emergency medicine

1. Sudden Cardiac Death
ASHMAL KT

2.  Coronary artery disease is the major
cause of sudden cardiac death in
adults and is presentin 80% of cases,
 cardiomyopathy (10% to 15%)
 hereditary channelopathies, valvular
disease, congenital anomalies), which
account for most of the remaining
5% to 10% of cases.4

4. CARDIOMYOPATHY
 Risk of suddencardiac death increases at a rate of
approximately 1% per year
 Hypertrophic cardiomyopathy is the most
common cardiovascular cause of sudden cardiac
death in young athletes.
 AD defect in the myocardial contractile protiens

5.  Presentation
 Sudden cardiac death,dyspnea,
heart failure,syncope ,paliptations
 Double apical impulse,
 Systolic crescendo-decrescendo
murmur.
 Prominent a wave in jvp
 Ecg –LVH
 symmetrical septal hypertrophy
produces deep, narrow (“dagger-
like”) Q waves in the lateral (V5-6,
I, aVL) and inferior (II, III, aVF)
leads.

8.  Arrhythmogenic right ventricular
cardiomyopathy
 Defective desmosome
 electrocardiogram typically showsT-
waveinversion in the right precordial
leads (V1-3).

10.  keratoderma with woolly hair and
cardiomyopath

11. CONGENITAL HEART DISEASE

12.  The most frequent coronary artery
anomaly associated with suddencardiac
death is anomalous origin of the left
coronary artery from thepulmonary
artery syndrome.
 The greatest risk of sudden cardiac
death in children and adultswith
congenital heart disease exists in those
with left heart obstructive lesions .

13. HEREDITARY
CHANNELOPATHIES
 Sudden Arrhythmic Death
Syndrome-characterized by sudden
cardiac death occurringout of hospital
in relatively young adults (mostly
men), oftenduring sleep or at rest,
usually without any premonitory
symptoms(including syncope) and
with no anatomic abnormality
identified at autopsy

14. Brugada’s Syndrome
 Brugada’s syndrome most commonly
affectsmen and consists of a prominent
J-wave with a characteristic downsloping
ST-segment elevation in
electrocardiogram leadsV1–3
 autosomal dominant inheritance
 sudden unexplained nocturnal death
syndrome.

16. Long QT Syndrome
 characterized by prolongation of the
corrected QT interval (QTc), syncope, and
suddendeath caused by torsade de
pointes and ventricular fibrillation.
 AD-Romano ward with nerve deafness
 AR-Jervell lange
 PRESENTATION
Palpitation,syncope,cardiac arrest
QTc= QT/ square root of R-R
Schwarts scoring for prognosis

17. Early Repolarization
Syndrome
 prominent, notch-like J wave on the QRS
down-slope, followed by upsloping ST-
segment elevation

18. PREVENTION OF SUDDEN
CARDIAC DEATH
chest discomfort, dyspnea, and “not
feeling well.”
Ecg , cag , tmt
Avoid proarrythmic drugs
B blockers
Implantable cardiac defibrillators

19.  A) vsd
 B) mvp
 C)hocm
 D)as

20.  A) arvd
b) hocm
 C)mvp
 D)long qt