This document discusses sudden coronary death and its causes, diagnosis, and emergency treatment. It defines sudden cardiac death as unexpected natural death from cardiac causes within 1 hour of symptom onset. The main causes are atherosclerotic coronary artery disease, nonatherosclerotic abnormalities of the coronary arteries, ventricular hypertrophy, acute heart failure, electrophysiological abnormalities, and central nervous system influences. Emergency therapy for clinical death involves immediate CPR and defibrillation to restart the heart, followed by medical stabilization and long-term treatment or procedures in the hospital.

1. SOUTH KAZAKHSTAN MEDICAL
ACADEMY
TOPIC : CORONARY DEATH
SUBMITTED BY:- Chesam Sahid Ahmad
SUBMITTED TO:- MISS Mira
GROUP NO:- 405 (a)
Shymkent 2022-2023
DEPARTMENT OF FUNDAMENTAL OF INTERNAL DISEASES-1

2. CONTENT
▪Sudden coronary death.
▪Definition, clinic.
▪Emergency therapy at the stage of
clinical death.
▪Acute left ventricular heart failure.
▪Conclusion

3. DEFINITION
• Sudden cardiac death (SCD) is unexpected, abrupt natural death
from cardiac causes within 1 hour of symptom onset.
• Preexisting heart disease may or may not have been known to be
present, but the time and mode of death are unexpected

5. 1. Atherosclerotic Coronary Artery Disease
2. Nonatherosclerotic Coronary Artery Abnormalities
🔹️Anomalous Origin of Coronary Arteries from the Wrong Sinus
of Valsalva.
🔹️Embolism to the Coronary Arteries.
🔹️Coronary Arteritis.- Kawasaki disease , polyarteritis nodosa
,syphilitic aortitis
🔹️Mechanical Obstruction of Coronary Arteries. –Coronary
artery dissection, prolapse of myxomatous polyps, dissection or
rupture of a sinus of Valsalva aneurysm
🔹️Deep myocardial bridges over coronary arteries- common in
association with hypertrophic cardiomyopathy.
🔹️ Coronary artery spasm.
CAUSES OF SUDDEN CARDIAC DEATH

6. 3. Ventricular Hypertrophy and Hypertrophic Cardiomyopathy
1. Left ventricular hypertrophy is an independent risk factor for SCD -
hypertensive heart disease with or without atherosclerosis,
2. valvular heart disease,
3. obstructive and nonobstructive hypertrophic cardiomyopathy
4. ,primary pulmonary hypertension with right ventricular
hypertrophy,
5. and advanced right ventricular overload secondary to congenital
heart disease.

7. 4. Acute Heart Failure
▪︎massive acute myocardial infarction
▪︎acute myocarditis,
▪︎acute alcoholic cardiac dysfunction
▪︎ acute pulmonary edema
▪︎ massive pulmonary embolism,
▪︎mechanical disruption of intracardiac structures secondary
to infarction or infection
5 .Electrophysiologic Abnormalities
• Long QT syndrome
• Short QT syndrome
• Brugada stndrome
• Catecholaminergic Polymorphic Ventricular Tachycardia.
• Central Nervous System Influences

8. PATHOLOGY
• More than 80% of SCD victims have pathologic
findings of CHD
• 70–75% of males who die suddenly have preexisting
healed MIs,
• whereas only 20–30% have recent acute MIs
• Transient ischemia Is the mechanism of onset.

11. DIAGNOSIS
▪ECG
▪Echocardiogram
▪Coronary angiography
▪Exercise test
▪Electrophysiology testing
▪Cardiac MRI
▪Genetic testing if ARVC, Brugada syndrome, CPVT, or
LQTS are found
▪Cardiac biopsy may be considered if no other cause is
found

12. Differential Diagnosis
Angina Pectoris
Aortic Stenosis
Dilated Cardiomyopathy
Ebstein Anomaly
Hypertrophic Cardiomyopathy
MI
Teratology of Fallot
Ventricular Fibrillation
Ventricular Premature Complexes
Ventricular Tachycardia
Woff-Parkinson-White Syndrome

13. Emergency therapy at the
stage of clinical death
CPR :-
Immediate CPR is
crucial for treating
sudden cardiac arrest.
By maintaining a flow of
oxygen-rich blood to
the body's vital organs,
CPR can provide a vital
link until more-
advanced emergency
care is available

14. Defibrillation :-
Advanced care for
ventricular fibrillation, a
type of arrhythmia that
can cause sudden cardiac
arrest, generally includes
delivery of an electrical
shock through the chest
wall to the heart. The
procedure, called
defibrillation,
momentarily stops the
heart and the chaotic
rhythm. This often allows
the normal heart rhythm
to resume.

15. At the emergency room :-
Once you arrive in the emergency room, the medical staff will work to
stabilize your condition and treat a possible heart attack, heart failure
or electrolyte imbalances. You might be given medications to stabilize
your heart rhythm.
Long-term treatment :-
After you recover, your doctor will discuss with you or your family what
other tests might help determine the cause of the cardiac arrest.
Treatment may include;
• Drugs
• Implantable cardioverter-defibrillator (ICD).
• Coronary angioplasty.
• Coronary bypass surgery
• Radiofrequency catheter ablation
• Corrective heart surgery.

16. CONCLUSION
SCD occurs most often at home in the
presence of relatives and after a longer
period of typical warning symptoms.
Although the much-hailed use of public
access defibrillation is supported by
several studies, the present results raise
the question of whether educational
measures and targeted educational
programs tailored for patients at risk and
their relatives should have a higher priority.

17. REFERENCE
1. 2017 AHA/ACC/HRS Guideline for
Management of Patients With Ventricular
Arrhythmias and the Prevention of Sudden
Cardiac Death
2. Braunwald’s heart disease
3. Harrisons principles of internal medicine
4. Paul l marino ICU Book
5. Hayashi M, Shimizu W, Albert CM. The
spectrum of epidemiology underlying sudden
cardiac death. Circ Res. 2015 Jun
05;116(12):1887-906