Sudden cardiac death

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Overview

The term sudden cardiac death refers to natural death from cardiac causes, heralded by abrupt loss of consciousness within one hour of the onset of acute symptoms. Other forms of sudden death may be noncardiac in origin and are therefore termed sudden death rather than sudden cardiac death. Examples of this include respiratory arrest (such as due to airway obstruction, which may be seen in cases of choking or asphyxiation), toxicity or poisoning, anaphylaxis, or trauma.

It is important to make a distinction between this term and the related term cardiac arrest, which refers to cessation of cardiac pump function which may be reversible (i.e., may not be fatal). The phrase Sudden Cardiac Death is a public health concept incorporating the features of natural, rapid, and unexpected. It does not specifically refer to the mechanism or cause of death. Although the most frequent underlying cause of Sudden Cardiac Death is Coronary Artery Disease, other categories of causes are listed below.

Complete Differential Diagnosis for Sudden Cardiac Death

• Acute aortic insufficiency
• Acute coronary syndrome
• Aortic dissection
• Aortic stenosis
• Arrhythmogenic right ventricular dysplasia
• Brugada syndrome
• Cardiac tamponade
• Cardiomyopathy
• Catecholaminergic polymorphic ventricular tachycardia
• Commotio cordis
• Complete heart block
• Congenital heart disease
• Congestive heart failure
• Coronary artery disease
• Dilated cardiomyopathy
• Hypertrophic cardiomyopathy
• Jervell and Lange-Nielsen syndrome
• Kugel-Stoloff syndrome
• Long QT syndrome, both congenital and acquired
• Mitral valve prolapse
• Myocarditis
• Naxos disease
• Noncompaction Cardiomyopathy
• Papillary muscle rupture
• Prolonged Q-T Interval Syndrome
• Pulmonary embolism
• Romano-Ward syndrome
• Ruptured abdominal aortic aneurysm
• Sick sinus syndrome
• ST Elevation Myocardial Infarction
• Stokes-Adams Syndrome
• Sudden Infant Death Syndrome
• Timothy syndrome
• Uhl anomaly
• Valvular Heart Disease
• Ventricular rupture
• Wolf-Parkinson-White syndrome with rapid conduction

Complete Differential Diagnosis for Sudden Non-Cardiac Death

• 3-methylglutaconic aciduria, type 1
• Alpha-ketoglutarate dehydrogenase deficiency
• Amniotic fluid syndrome
• Arterial dissections with lentiginosis
• Anaphylaxis
• Aneurysm
• Apoplexy
• Appendicitis
• Asphyxia
• Birth injury
• Bleeding excessive
• Childbirth hemorrhage
• Diabetic ketoacidosis - typically from undiagnosed diabetes
• Drug allergy
• Drug overdose
• Encephalitis
• Fetal death
• Flu mainly in the elderly, infants, infirm or chronically ill
• Food allergy
• Gastrointestinal bleeding
• Homicide
• Hyperbilirubinemia transient, familial, neonatal
• Hypercalcemia
• Hypercapnia
• Hyperkalemia
• Hypokalemia
• Hypoxia
• Injury
• Insect bite
• Intracranial hemmorhage
• Marfan syndrome
• Meningitis
• Meningococcal disease
• Motor Vehicle accident
• Myasthenia Gravis
• Neurocysticercosis
• Opioid overdose
• Oxycontin overdose
• Pain killer overdose
• Pickwickian Syndrome
• Poisoning
• Pulmonary embolism
• Retroperitoneal bleed
• Sepsis syndrome
• Shock
• Sleep apnea
• Snake bite
• Status asthmaticus
• Stillbirth
• Stroke
• Subarachnoid hemorrhage
• Sudden Infant Death Syndrome
• Suicide
• Sleeping pill overdose
• Toxic/metabolic disturbances
• Tranquilizer addiction
• Tension pneumothorax
• Toxic/metabolic disturbances
• Thyrotoxicosis
• Toxic shock syndrome
• Transfusion reaction
• Venom

Complete Differential Diagnosis of the Causes of Sudden Death Including Sudden Cardiac Death

