sudden cardiac-death
TRANSCRIPT
Sudden Cardiac DeathDR ABDULPGY3MEM
Definition
The natural death from cardiac causes, heralded by abrupt loss of consciousness within 1 hour of the onset of an acute change in cardiovascular status.
Epidemiology
300,000 cases per year 1-2/1000 Bimodal distribution
Causes
Long QT Syndrome Brugada Syndrome Hypertrophic Cardiomyopathy Arrhythmogenic Right Ventricular Dysplasia Commotio Cordis Coronary Anomaly
Long QT Syndrome
Autosomal Dominate- Romano-Ward Autosomal Recessive- Jervell and Lange-Nielsen Acquired 1/10,000
Presentation
Palpitations, Presyncope, Syncope, Seizures, or Cardiac arrest
Asymptomatic prolonged QTc Referred by family members Has a predilection for younger patient
http://www.torsades.org/
Diagnosis: Schwartz score
Therapy
NEJM 2008; 358:169-175
Brugada Syndrome
Autosomal dominate defect in cardiac Na channels- variable expression
0.4% US population Male predominance Average age of Dx=41
Texas Heart Inst J 2007;34:67-75
Presentation
Funny looking ECG SCD/Syncope Triggers
Fever Sleep Glucose/insulin Cocaine/ETOH Electrolytes
Unmasking Agents
Na channel blockers-ajmaline Calcium Channel blockers Beta blockers Nitrates Tricyclics SSRI
Prognosis & TREATMENT SCD or VF/VT Syncope
Hypertrophic Cardiomyopathy
defect in the myocardial contractile proteins
HCM is a familial disease
hallmark : myocardial hypertrophy that is inappropriate, often asymmetrical, and occurs in the absence of an obvious inciting hypertrophy stimulus.
Presentation
SCD DOE Syncope Heart failure Chest Pain Palpitation Asymptomatic
Physical Exam
Systolic Crescendo-decrescendo murmur LLSB/apex
Decreases w/ squatting, hand drip Increase w/ standing Bifid pulses EKG-LVH
Diagnosis
ECHO
Treatment
Pharmocologic Verapamil Beta blockers
ICD Class I- h/o sustained VT/VF One or more major risk factor
Ablation/Surgery
Arrhythmogenic Right Ventricular Dysplasia
Defective Desmosome Fibrofatty replacement of the RV myocardium 1:1000 Autosomal dominant -mcf
Presentation Asymptomatic Palpitation, syncope, atypical chest pain,
dyspnea Arrhythmias SCD
Exercise associated
Diagnosis
History Familial disease by histologyEKG Epsilon waves or QRS 110 ms+ in V1-V3
Biopsy Endomyocardial biopsy with fibrofatty replacementSevere isolated RV dilatation & dysfunction
Severe segmental dilatation of RVLocalized RV aneurysm (DK)
History Family history of SCDLBBB VT
Late potentials on SAECGTWI in V2 & V3 (no rbbb)
Mild isolated global RV dilatation and/or dysfunctionMild segmental dilatation of RV
Regional RV HKEcho/MRI
MINOR
Criteria for the Diagnosis of ARVD
MAJOR
Echo/MRI
EKG
2major or 1major + 2minor or 4minor
Treatment
ICD: Class I: History of sustained VT/VF Class IIa: extensive disease, LV involvement,
family members w/ SCD, syncope Amiodarone or Sotalol-Class IIA Ablation-Class IIA
Commotio Cordis
SCD due to low-impact precordial trauma Male predominance, young age High mortality Probability related to speed, time, hardness of
object and location of impact
Commotio cordis
Treatment CPR Shock
Prevention Safety baseballs Chest protectors
Follow up EKG Holter Echo
Congenital Coronary Artery Anomalies
Variation in the take off the Coronary Arteries Incidence 5.60.17% Deaths related to exertion
Pathophysiology Compression between the pulmonary artery
and aorta Acute angle take off Myocardial necrosis
Presentation
Angina Atypical chest pain Syncope Palpitation Dizziness SCD
Diagnosis
ECHO Cardiac MRI CT angiography Cardiac Cath
Military Significance
Treatment
Beta Blockers Surgery Coronary Stents Avoid strenuous activities
0/1-not advisable, 2/3 intermediate risk, 4/5-permitted
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