wikidoc - Changes related to "Category:CS1 errors: PMID" [en]

Sudden cardiac death epidemiology and demographics

2026-04-07T15:38:11Z

Cardiac arrest in young athletes:

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	*In a US study from 1999 through 2015 (n = 31492), Black individuals younger than 34 years had a higher incidence of presumed sudden cardiac deaths (1.88 per 100000 person-years in 2015) than Hispanic individuals (0.66 per 100000 person-years),and White individuals (1.17 per 100000 person-years),<ref>El-AssaadI, Al-Kindi SG, Aziz PF. Trends of out-of-hospital sudden cardiac death among children and youngadults. Pediatrics. 2017;140(6): e20171438. doi:10.1542/peds.2017-1438</ref> which may be due to inequitable access to care <ref>Noonan AS, Velasco-Mondragon HE, Wagner FA. Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Rev. 2016;37:12. doi:10. 1186/s40985-016-0025-4</ref> and racial disparities among out-of hospital resuscitation attempts.		*In a US study from 1999 through 2015 (n = 31492), Black individuals younger than 34 years had a higher incidence of presumed sudden cardiac deaths (1.88 per 100000 person-years in 2015) than Hispanic individuals (0.66 per 100000 person-years),and White individuals (1.17 per 100000 person-years),<ref>El-AssaadI, Al-Kindi SG, Aziz PF. Trends of out-of-hospital sudden cardiac death among children and youngadults. Pediatrics. 2017;140(6): e20171438. doi:10.1542/peds.2017-1438</ref> which may be due to inequitable access to care <ref>Noonan AS, Velasco-Mondragon HE, Wagner FA. Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Rev. 2016;37:12. doi:10. 1186/s40985-016-0025-4</ref> and racial disparities among out-of hospital resuscitation attempts.
	*White individuals were more likely to receive bystander CPR after a witnessed cardiac arrest and postresuscitation care than were Black and Hispanic persons in several US based studies.<ref>Toy J, Bosson N, Schlesinger S,Gausche-Hill M. Racial and ethnic disparities in the provision of bystander CPR after witnessed out-of-hospital cardiac arrest in the United States. Resuscitation. 2023;190:109901. doi:10.1016/j.resuscitation.2023. 109901</ref><ref>Casey SD, Mumma BE.Sex,race,and insurance status differences in hospital treatment and outcomes following out-of-hospital cardiac arrest. Resuscitation. 2018;126:125-129. doi:10.1016/j. resuscitation.2018.02.027</ref>		*White individuals were more likely to receive bystander CPR after a witnessed cardiac arrest and postresuscitation care than were Black and Hispanic persons in several US based studies.<ref>Toy J, Bosson N, Schlesinger S,Gausche-Hill M. Racial and ethnic disparities in the provision of bystander CPR after witnessed out-of-hospital cardiac arrest in the United States. Resuscitation. 2023;190:109901. doi:10.1016/j.resuscitation.2023. 109901</ref><ref>Casey SD, Mumma BE.Sex,race,and insurance status differences in hospital treatment and outcomes following out-of-hospital cardiac arrest. Resuscitation. 2018;126:125-129. doi:10.1016/j. resuscitation.2018.02.027</ref>

			=== Cardiac arrest in young athletes: ===

			* Commotio cordis is cardiac arrest precipitated by chest blunt force sufficient to trigger VF.<ref>Maron BJ, Estes NA III. Commotio cordis. N Engl J Med. 2010;362(10):917-927.doi:10.1056/ NEJMra0910111</ref>,<ref>Peng T, Derry LT, Yogeswaran V, Goldschlager NF. Commotio cordis in 2023. SportsMed.2023;53 (8):1527-1536. doi:10.1007/s40279-023-01873-6</ref> Although commotio cordis incidence is unknown, more than 90% of cases in the US occur among individuals younger than 25 years.<ref name=":8">Maron BJ, Ahluwalia A, Haas TS, Semsarian C, Link MS, Estes NA III. Global epidemiology and JAMA March18,2025 Volume 333,Number11 (Reprinted) demographics of commotio cordis. HeartRhythm. 2011;8(12):1969-1971. doi:10.1016/j.hrthm.2011.07. 014</ref> Commotio cordis is common in baseball, softball, and football in the US, whereas soccer, cricket, and hockey were the sports most commonly associated with it in non-US populations.<ref name=":8" />