3-methylglutaconic aciduria, type 1 Acute aortic insufficiency Acute coronary syndrome Alpha-ketoglutarate dehydrogenase deficiency Amniotic fluid syndrome Amyloid cardiopathy Anaphylaxis Aneurysm Aortic dissection Aortic stenosis Aorto-ventricular tunnel Apoplexy Appendicitis Arrhythmogenic right ventricular dysplasia Arterial dissections with lentiginosis Asphyxia Asymmetric septal hypertrophy Atrial cardiomyopathy with heart block Atrial fibrillation, familial 1 Atrial myxoma, familial Bleeding excessive Brugada syndrome Cardiac tamponade Cardiomyopathy dilated with conduction defect Catecholaminergic polymorphic ventricular tachycardia Childbirth hemorrhage Commotio cordis Complete heart block Congenital heart block Congenital heart disease Congestive heart failure Coronary arteries - congenital malformation Coronary artery disease Diabetic ketoacidosis - typically from undiagnosed diabetes Drug allergy Drug overdose Encephalitis Familial dilated cardiomyopathy Familial hypertrophic cardiomyopathy 1 Flumainly in the elderly, infants, infirm or chronically ill Food allergy Gastrointestinal bleeding Giant cell myocarditis Heart attack Heart failure Homicide Hyperbilirubinemia transient, familial, neonatal Hypercalcemia Hypercapnia Hyperkalemia Hypokalemia Hypoxia Injury Insect bite Intracranial hemmorhage Jervell and Lange-Nielsen syndrome Kugel-Stoloff syndrome

Marfan syndrome Meningitis Meningococcal disease Mitral valve prolapse Multifocal ventricular premature beats Myasthenia gravis Myocarditis Naxos disease Neurocysticercosis Noncompaction Cardiomyopathy Opioid overdose Oxycontin overdose Pain killer overdose Papillary muscle rupture Paroxysmal ventricular fibrillation Pickwickian Syndrome Poisoning Polymorphic catecholergic ventricular tachycardia Prescribed medication addiction Prinzmetal's variant angina Prolonged Q-T Interval Syndrome Pulmonary embolism Retroperitoneal bleed Motor Vehicle accident Romano-Ward syndrome Ruptured abdominal aortic aneurysm Sepsis syndrome Shock Short QT syndrome Sick sinus syndrome Sinus node disease Sleep apnea Sleeping pill overdose Snake bite ST Elevation Myocardial Infarction Status asthmaticus Stillbirth Stokes-Adams Syndrome Stroke Subaortic stenosis - short stature syndrome Subarachnoid hemorrhage Sudden Arrhythmia Death Syndrome Sudden Infant Death Syndrome Suicide Tension pneumothorax Thyrotoxicosis Timothy syndrome Toxic shock syndrome Toxic/metabolic disturbances Tranquilizer addiction Transfusion reaction Uhl anomaly Valvular Heart Disease Venom Ventricular rupture Ventricular tachycardia, catecholaminergic polymorphic, 1 Wolf-Parkinson-White syndrome

Complete Differential Diagnosis of the Causes of Sudden Death Including Sudden Cardiac Death

(By organ system)

