2. Whatis suddendeath?
• Sudden death is the sudden, unexpected death,
caused by a loss of heart function. It occurs most
often as a result of sustained abnormal electrical
activity in the heart. This can result from structural
problems in the heart and as a result of heart
attacks. But the causes of sudden cardiac death are
diverse.
3. Howdoesit presentclinically?
• Sudden cardiac death is responsible for up to one half of heart
disease deaths. It is not a specific disease itself, but results from a
number of very common heart diseases including heart attacks and
myocarditis. It might be best recognized from media reports
featuring apparently health young athletes that die during physical
activities. Many times these young athletes have an underlying
genetic heart disease that results in death despite their athletic
training. Similarly, myocarditis can occur in athletes following an
infection.
4. Whataretheknowncausesof suddendeath?
• There are multiple causes of sudden death. As many as 70% of
sudden death cases have been attributed to coronary heart
disease, including heart attacks and heart failure . The actual
incidence of sudden death due to myocarditis is not known, but
in routine autopsies, 1-9% of patients demonstrate evidence of
cardiac inflammation; in young adults up to 20% of sudden
death cases have been reported to be due to myocarditis. Up to
50% of patients with HIV have evidence of myocarditis on
autopsy .
5. CONTI....
• Other acquired and hereditary causes, including left ventricular
hypertrophy (enlarged heart usually due to high blood pressure),
hypertrophic cardiomyopathy (due to genetic mutations in heart
proteins), arrhythmogenic right ventricular cardiomyopathy (also
due to genetic mutations in heart proteins), mitral valve prolapse
(mainly secondary to infections), and congenital coronary artery
anomalies (due to inherited defects) have been reported. Another
10-12% of cases under the age of 45 (~5% in those older) occur
without structural heart disease.
6. Are there factors that increase ones risk of sudden death?
• Several factors are associated with an increased
risk of sudden death, including high blood
pressure, high cholesterol (High LDL, low
HDL), cigarette smoking, physical inactivity,
obesity, diabetes mellitus, and a family history
of premature death (sudden death)
7. Canexerciseput susceptiblepeopleat riskof suddendeath?
• The risk of sudden death increases during exercise and for 30 minutes
after strenuous exercise . However, the actual risk during any one episode
is extremely low (1 per 1.5+ million hours of exercise) . The transient
increase in risk is lower among those who regularly exercise . And this
small increase in risk is far outweighed by the benefits of reducing the
risk of sudden cardiac death by exercising. The exception to this is in
people with inherited heart diseases, which put them a higher risk of
sudden during exercise, including hypertrophic cardiomyopathy,
arrhythmogenic right ventricular cardiomyopathy, long QT syndrome
subtypes, and myocarditis.
9. Cansuddendeathbe predicted?
• Generally, sudden death cannot be
predicted, which makes the disease so
insidious. But people at risk can be screened
(e.g. stress testing and ECG monitoring) and
may benefit from specific interventions if
issues are identified.
10. Canriskfactorsbe reduced?
• Primary interventions: Maybe. Effective treatment of high
cholesterol, high blood pressure, the adoption of a heart-healthy
diet, regular exercise, smoking cessation, moderation of alcohol
consumption, and diabetes treatment/management may
decrease the risk of sudden death. While studies have
demonstrated that interventions to reduce risk factors reduces
coronary heart disease, the most common cause of sudden death,
risk factor reduction on sudden death itself has not been
extensively studied
11. CONTI.....
• Secondary interventions: Implantable cardioverter-defibrillator
(ICD) devices are the preferred modality of survivors of sudden
death. ICDs can detect abnormal electrical signals in the heart
which dont allow the heart to pump blood, and correct them with a
shock. While ICDs do not prevent malignant arrhythmias
(abnormal electrical signals), it terminates them when they (rarely)
happen so the heart can continue pumping. Anti-arrhythmic
drugs can also be given to prevent these abnormal electrical signals
in the heart.