	==References==		==References==

Sudden cardiac death screening

2026-04-07T15:15:15Z

Screening in young athletes:

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	__NOTOC__		__NOTOC__
	{{Sudden cardiac death}}		{{Sudden cardiac death}}
	{{CMG}} {{AE}} {{Sara.Zand}} {{EdzelCo}}		{{CMG}} {{AE}} {{Sara.Zand}} {{EdzelCo}} {{Nehal}}

	==Overview==		==Overview==
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	==Screening==		==Screening==
	*~~[[Screening]]~~ in the ~~first relative~~ of [[patients]] with [[sudden cardiac arrest~~]] should be done if there is concern about inherited causes~~ of [[cardiac arrest]].		*If the phenotype in a patient resuscitated after sudden cardiac arrest is established, a recent expert consensus statement<ref name=":0">Stiles MK, Wilde AAM, Abrams DJ, et al. 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families. Heart Rhythm. 2021;18(1):e1-e50. doi:10.1016/j.hrthm.2020.10.010</ref> recommends genetic testing focused on potential candidate genes and clinical evaluation of family members to identify relatives who have or are at risk of developing a clinical condition.
			*If the cause of sudden cardiac arrest is not determined, first-degree relatives may undergo clinical evaluation, including ECG, cardiac imaging, ambulatory monitoring, and provocative testing.
			*Psychological evaluation and treatment of grief and post traumatic stress in survivors and their immediate family members by trained mental health professionals is recommended.<ref name=":0" />
	*Several [[SCD]] [[risk calculators]] are available for all age groups <ref name="pmid31155932">{{cite journal\| author=Wahbi K, Ben Yaou R, Gandjbakhch E, Anselme F, Gossios T, Lakdawala NK \| display-authors=etal\| title=Development and Validation of a New Risk Prediction Score for Life-Threatening Ventricular Tachyarrhythmias in Laminopathies. \| journal=Circulation \| year= 2019 \| volume= 140 \| issue= 4 \| pages= 293-302 \| pmid=31155932 \| doi=10.1161/CIRCULATIONAHA.118.039410 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31155932 }} </ref> <ref name="pmid30915475">{{cite journal\| author=Cadrin-Tourigny J, Bosman LP, Nozza A, Wang W, Tadros R, Bhonsale A \| display-authors=etal\| title=A new prediction model for ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy. \| journal=Eur Heart J \| year= 2019 \| volume= 40 \| issue= 23 \| pages= 1850-1858 \| pmid=30915475 \| doi=10.1093/eurheartj/ehz103 \| pmc=6568197 \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30915475 }} </ref> <ref name="pmid32418493">{{cite journal\| author=Miron A, Lafreniere-Roula M, Steve Fan CP, Armstrong KR, Dragulescu A, Papaz T \| display-authors=etal\| title=A Validated Model for Sudden Cardiac Death Risk Prediction in Pediatric Hypertrophic Cardiomyopathy. \| journal=Circulation \| year= 2020 \| volume= 142 \| issue= 3 \| pages= 217-229 \| pmid=32418493 \| doi=10.1161/CIRCULATIONAHA.120.047235 \| pmc=7365676 \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32418493 }} </ref> <ref name="pmid31411652">{{cite journal\| author=Norrish G, Ding T, Field E, Ziólkowska L, Olivotto I, Limongelli G \| display-authors=etal\| title=Development of a Novel Risk Prediction Model for Sudden Cardiac Death in Childhood Hypertrophic Cardiomyopathy (HCM Risk-Kids). \| journal=JAMA Cardiol \| year= 2019 \| volume= 4 \| issue= 9 \| pages= 918-927 \| pmid=31411652 \| doi=10.1001/jamacardio.2019.2861 \| pmc=6694401 \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31411652 }} </ref> <ref name="pmid24126876">{{cite journal\| author=O'Mahony C, Jichi F, Pavlou M, Monserrat L, Anastasakis A, Rapezzi C \| display-authors=etal\| title=A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM risk-SCD). \| journal=Eur Heart J \| year= 2014 \| volume= 35 \| issue= 30 \| pages= 2010-20 \| pmid=24126876 \| doi=10.1093/eurheartj/eht439 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24126876 }} </ref>		*Several [[SCD]] [[risk calculators]] are available for all age groups <ref name="pmid31155932">{{cite journal\| author=Wahbi K, Ben Yaou R, Gandjbakhch E, Anselme F, Gossios T, Lakdawala NK \| display-authors=etal\| title=Development and Validation of a New Risk Prediction Score for Life-Threatening Ventricular Tachyarrhythmias in Laminopathies. \| journal=Circulation \| year= 2019 \| volume= 140 \| issue= 4 \| pages= 293-302 \| pmid=31155932 \| doi=10.1161/CIRCULATIONAHA.118.039410 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31155932 }} </ref> <ref name="pmid30915475">{{cite journal\| author=Cadrin-Tourigny J, Bosman LP, Nozza A, Wang W, Tadros R, Bhonsale A \| display-authors=etal\| title=A new prediction model for ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy. \| journal=Eur Heart J \| year= 2019 \| volume= 40 \| issue= 23 \| pages= 1850-1858 \| pmid=30915475 \| doi=10.1093/eurheartj/ehz103 \| pmc=6568197 \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30915475 }} </ref> <ref name="pmid32418493">{{cite journal\| author=Miron A, Lafreniere-Roula M, Steve Fan CP, Armstrong KR, Dragulescu A, Papaz T \| display-authors=etal\| title=A Validated Model for Sudden Cardiac Death Risk Prediction in Pediatric Hypertrophic Cardiomyopathy. \| journal=Circulation \| year= 2020 \| volume= 142 \| issue= 3 \| pages= 217-229 \| pmid=32418493 \| doi=10.1161/CIRCULATIONAHA.120.047235 \| pmc=7365676 \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32418493 }} </ref> <ref name="pmid31411652">{{cite journal\| author=Norrish G, Ding T, Field E, Ziólkowska L, Olivotto I, Limongelli G \| display-authors=etal\| title=Development of a Novel Risk Prediction Model for Sudden Cardiac Death in Childhood Hypertrophic Cardiomyopathy (HCM Risk-Kids). \| journal=JAMA Cardiol \| year= 2019 \| volume= 4 \| issue= 9 \| pages= 918-927 \| pmid=31411652 \| doi=10.1001/jamacardio.2019.2861 \| pmc=6694401 \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31411652 }} </ref> <ref name="pmid24126876">{{cite journal\| author=O'Mahony C, Jichi F, Pavlou M, Monserrat L, Anastasakis A, Rapezzi C \| display-authors=etal\| title=A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM risk-SCD). \| journal=Eur Heart J \| year= 2014 \| volume= 35 \| issue= 30 \| pages= 2010-20 \| pmid=24126876 \| doi=10.1093/eurheartj/eht439 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24126876 }} </ref>
	**[[HCM Risk-Kids Score]] is a validated [[risk calculator]] used for [[patients]] with [[hypertrophic cardiomyopathy]] ([[HCM]]) who are up to 16 years of [[age]].		**[[HCM Risk-Kids Score]] is a validated [[risk calculator]] used for [[patients]] with [[hypertrophic cardiomyopathy]] ([[HCM]]) who are up to 16 years of [[age]].
	**LQTS Risk Calculator		**LQTS Risk Calculator
	**VA calculator		**VA calculator

