Transcript Slide 1

Sudden Cardiac Death
(SCD)
Definition
SCD is natural death from cardiac causes, heralded by abrupt loss of
consciousness within 1 hour of the onset of an acute change in cardiovascular
status.
Preexisting heart disease may or may not have been known to be present but the
time and mode of death are unexpected.
Prodromes, occurring weeks or months before an event, are not sensitive or
specific predictors of an impending event.
Definition
Sudden cardiac death
Cardiac arrest
Cardiovascular collapse
Sudden, irreversible cessation of all biologic
functions
Abrupt cessation of cardiac mechanical
function, which may be reversible by a prompt
intervention but will lead to death in its
absence
Sudden loss of effective blood flow due to
cardiac and/or peripheral vascular factors that
may reverse spontaneously (e.g. vasovagal
syncope) or require interventions (e.g., cardiac
arrest)
Definition
Epidemiology
SCD accounts for 5-15% of the total mortality in the US.
In absolute terms, the estimated number of SCD in the US is 350,000/yr
RISK FACTORS
Cigarette smoking
Like most of risk factors for CHD
Exercise
Transiently increased during and up to 30 minutes
after.
Family history of SCD
1.5 to 1.8-fold increased risk of SCD
Serum CRP
Chronic inflammation
Excess alcohol intake
Heavy alcohol consumption (6 or more drinks per day)
or binge drinking
Psychosocial factors
Acutely stressful situations (earthquakes, war)
Caffeine
No significant association
Major causes of SCD
70%
10%
10%
Major causes of sudden death
‫מקרה ‪1‬‬
‫בת ‪ 30‬פנתה לרופא המשפחה בשל חום (‪ )38.7‬ושיעול ליחתי‪.‬‬
‫מקרה ‪1‬‬
‫יומיים לאחר התחלת טיפול אנטיביוטי התמוטטה בביתה‪.‬‬
‫‪Polymorphic VT‬‬
‫)‪Torsade de pointes (TdP‬‬
‫מקרה ‪1‬‬
‫מקרה ‪1‬‬
Acquired LQTS
Electrolyte imbalance
Hypokalemia, Hypocalcaemia, Hypomagnesemia
Metabolic disturbance
Hypothermia, Starvation Diets, Exposure to Organophosphates
Drug Therapy
Antiarrhythmics, Cisapride, Fluconazole, Phenothiazines, Tricyclic
Antidepressants, CNC stimulants: Concerta/Ritaline
(methylphenidate), Strattera (Atomoxetine)
Inherited LQTS
Inherited LQTS
‫מקרה ‪2‬‬
‫בן ‪ – 30‬עבר החייאה לאחר שהתמוטט בביתו‪.‬‬
Brugada Syndrome
An autosomal dominant genetic disorder.
Characterized by abnormal findings on ECG in conjunction with an increased risk of
ventricular tachyarrhythmias and SCD.
Genetic analysis has led to the identification of causative mutations in the SCN5A
gene, encoding subunits of a cardiac sodium channel.
Sudden cardiac arrest may be the initial presentation (30%)
Arrhythmic events generally occur between the ages 22 - 65
More common at night than in the day and during sleep than while awake.
Brugada Syndrome
Brugada pattern Vs. Brugada syndrome
–
A 10% event rate at 2.5 years
Typical ECG plus one of the following:
–
Documented ventricular fibrillation (VF)
–
Polymorphic ventricular tachycardia (VT)
–
Family history of SCD at less than 45 years of age
–
Inducible VT during electrophysiology study
–
Unexplained syncope suggestive of a tachyarrhythmia
‫מקרה ‪3‬‬
‫בן ‪ 60‬התלונן על כאבים בחזה והתמוטט‪.‬‬
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‫עבר החייאה מוצלחת (כ ‪ 10‬דקות) והובא למיון‪.‬‬
‫מקרה ‪4‬‬
‫בן ‪ – 70‬התלונן על חולשה ולאחר כשעה התמוטט‪ .‬עבר החייאה והובא למיון‪.‬‬
‫מקרה ‪4‬‬
‫בן ‪ – 70‬התלונן על חולשה ולאחר כשעה התמוטט‪ .‬עבר החייאה והובא למיון‪.‬‬
‫מקרה ‪4‬‬
‫בן ‪ – 70‬התלונן על חולשה ולאחר כשעה התמוטט‪ .‬עבר החייאה והובא למיון‪.‬‬
Conduction system
‫מקרה ‪5‬‬
‫בן ‪ 18‬התמוטט במהלך משחק כדורגל‪ .‬עבר החייאה והובא למיון‪.‬‬
5 ‫מקרה‬
Normal
HCM
‫מקרה ‪5‬‬
HCM
Hypertrophic cardiomyopathy (HCM) is a genetically determined (AD) heart muscle
disease.
Most often (60-70%) caused by mutations in one of several sarcomere genes.
Symptoms (particularly during or immediately following exertion)
–
Dyspnea
–
Fatigue
–
Chest pain
–
Presyncope and syncope
–
Palpitation
–
SCD
‫מקרה ‪6‬‬
‫בן ‪ 25‬התמוטט במהלך ריצה‪ .‬עבר החייאה והובא למיון‪.‬‬
‫‪epsilon wave‬‬
ARVC
Arrythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disease,
typically inherited as an autosomal dominant trait.
SCD can be the first presentation
–
10% of SCD
–
75% during routine daily activities
–
10% during the perioperative period
–
3.5% while participating in sports
‫מקרה ‪7‬‬
‫בת ‪ 68‬התמוטטה במהלך ריצה‪ .‬עברה החייאה והובאה למיון‪.‬‬
‫בבדיקה – א"ס‪ ,‬גסה‪ ,‬בנקודה אאורטלית קורנת לקרוטידים‪ .‬קול שני לא נשמע‪.‬‬
Management
Identification and treatment of acute reversible causes (cath, electrolytes etc.)
Evaluation for structural heart disease
In patients without obvious arrhythmic triggers or cardiac structural abnormalities,
an evaluation for primary electrical diseases
Neurologic and psychologic assessment
In selected patients with a suspected or confirmed heritable syndrome, evaluation
of family members
Management
Secondary prevention – An implantable cardioverter-defibrillator (ICD) therapy