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- 1. SUDDEN CARDIAC ARREST ANDDEATH DR. SOUMEN PRASAD BEHERA CONSULTANT CARDIOLOGIST APOLLO HOSPITALS, BBSR
- 2. 5 6 78 1 2 3 4 DEFINATION DATA ON SCD CAUSES PATHOPHYSIOLOGY ECG PREDICTORS MANAGEMENT PREVENTION SUDDEN CARDIAC DEATH RISK FACTORS
- 3. SUDDEN CARDIAC DEATH •Naturaldeath from cardiac causes •Abrupt loss of consciousness within 1 hour of the onset of an acute change in cardiovascular status •Some definitions of SCD include up to a 24 hour period and death during sleep
- 4. SUDDEN CARDIAC DEATH SUDDEN IRREVERSIBLECESSATION OF ALL BIOLOGIC FUNCTIONS AS A CONSEQUENCE OF CARDIAC ARREST CARDIAC ARREST
- 5. SUDDEN CARDIAC DEATH SUDDEN IRREVERSIBLECESSATION OF ALL BIOLOGIC FUNCTIONS AS A CONSEQUENCE OF CARDIAC ARREST CARDIAC ARREST ABRUPT CESSATION OF CARDIAC MECHANICAL FUNCTION LEADING TO DEATH IN THE ABSENCE OF REVERSAL BY A PROMPT INTERVENTION
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- 7. 2 LAKHS/YEAR 3.8LAKHS/YEAR 7 LAKHS/YEAR IN HOSPITAL SCA (US) OUT OF HOSPITAL SCD (US) SCD INDIA
- 9. 50 % RULE 50% ofall cardiovascular deaths 50% of all SCDs are unexpected first expressions of a cardiac disorder 50% of years of potential life lost due to heart disease as it affects the productive years of one’s life
- 12. PERSONAL OR FAMILYHISTORY OF HEART DISEASE 04 03 02 01 SMOKING HYPERCHOLESTEROLEMIA RISK FACTORS FOR SUDDEN CARDIAC DEATH HYPERTENSION
- 13. OBESITY 08 07 06 05 DIABETES ALCOHOL CONSUMPTION RISK FACTORSFOR SUDDEN CARDIAC DEATH SEDENTARY LIFE STYLE
- 14. AGE : TWOPEAKS – 1ST YEAR OF LIFE & 45-75 YRS 12 11 10 09 GENDER :MALES > 2 TO 3 TIMES AS FEMALES PSYCHOLOGICAL STRESS RISK FACTORS FOR SUDDEN CARDIAC DEATH DRUG ABUSE OF COCAINE AND AMPHETAMINES
- 15. 14 13 VENTRICULAR ARRYTHYMMIAS(> 10 VPC/hr) RISK FACTORS FOR SUDDEN CARDIAC DEATH LOW LVEF IN CHRONIC IHD
- 16. A FIRST DEGREERELATIVE OF A SUDDEN CARDIAC DEATH VICTIM PRIMARY CARDIAC ARREST
- 17. RISK FACTORS FORSCD IN HCM YOUNG AGE OF ONSET STRONG FAMILY HISTORY OF SCD SEPTAL THICKNESS > 30 mm VENTRCULAR ARRYTHYMIAS
- 18. RISK FACTORS FORSCD IN HCM FALL IN BP DURING EXERCISE SYNCOPE NON SUSTAINED VT ON AMBULATORY ECG RECORDING DEGREE OF CARDIAC FIBROSIS
- 20. ECG PREDICTORS OFSCD 1 2 4 3 PATHOLOGICAL Q WAVES OR DYNAMIC ST/T CHANGES PROLONGED QRS DURATION OR QT INTERVAL OR LBBB INCREASE R WAVE VOLTAGE FRAGMENTED QRS
- 21. • Any Q-wavein leads V2–V3 ≥ 2 mm or QS complex in leads V2 and V3 • Q-wave ≥ 0.03 s and > 1 mm deep or QS complex in leads I, II, aVL, aVF, or V4–V6 in any two leads of a contiguous lead grouping • I, aVL,V6; • V4–V6; • II, III, and aVF PATHOLOGICAL Q WAVE
- 22. PREDICTORS OF SCD TMT 24HOURS HOLTER EPISODES OF NON SUSUTAINED VENTRCULAR TACHYCARDIA. REDUCED HR VARIABILITY. INCREASED VENTRCULAR ECTOPICS.
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- 24. CAD 18% NORMAL HEART17% VIRAL MYOCARDITIS 12% ARRHYTHMOGENIC CARDIOMYOPATHY 10% HCM 9% MVP 8% CONDUCTION SYSTEM ABNORMALITIES 6% ALCAPA 5% AORTIC RUPTURE 3% OTHERS 12%
- 28. SCD IN ATHELETES < 35YRS : HCM > 35 YRS : CAD
- 29. Ø DELTA WAVE ØSHORT PR INTERVAL Ø DIRECTION OF ST AND T WAVE OPPOSITE TO THE DELTA WAVE WPW SYNDROME
- 30. EARLY REPOLARISATION SYNDROME •WIDESPREADCONCAVE ST ELEVATION, MOST PROMINENT IN THE MID-TO-LEFT PRECORDIAL LEADS (V2-5) •NOTCHING OR SLURRING AT THE J POINT •NO RECIPROCAL ST DEPRESSION TO SUGGEST OCCLUSION MI
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- 32. TYPE 1 COVED STSEGMENT ELEVATION >2MM IN >1 OF V1-V3 FOLLOWED BY A NEGATIVE T WAVE. IT IS OFTEN REFERRED TO AS BRUGADA SIGN
- 33. TYPE 2 >2 mmOF SADDLEBACK SHAPED ST ELEVATION.
- 34. TYPE 3 MORPHOLOGY OFEITHER TYPE 1 OR TYPE 2, BUT WITH <2MM OF ST SEGMENT ELEVATION
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- 39. SUDDEN CARDIAC DEATH FOURTEMPORAL PERSPECTIVES
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- 48. DC SHOCK ANDCPR B
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- 52. 01 02 0304 ANTI ARRHYTHMIC DRUGS ICD CATHETER ABLATION THERAPY SURGICAL INTERVENTIONAL STRATEGY