			=== Screening in young athletes: ===
			The American Heart Association–American College of Cardiology consensus statement<ref name=":1">Maron BJ, Levine BD, Washington RL, Baggish AL, Kovacs RJ, Maron MS; American Heart Association Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 2: preparticipation screening for cardiovascular disease in competitive athletes: a scientific statement from the American Heart Association and AmericanCollege of Cardiology. Circulation. 2015;132(22):e267-e272.</ref> on preparticipation screening recommends the American Heart Association 14-point screening guide, including a comprehensive history taking and a physical examination for young athletes (class I recommendation), but does not recommend routine ECG screening of young adults (athletes and non-athletes) in the general population (class III), due to concerns about diagnostic accuracy, cost-effectiveness, and availability of physicians and equipment needed for screening. ECG or transthoracic echocardiography should only be performed in select individuals in whom genetic,congenital,or other cardiovascular abnormalities are suspected or identified (class IIb).<ref name=":1" />

			However, recent ESC guideline recommends a 12-lead ECG as part of preparticipation for all competitive athletes younger than 35 years (class IIa).<ref name="pmid36017572" /> This recommendation was supported by outcome data from the Veneto region, which showed declining incidence of sudden death in young competitive athletes after introduction of a nationwide prescreening program using ECG.<ref>Corrado D, Basso C, Pavei A, Michieli P, Schiavon M,ThieneG. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA.2006;296(13):1593-1601. doi:10.1001/jama.296.13.1593</ref> Some data suggest that compared with history and physical examination, ECG may provide superior accuracy to identify potential risk of sudden death, primarily due to detection of preexcitation syndromes (sensitivity 88% vs 19%, specificity 98% vs 75%).<ref>Williams EA, Pelto HF, Toresdahl BG, et al. Performance of the American Heart Association (AHA)14-point evaluation versus electrocardiography for the cardiovascular screening of high school athletes: a prospective 996 study. J AmHeartAssoc.2019;8(14):e012235. doi:10.1161/JAHA.119.012235</ref>,<ref>Goff NK, Hutchinson A, Koek W, Kamat D. Meta-analysis on the effectiveness of ECG screening for conditions related to sudden cardiac death in young athletes. Clin Pediatr (Phila). 2023;62(10):1158-1168. doi:10.1177/ 00099228231152857</ref>

			In the last 2 decades, preparticipation screening for early identification of young competitive athletes at risk of sudden cardiac arrest in high school, college, and professional settings has been investigated. A comparable incidence of cardiovascular deaths was found between 1993 and 2015 in these studies screening competitive athletes. In the Veneto region of Italy, where ECG is routinely employed as part of preparticipation screening, and those in the US (Minnesota), where preparticipation prescreening is limited to history and physical examination.<ref>Maron BJ, Haas TS, Doerer JJ, Thompson PD, Hodges JS. Comparison of U.S.and Italian experiences with sudden cardiac deaths in young competitive athletes and implications for preparticipation screening strategies. Am J Cardiol. 2009;104(2):276-280. doi:10.1016/j.amjcard.2009. 03.037</ref>

Sudden cardiac death other diagnostic studies

2026-04-06T14:33:31Z

Postmortem Genetic Investigation:

