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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

‘Death from an unexpected circulatory arrest, usually due to a cardiac arrhythmia occurring

within an hour of the onset of symptoms’

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• 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

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Right ventricular cardiomyopathy• Autosomal dominant, young age group• ECG:

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Hypertrophic obstructive cardiomyopathy

• Autosomal dominant• Young, athlete • Family history sudden death• ECG – VT, AF, VF• Echo – asymmetrical septal hypertrophy

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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

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Congenital long QT syndrome

• Commonly autosomal dominant• Prolonged ventricle repolarization• Elicit by stress or may occurred at rest• Lifestyle changes, beta blocker, ICD

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Brugada like ECG• Autosomal dominant• Cardiac sodium channel gene• >Male

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THANK YOU

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