Sudden cardiac death
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Sudden cardiac death is defined as an unexpected circulatory arrest usually due to a cardiac arrhythmia occurring within an hour of the onset of symptoms. It is often caused by coronary heart disease leading to cardiac arrest, most commonly ventricular fibrillation. Diagnostic tests include ECG, echocardiogram, ambulatory ECG, electrophysiology testing, MRI, and angiogram. Treatment includes drugs that block sodium channels, beta blockers, potassium channel blockers, calcium channel antagonists, drugs for cardiac remodeling, aspirin, statins, cardioverter-defibrillators, and ablation. An implantable cardioverter-defibrillator is recommended for patients with sustained ventricular tachycardia or ventricular fibrill
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Sudden cardiac death
- 1. Sudden Cardiac Death By: Dr. Ismah, Medical Department HKK Reference: ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 8/6/2014 1 ‘Death from an unexpected circulatory arrest, usually due to a cardiac arrhythmia occurring within an hour of the onset of symptoms’
- 2. • ¾ caused by CHD cardiac arrest (commonest VF, 80%) • Important symptoms: palpitation, pre & syncope • Ix: ecg, echo, ambulatory ecg, intracardiac electrophysiology testing, MRI, angiogram • Rx: drugs (type I: fast sodium channel blockers, type II: beta blockers, type III: repolarization potassium current blockers e.g. amiodarone, type IV: calcium channel antagonists), drugs for cardiac remodelling, ASA, statin, cardioverter-defibrillator, ablation *ICD therapy should be used for treatment in patients who have sustained VT and/or VF and who are receiving chronic optimal medical therapy and who have reasonable expectation of survival with a good functional status for more than 1 year 8/6/2014 2
- 3. Right ventricular cardiomyopathy • Autosomal dominant, young age group • ECG: 8/6/2014 3
- 4. Hypertrophic obstructive cardiomyopathy • Autosomal dominant • Young, athlete • Family history sudden death • ECG – VT, AF, VF • Echo – asymmetrical septal hypertrophy 8/6/2014 4
- 5. Takotsuba cardiomyopathy • Surge of stress hormone mimic MI arrhythmias cardiac death • Ecg mimic ant MI • Echo: hyperkinetic/normal at basal LV while other region of LV hypokinetic • If survive, LV fx improves in 2 months 8/6/2014 5
- 6. Congenital long QT syndrome • Commonly autosomal dominant • Prolonged ventricle repolarization • Elicit by stress or may occurred at rest • Lifestyle changes, beta blocker, ICD 8/6/2014 6
- 7. Brugada like ECG • Autosomal dominant • Cardiac sodium channel gene • >Male 8/6/2014 7
- 9. 8/6/2014 9
- 10. 8/6/2014 10
Editor's Notes
- - Cardiac arrest Death from an unexpected circulatory arrest, usually due to a cardiac arrhythmia occurring within an hour of the onset of symptoms, in whom medical intervention (e.g., defibrillation) reverses the event ¾ caused by CHD cardiac arrest (commonest VF, 80%) Important symptoms palpitation, pre & syncope Cardiomyopathy Inherited abnormality e.g. brugada syndrome & long QT syndrome Premature sudden death < 60 y/o ECG 1 small box = 0.04s Ix: ecg, echo, ambulatory ecg, intracardiac electrophysiology testing, MRI, angiogram Rx: drugs (type I: fast sodium channel blockers, type II: beta blockers, type III: repolarization potassium current blockers e.g. amiodarone, type IV: calcium channel antagonists), drugs for cardiac remodelling, ASA, statin, cardioverter-defibrillator, ablation *ICD therapy should be used for treatment in patients who have sustained VT and/or VF and who are receiving chronic optimal medical therapy and who have reasonable expectation of survival with a good functional status for more than 1 y.
- Dysplasia – fibrofatty infiltration Rx: ICD, ablation, heart transplant
- Pharmacological: beta blocker, verapamil ICD Life style: avoid active sports
- Also known as broken heart syndrome, stress cardiomyopathy, stress-induced cardiomyopathy or apical ballooning syndrome Ventriculogram
- Rx: lifestyle, b blocker, ICD + b bloker Corrected QT =QT/√RR 0.38-0.42s aka 2 large boxes Autosomal dominant Romano-Ward and Timothy syndromes and the much rarer autosomal recessive cases Potassium-sensitive periodic paralysis, ventricular arrhythmias, and dysmorphic features (short stature, defect soft & hard palate Anderson syndrome) Drugs causing long QT: amiodarone, sotalol, levofloxacin, ees, antidepressant
- Brugada – name of Spanish cardiologist
- Acute management cardiac arrest