sudden cardiac death (scd). scd is natural death from cardiac causes, heralded by abrupt loss of...
TRANSCRIPT
SCD is natural death from cardiac causes, heralded by abrupt loss of
consciousness within 1 hour of the onset of an acute change in
cardiovascular status.
Preexisting heart disease may or may not have been known to be
present but the time and mode of death are unexpected.
Prodromes, occurring weeks or months before an event, are not
sensitive or specific predictors of an impending event.
Definition
Definition
Sudden cardiac deathSudden, irreversible cessation of all biologic functions
Cardiac arrestAbrupt cessation of cardiac mechanical function, which may be reversible by a prompt intervention but will lead to death in its absence
Cardiovascular collapse
Sudden loss of effective blood flow due to cardiac and/or peripheral vascular factors that may reverse spontaneously (e.g. vasovagal syncope) or require interventions (e.g., cardiac arrest)
SCD accounts for 5-15% of the total mortality in the US.
In absolute terms, the estimated number of SCD in the US is
350,000/yr
Epidemiology
RISK FACTORS
Cigarette smoking Like most of risk factors for CHD
Exercise Transiently increased during and up to 30 minutes after.
Family history of SCD 1.5 to 1.8-fold increased risk of SCD
Serum CRP Chronic inflammation
Excess alcohol intake Heavy alcohol consumption (6 or more drinks per day) or binge drinking
Psychosocial factors Acutely stressful situations (earthquakes, war)
CaffeineNo significant association
Acquired LQTS
Electrolyte imbalance
Hypokalemia, Hypocalcaemia, Hypomagnesemia
Metabolic disturbance
Hypothermia, Starvation Diets, Exposure to Organophosphates
Drug Therapy
Antiarrhythmics, Cisapride, Fluconazole, Phenothiazines, Tricyclic Antidepressants, CNC stimulants:
Concerta/Ritaline (methylphenidate), Strattera (Atomoxetine)
An autosomal dominant genetic disorder.
Characterized by abnormal findings on ECG in conjunction with an
increased risk of ventricular tachyarrhythmias and SCD.
Genetic analysis has led to the identification of causative mutations in
the SCN5A gene, encoding subunits of a cardiac sodium channel.
Sudden cardiac arrest may be the initial presentation (30%)
Arrhythmic events generally occur between the ages 22 - 65
More common at night than in the day and during sleep than while
awake.
Brugada Syndrome
Brugada pattern Vs. Brugada syndrome
– A 10% event rate at 2.5 years
Typical ECG plus one of the following:
– Documented ventricular fibrillation (VF)
– Polymorphic ventricular tachycardia (VT)
– Family history of SCD at less than 45 years of age
– Inducible VT during electrophysiology study
– Unexplained syncope suggestive of a tachyarrhythmia
Brugada Syndrome
Hypertrophic cardiomyopathy (HCM) is a genetically determined (AD) heart
muscle disease.
Most often (60-70%) caused by mutations in one of several sarcomere genes.
Symptoms (particularly during or immediately following exertion)
– Dyspnea
– Fatigue
– Chest pain
– Presyncope and syncope
– Palpitation
– SCD
HCM
Arrythmogenic right ventricular cardiomyopathy (ARVC) is an inherited
disease, typically inherited as an autosomal dominant trait.
SCD can be the first presentation
– 10% of SCD
– 75% during routine daily activities
– 10% during the perioperative period
– 3.5% while participating in sports
ARVC
7 מקרה
התמוטטה במהלך ריצה. עברה החייאה והובאה למיון. 68בת
בבדיקה – א"ס, גסה, בנקודה אאורטלית קורנת לקרוטידים. קול שני לא נשמע.
Identification and treatment of acute reversible causes (cath,
electrolytes etc.)
Evaluation for structural heart disease
In patients without obvious arrhythmic triggers or cardiac structural
abnormalities, an evaluation for primary electrical diseases
Neurologic and psychologic assessment
In selected patients with a suspected or confirmed heritable
syndrome, evaluation of family members
Management