sudden cardiac-death
TRANSCRIPT
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Sudden Cardiac DeathDR ABDULPGY3MEM
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Definition
The natural death from cardiac causes, heralded by abrupt loss of consciousness within 1 hour of the onset of an acute change in cardiovascular status.
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Epidemiology
300,000 cases per year 1-2/1000 Bimodal distribution
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Causes
Long QT Syndrome Brugada Syndrome Hypertrophic Cardiomyopathy Arrhythmogenic Right Ventricular Dysplasia Commotio Cordis Coronary Anomaly
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Long QT Syndrome
Autosomal Dominate- Romano-Ward Autosomal Recessive- Jervell and Lange-Nielsen Acquired 1/10,000
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Presentation
Palpitations, Presyncope, Syncope, Seizures, or Cardiac arrest
Asymptomatic prolonged QTc Referred by family members Has a predilection for younger patient
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http://www.torsades.org/
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Diagnosis: Schwartz score
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Therapy
NEJM 2008; 358:169-175
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Brugada Syndrome
Autosomal dominate defect in cardiac Na channels- variable expression
0.4% US population Male predominance Average age of Dx=41
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Texas Heart Inst J 2007;34:67-75
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Presentation
Funny looking ECG SCD/Syncope Triggers
Fever Sleep Glucose/insulin Cocaine/ETOH Electrolytes
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Unmasking Agents
Na channel blockers-ajmaline Calcium Channel blockers Beta blockers Nitrates Tricyclics SSRI
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Prognosis & TREATMENT SCD or VF/VT Syncope
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Hypertrophic Cardiomyopathy
defect in the myocardial contractile proteins
HCM is a familial disease
hallmark : myocardial hypertrophy that is inappropriate, often asymmetrical, and occurs in the absence of an obvious inciting hypertrophy stimulus.
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Presentation
SCD DOE Syncope Heart failure Chest Pain Palpitation Asymptomatic
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Physical Exam
Systolic Crescendo-decrescendo murmur LLSB/apex
Decreases w/ squatting, hand drip Increase w/ standing Bifid pulses EKG-LVH
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Diagnosis
ECHO
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Treatment
Pharmocologic Verapamil Beta blockers
ICD Class I- h/o sustained VT/VF One or more major risk factor
Ablation/Surgery
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Arrhythmogenic Right Ventricular Dysplasia
Defective Desmosome Fibrofatty replacement of the RV myocardium 1:1000 Autosomal dominant -mcf
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Presentation Asymptomatic Palpitation, syncope, atypical chest pain,
dyspnea Arrhythmias SCD
Exercise associated
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Diagnosis
History Familial disease by histologyEKG Epsilon waves or QRS 110 ms+ in V1-V3
Biopsy Endomyocardial biopsy with fibrofatty replacementSevere isolated RV dilatation & dysfunction
Severe segmental dilatation of RVLocalized RV aneurysm (DK)
History Family history of SCDLBBB VT
Late potentials on SAECGTWI in V2 & V3 (no rbbb)
Mild isolated global RV dilatation and/or dysfunctionMild segmental dilatation of RV
Regional RV HKEcho/MRI
MINOR
Criteria for the Diagnosis of ARVD
MAJOR
Echo/MRI
EKG
2major or 1major + 2minor or 4minor
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Treatment
ICD: Class I: History of sustained VT/VF Class IIa: extensive disease, LV involvement,
family members w/ SCD, syncope Amiodarone or Sotalol-Class IIA Ablation-Class IIA
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Commotio Cordis
SCD due to low-impact precordial trauma Male predominance, young age High mortality Probability related to speed, time, hardness of
object and location of impact
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Commotio cordis
Treatment CPR Shock
Prevention Safety baseballs Chest protectors
Follow up EKG Holter Echo
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Congenital Coronary Artery Anomalies
Variation in the take off the Coronary Arteries Incidence 5.60.17% Deaths related to exertion
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Pathophysiology Compression between the pulmonary artery
and aorta Acute angle take off Myocardial necrosis
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Presentation
Angina Atypical chest pain Syncope Palpitation Dizziness SCD
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Diagnosis
ECHO Cardiac MRI CT angiography Cardiac Cath
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Military Significance
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Treatment
Beta Blockers Surgery Coronary Stents Avoid strenuous activities
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0/1-not advisable, 2/3 intermediate risk, 4/5-permitted
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thanks