Cardiovascular	Amyloid cardiopathy, Congestive heart failure, Ventricular rupture,
* Ischemic	Hypoxia, Coronary thrombosis, Coronary vasospasm, Coronary artery aneurysm, Prinzmetal's variant angina ,
* Pericardial	Cardiac tamponade,
* Myocardial	Asymmetric septal hypertrophy , ST Elevation Myocardial Infarction, Dilated cardiomyopathy, Giant cell myocarditis , Hypertrophic cardiomyopathy, Kugel-Stoloff syndrome , Myocardial infarction, Myocarditis, Rupture of the papillary muscles,
* Endocardial/Valvular	Mitral valve prolapse, Valvular Heart Disease,
* Conduction/Arrhythmia	Arrhythmogenic right ventricular cardiomyopathy, Arrhythmogenic right ventricular dysplasia, Brugada syndrome, Complete atrioventricular block, Jervell and Lange-Nielsen Syndrome, Prolonged Q-T Interval Syndrome, Multifocal ventricular premature beats , Naxos disease , Romano-Ward syndrome , Sick sinus syndrome, Short QT syndrome , Sinus node disease, Stokes-Adams Syndrome, Sudden Arrhythmia Death Syndrome, Wolf-Parkinson-White syndrome,
* Vascular	Acute aortic insufficiency, Acute coronary syndrome, Aortic dissection, Aortic stenosis, Aorto-ventricular tunnel, Arteritis, Coronary artery disease, Coronary arteries - congenital malformation , Ruptured abdominal aortic aneurysm,
Congenital/Developmental	Congenital heart disease, Congenital heart block , Congenital Long QT syndrome, Noncompaction Cardiomyopathy, Sudden Infant Death Syndrome, Uhl anomaly
Chemical / poisoning	Snake bite
Dermatologic	No underlying causes
Drug Side Effect	Drug allergy, Drug overdose
Ear Nose Throat	No underlying causes
Endocrine	Catecholaminergic polymorphic ventricular tachycardia, Diabetic ketoacidosis - typically from undiagnosed diabetes, Thyrotoxicosis,
Environmental	Hypothermia,
Gastroenterologic	Appendicitis, Gastrointestinal bleeding, Retroperitoneal bleed,
Genetic	Brugada syndrome, 3-methylglutaconic aciduria, type 1, Familial dilated cardiomyopathy , Familial hypertrophic cardiomyopathy 1, Hyperbilirubinemia transient, familial neonatal, Marfan syndrome , Timothy syndrome
Hematologic	No underlying causes
Iatrogenic	Transfusion reaction
Infectious Disease	Flu mainly in the elderly, infants, infirm or chronically ill, Neurocysticercosis
Musculoskeletal / Ortho	No underlying causes
Neurologic	Apoplexy, Encephalitis, Intracranial hemmorhage, Meningitis, Stroke, Subarachnoid hemorrhage,
Nutritional / Metabolic	3-methylglutaconic aciduria, type 1, Alpha-ketoglutarate dehydrogenase deficiency , Food allergy
Obstetric/Gynecologic	Amniotic fluid syndrome , Childbirth hemorrhage,
Oncologic	Atrial myxoma, familial
Opthalmologic	No underlying causes
Overdose / Toxicity	Opioid overdose , Oxycontin overdose, Pain killer overdose , Sleeping pill overdose
Psychiatric	No underlying causes
Pulmonary	Hypercapnia, Pickwickian Syndrome, Pulmonary embolism, Tension pneumothorax, Status asthmaticus
Renal / Electrolyte	Hypercalcemia, Hypokalemia, Hyperkalemia,
Rheum / Immune / Allergy	Amyloidosis, Anaphylaxis, Myasthenia gravis, Sarcoidosis,
Sexual	No underlying causes
Trauma	Commotio cordis, Homicide, Motor Vehicle accident
Urologic	No underlying causes
Miscellaneous	Shock, Asphyxia, Insect bite Sepsis syndrome, Shock

Prevention of Sudden Cardiac Death

ACC / AHA Guidelines- Recommendations for Implantable Cardioverter Defibrillators (DO NOT EDIT)