← Older revision		Revision as of 14:33, 6 April 2026
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	===Genetic testing===		===Genetic testing===
	* ~~Genetic testing of young adults may be useful~~ for ~~diagnosis~~ and ~~treatment of cardiomyopathies~~ and ~~primary arrhythmia syndromes~~.Genetic ~~testing of first-degree family members may help identify asymptomatically affected relatives. The reported diagnostic yield~~ of ~~genetic testing among individuals with~~ sudden ~~arrhythmic death syndrome(normal heart at autopsy with no cause of death identified) is 13% to 34%, whereas~~ the yield ~~of genetic testing of survivors of~~ sudden cardiac ~~arrest resuscitated~~ from ~~idiopathic ventricular arrhythmias is 2~~% to 22%.It is used to identify [[genetic]] composition of an individual and determine whether genetic variation modifications are present leading to [[Brugada syndrome]], [[long QT syndrome]] ([[LQTS]]), [[hypertrophic cardiomyopathy]] ([[HCM]]), and [[dilated cardiomyopathy]] ([[DCM]]) <ref name="~~pmid33831308~~">~~{{cite journal\| author=James CA~~, ~~Jongbloed JDH~~, ~~Hershberger RE~~, ~~Morales~~ A~~, Judge DP, Syrris P \| display~~-~~authors=etal\| title=International Evidence Based Reappraisal of Genes Associated With Arrhythmogenic Right Ventricular Cardiomyopathy Using the Clinical Genome Resource Framework~~. ~~\| journal=Circ Genom Precis Med \| year= 2021 \| volume= 14 \| issue= 3 \| pages= e003273 \| pmid=33831308 \|~~ doi=10.~~1161~~/~~CIRCGEN~~.~~120~~.~~003273 \| pmc=8205996 \| url=https~~:~~//www~~.~~ncbi~~.~~nlm.nih.gov/entrez/eutils~~/~~elink~~.~~fcgi?dbfrom=pubmed&tool=sumsearch~~.~~org/cite&retmode=ref&cmd=prlinks&id=33831308 }}~~ </ref> <ref name="~~pmid32429735~~">~~{{cite journal\| author=~~Lahrouchi N, ~~Tadros R, Crotti L~~, ~~Mizusawa Y~~, ~~Postema PG, Beekman L \| display~~-~~authors=etal\| title=Transethnic Genome-Wide Association Study Provides Insights~~ in ~~the Genetic Architecture and Heritability~~ of ~~Long QT Syndrome~~. ~~\| journal=Circulation \| year= 2020 \| volume= 142 \| issue= 4 \| pages= 324~~-~~338 \| pmid=32429735 \|~~ doi=10.~~1161~~/~~CIRCULATIONAHA~~.~~120~~.~~045956 \| pmc=7382531 \| url=https:~~/~~/www~~.~~ncbi~~.~~nlm~~.~~nih~~.~~gov~~/~~entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org~~/~~cite&retmode=ref&cmd=prlinks&id=32429735 }}~~ </ref> <ref name="~~pmid33164571~~">~~{{cite journal\| author=Wijeyeratne YD~~, ~~Tanck MW~~, ~~Mizusawa Y~~, ~~Batchvarov V, Barc J, Crotti L \| display-authors=etal\| title=SCN5A Mutation Type and a Genetic Risk Score Associate Variably With Brugada Syndrome Phenotype~~ in ~~SCN5A Families~~. ~~\| journal=Circ Genom Precis Med \| year= 2020 \| volume= 13 \| issue=~~ 6 ~~\| pages= e002911 \| pmid=33164571 \|~~ doi=10.~~1161~~/~~CIRCGEN~~.~~120~~.~~002911 \| pmc=7748043 \| url=https:~~/~~/www~~.~~ncbi~~.~~nlm~~.~~nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=~~ref~~&cmd~~=~~prlinks&id=33164571 }} <~~/~~ref~~> <ref name="~~pmid33495597~~">~~{{cite journal\| author=Harper AR~~, ~~Goel~~ A, ~~Grace C~~, ~~Thomson KL~~, ~~Petersen SE~~, ~~Xu X \| display~~-~~authors~~=~~etal\| title~~=~~Common genetic variants and modifiable risk factors underpin hypertrophic cardiomyopathy susceptibility and expressivity. \| journal~~=~~Nat Genet \| year~~= ~~2021 \| volume~~= ~~53 \| issue~~= ~~2 \| pages~~= ~~135-142 \| pmid~~=~~33495597 \| doi~~=~~10.1038/s41588-020-00764-0 \| pmc~~=~~8240954 \| url~~=~~https~~:~~//www~~.~~ncbi~~.~~nlm~~.~~nih~~.~~gov~~/~~entrez/eutils/elink~~.~~fcgi?dbfrom=pubmed&tool=sumsearch~~.~~org~~/~~cite&retmode=~~ref~~&cmd~~=~~prlinks&id=33495597 }} <~~/~~ref~~> <ref name="~~pmid33495596~~">~~{{cite journal\| author=Tadros R~~, ~~Francis C~~, ~~Xu X~~, ~~Vermeer AMC~~, ~~Harper AR~~, ~~Huurman R \| display-authors=etal\| title=Shared genetic pathways contribute to risk~~ of ~~hypertrophic~~ and ~~dilated cardiomyopathies with opposite directions~~ of ~~effect~~. ~~\| journal=Nat Genet \| year=~~ 2021 ~~\| volume= 53 \| issue= 2 \| pages= 128~~-~~134 \| pmid=33495596 \|~~ doi=10.~~1038~~/~~s41588-020-00762-~~2 ~~\| pmc=7611259 \| url=https~~:~~//www~~.~~ncbi~~.~~nlm~~.~~nih~~.~~gov/entrez~~/~~eutils/elink~~.~~fcgi?dbfrom=pubmed&tool=sumsearch~~.~~org/cite&retmode=ref&cmd=prlinks&id=33495596 }}~~ </ref> <ref ~~name="pmid31504448"~~>~~{{cite journal\| author=Tadros R~~, ~~Tan HL~~, ~~ESCAPE-NET Investigators~~. ~~El Mathari S, Kors JA, Postema PG \| display~~-~~authors=etal\| title=Predicting cardiac electrical response to sodium-channel blockade and Brugada syndrome using polygenic risk scores~~. ~~\| journal=Eur~~ Heart ~~J \| year= 2019 \| volume= 40 \| issue= 37 \| pages= 3097~~-~~3107 \| pmid=31504448 \|~~ doi=10.~~1093~~/~~eurheartj~~/~~ehz435 \| pmc=6769824 \| url=https~~://~~www~~.~~ncbi~~.~~nlm~~.~~nih~~.~~gov~~/~~entrez/eutils/elink~~.~~fcgi?dbfrom=pubmed&tool=sumsearch~~.~~org/cite&retmode=ref&cmd=prlinks&id=31504448 }}~~ </ref>.
			====== Postmortem Genetic Investigation: ======

