This document discusses sudden cardiac arrest and death (SCD). It defines SCD and provides data on its prevalence. It outlines various risk factors for SCD including personal or family history of heart disease, smoking, hypertension, obesity, and more. The document discusses ECG predictors of SCD and various cardiac conditions that can cause SCD like coronary artery disease, cardiomyopathies, channelopathies and more. It also outlines the management of sudden cardiac arrest including assessing rhythm and providing defibrillation and CPR if needed. Prevention strategies discussed include antiarrhythmic drugs, ICD implantation, catheter ablation and surgery.
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SUDDEN CARDIAC DEATH@.pdf
1. SUDDEN CARDIAC ARREST
AND DEATH
DR. SOUMEN PRASAD BEHERA
CONSULTANT CARDIOLOGIST
APOLLO HOSPITALS, BBSR
2. 5 6 7 8
1 2 3 4
DEFINATION DATA ON SCD
CAUSES PATHOPHYSIOLOGY
ECG
PREDICTORS
MANAGEMENT PREVENTION
SUDDEN CARDIAC DEATH
RISK FACTORS
3. SUDDEN CARDIAC DEATH
•Natural death 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
5. SUDDEN
CARDIAC DEATH
SUDDEN IRREVERSIBLE CESSATION 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
7. 2 LAKHS/YEAR 3.8 LAKHS/YEAR 7 LAKHS/YEAR
IN HOSPITAL
SCA (US)
OUT OF
HOSPITAL SCD
(US)
SCD
INDIA
8.
9. 50 %
RULE
50% of all
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
10.
11.
12. PERSONAL OR FAMILY HISTORY OF HEART DISEASE
04
03
02
01
SMOKING
HYPERCHOLESTEROLEMIA
RISK FACTORS FOR SUDDEN CARDIAC DEATH
HYPERTENSION
14. AGE : TWO PEAKS – 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
16. A FIRST DEGREE RELATIVE
OF A SUDDEN CARDIAC DEATH VICTIM
PRIMARY CARDIAC ARREST
17. RISK FACTORS FOR SCD IN HCM
YOUNG AGE OF ONSET
STRONG FAMILY HISTORY OF SCD
SEPTAL THICKNESS > 30 mm
VENTRCULAR ARRYTHYMIAS
18. RISK FACTORS FOR SCD IN HCM
FALL IN BP DURING EXERCISE
SYNCOPE
NON SUSTAINED VT ON AMBULATORY ECG RECORDING
DEGREE OF CARDIAC FIBROSIS
19.
20. ECG PREDICTORS OF SCD
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-wave in 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
24 HOURS
HOLTER
EPISODES OF NON SUSUTAINED VENTRCULAR
TACHYCARDIA.
REDUCED HR VARIABILITY.
INCREASED VENTRCULAR
ECTOPICS.
29. Ø DELTA WAVE
Ø SHORT PR INTERVAL
Ø DIRECTION OF ST AND T WAVE OPPOSITE TO THE DELTA WAVE
WPW SYNDROME
30. EARLY REPOLARISATION SYNDROME
•WIDESPREAD CONCAVE 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