Sudden Cardiac Death(SCD)

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

Definition

Sudden cardiac deathSudden, irreversible cessation of all biologic functions

Cardiac arrestAbrupt cessation of cardiac mechanical function, which may be reversible by a prompt intervention but will lead to death in its absence

Cardiovascular collapse

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

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

Epidemiology

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)

CaffeineNo significant association

Major causes of SCD

70%

10%

10%

Major causes of sudden death

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יומיים לאחר התחלת טיפול אנטיביוטי התמוטטה בביתה.

Polymorphic VT

Torsade de pointes (TdP)

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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

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– עבר החייאה לאחר שהתמוטט בביתו.30בן

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

Brugada Syndrome

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– התלונן על חולשה ולאחר כשעה התמוטט. עבר החייאה והובא למיון.70בן

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– התלונן על חולשה ולאחר כשעה התמוטט. עבר החייאה והובא למיון.70בן

Conduction system

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Normal HCM

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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

HCM

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התמוטט במהלך ריצה. עבר החייאה והובא למיון.25 בן

epsilon wave

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

ARVC

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התמוטטה במהלך ריצה. עברה החייאה והובאה למיון. 68בת

בבדיקה – א"ס, גסה, בנקודה אאורטלית קורנת לקרוטידים. קול שני לא נשמע.

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

Management