“

Class I 1. ICD therapy is indicated in patients who are survivors of cardiac arrest due to VF or hemodynamically unstable sustained VT after evaluation to define the cause of the event and to exclude any completely reversible causes. (Level of Evidence: A) 2. ICD therapy is indicated in patients with structural heart disease and spontaneous sustained VT, whether hemodynamically stable or unstable. (Level of Evidence: B) 3. ICD therapy is indicated in patients with syncope of undetermined origin with clinically relevant, hemodynamically significant sustained VT or VF induced at electrophysiological study. (Level of Evidence: B) 4. ICD therapy is indicated in patients with LVEF less than 35% due to prior MI who are at least 40 days post-MI and are in NYHA functional Class II or III. (Level of Evidence: A) 5. ICD therapy is indicated in patients with nonischemic DCM who have an LVEF less than or equal to 35% and who are in NYHA functional Class II or III. (Level of Evidence: B) 6. ICD therapy is indicated in patients with LV dysfunction due to prior MI who are at least 40 days post-MI, have an LVEF less than 30%, and are in NYHA functional Class I. (Level of Evidence: A) 7. ICD therapy is indicated in patients with nonsustained VT due to prior MI, LVEF less than 40%, and inducible VF or sustained VT at electrophysiological study. (Level of Evidence: B) Class IIa 1. ICD implantation is reasonable for patients with unexplained syncope, significant LV dysfunction, and nonischemic DCM. (Level of Evidence: C) 2. ICD implantation is reasonable for patients with sustained VT and normal or near-normal ventricular function. (Level of Evidence: C) 3. ICD implantation is reasonable for patients with HCM who have 1 or more major{dagger} risk factors for SCD. (Level of Evidence: C) 4. ICD implantation is reasonable for the prevention of SCD in patients with ARVD/C who have 1 or more risk factors for SCD. (Level of Evidence: C) 5. ICD implantation is reasonable to reduce SCD in patients with long-QT syndrome who are experiencing syncope and/or VT while receiving beta blockers. (Level of Evidence: B) 6. ICD implantation is reasonable for non hospitalized patients awaiting transplantation. (Level of Evidence: C) 7. ICD implantation is reasonable for patients with Brugada syndrome who have had syncope. (Level of Evidence: C) 8. ICD implantation is reasonable for patients with Brugada syndrome who have documented VT that has not resulted in cardiac arrest. (Level of Evidence: C) 9. ICD implantation is reasonable for patients with catecholaminergic polymorphic VT who have syncope and/or documented sustained VT while receiving beta blockers. (Level of Evidence: C) 10. ICD implantation is reasonable for patients with cardiac sarcoidosis, giant cell myocarditis, or Chagas disease. (Level of Evidence: C) Class IIb 1. ICD therapy may be considered in patients with nonischemic heart disease who have an LVEF of less than or equal to 35% and who are in NYHA functional Class I. (Level of Evidence: C) 2. ICD therapy may be considered for patients with long-QT syndrome and risk factors for SCD. (Level of Evidence: B) 3. ICD therapy may be considered in patients with syncope and advanced structural heart disease in whom thorough invasive and noninvasive investigations have failed to define a cause. (Level of Evidence: C) 4. ICD therapy may be considered in patients with a familial cardiomyopathy associated with sudden death. (Level of Evidence: C) 5. ICD therapy may be considered in patients with LV noncompaction. (Level of Evidence: C) Class III 1. ICD therapy is not indicated for patients who do not have a reasonable expectation of survival with an acceptable functional status for at least 1 year, even if they meet ICD implantation criteria specified in the Class I, IIa, and IIb recommendations above. (Level of Evidence: C) 2. ICD therapy is not indicated for patients with incessant VT or VF. (Level of Evidence: C) 3. ICD therapy is not indicated in patients with significant psychiatric illnesses that may be aggravated by device implantation or that may preclude systematic follow-up. (Level of Evidence: C) 4. ICD therapy is not indicated for NYHA Class IV patients with drug-refractory congestive heart failure who are not candidates for cardiac transplantation or CRT-D. (Level of Evidence: C) 5. ICD therapy is not indicated for syncope of undetermined cause in a patient without inducible ventricular tachyarrhythmias and without structural heart disease. (Level of Evidence: C) 6. ICD therapy is not indicated when VF or VT is amenable to surgical or catheter ablation (e.g., atrial arrhythmias associated with the Wolff-Parkinson-White syndrome, RV or LV outflow tract VT, idiopathic VT, or fascicular VT in the absence of structural heart disease). (Level of Evidence: C) 7. ICD therapy is not indicated for patients with ventricular tachyarrhythmias due to a completely reversible disorder in the absence of structural heart disease (e.g., electrolyte imbalance, drugs, or trauma). (Level of Evidence: B)

”

ACC / AHA Guidelines- Recommendations for Implantable Cardioverter-Defibrillators in Pediatric Patients and Patients With Congenital Heart Disease (DO NOT EDIT)

“

Class I 1. ICD implantation is indicated in the survivor of cardiac arrest after evaluation to define the cause of the event and to exclude any reversible causes. (Level of Evidence: B) 2. ICD implantation is indicated for patients with symptomatic sustained VT in association with congenital heart disease who have undergone hemodynamic and electrophysiological evaluation. Catheter ablation or surgical repair may offer possible alternatives in carefully selected patients. (Level of Evidence: C) Class IIa 1. ICD implantation is reasonable for patients with congenital heart disease with recurrent syncope of undetermined origin in the presence of either ventricular dysfunction or inducible ventricular arrhythmias at electrophysiological study. (Level of Evidence: B) Class IIb 1. ICD implantation may be considered for patients with recurrent syncope associated with complex congenital heart disease and advanced systemic ventricular dysfunction when thorough invasive and noninvasive investigations have failed to define a cause. (Level of Evidence: C) Class III 1. All Class III recommendations found in Section 3, "Indications for Implantable Cardioverter-Defibrillator Therapy," apply to pediatric patients and patients with congenital heart disease, and ICD implantation is not indicated in these patient populations. (Level of Evidence: C)

”

Sources

• ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons
• ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines)
• ACC/AHA Guidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Executive Summary--a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation)

External links

• Information from the Stanford Hypertrophic Cardiomyopathy Center

Additional resources

• ECGpedia: Course for interpretation of ECG
• The whole ECG - A basic ECG primer
• 12-lead ECG library
• Simulation tool to demonstrate and study the relation between the electric activity of the heart and the ECG
• ECG information from Children's Hospital Heart Center, Seattle
• ECG Challenge from the ACC D2B Initiative
• National Heart, Lung, and Blood Institute, Diseases and Conditions Index
• A history of electrocardiography
• EKG Interpretations in infants and children