

• physical performance by controlling the activity of our muscles
• blood pressure by controlling the system of hormones involved in regulating our blood volume and blood vessels
• body temperature by controlling our metabolism and our level of physical activity
• how our body handles drugs and toxins by controlling enzymes involved in how the liver and kidneys eliminate these substances from the body.

Morning light is important

But what does this all mean for us? Exposure to light, especially in the morning, is crucial for synchronising our circadian clock and bodily functions.

As well as setting us up for a good night’s sleep, increased morning light exposure benefits our mental health and reduces the risk of obesity. So boosting our exposure to morning light – for example, by going for a walk, or having breakfast outside – can directly benefit our mental and metabolic health.

However, there are other aspects about which we have less control, including the genes that control our body clock.

Frederic Gachon, Associate Professor, Physiology of Circadian Rhythms, Institute for Molecular Bioscience, The University of Queensland and Benjamin Weger, NHMRC Emerging Leadership Fellow Institute for Molecular Bioscience, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.