			* Its use increased recently for research purposes and to inform family members about potentially inherited disease. It investigates the association between genotypes and etiology by autopsy.
			* Genetic studies of sudden deaths in young adults demonstrate that the genetic yield for pathogenic or likely pathogenic variants in autopsy-confirmed sudden cardiac deaths ranged from 13% to 34%.<ref name=":1">Bagnall RD, Weintraub RG, Ingles J, et al. A prospective study of sudden cardiac death among children and young adults. NEnglJMed.2016;374 (25):2441-2452. doi:10.1056/NEJMoa1510687</ref>,<ref>Christiansen SL, Hertz CL, Ferrero-Miliani L, et al. Genetic investigation of 100 heart genes in sudden unexplained death victims in a forensic setting. Eur J HumGenet.2016;24(12):1797-1802. doi:10.1038/ejhg.2016.118</ref>,<ref name=":3">Lahrouchi N, Raju H, Lodder EM, et al.Utility of post-mortem genetic testing in cases of sudden arrhythmic death syndrome.JAmCollCardiol. 2017;69(17):2134-2145. doi:10.1016/j.jacc.2017.02. 046</ref>,<ref>Hansen BL, Jacobsen EM, Kjerrumgaard A, et al. Diagnostic yield in victims of sudden cardiac death and their relatives. Europace. 2020;22(6): 964-971. doi:10.1093/europace/euaa056</ref>-,<ref name=":2">Webster G,Puckelwartz MJ,Pesce LL, et al. Genomic autopsy of sudden deaths in young individuals. JAMA Cardiol. 2021;6(11):1247-1256. doi:10.1001/jamacardio.2021.2789</ref>. These yields are obtained after careful etiologic assessment by comprehensive postmortem investigation (including toxicology) for accurate genotype-phenotype correlation.
			* Sudden arrhythmic death without an apparent cause identified by autopsy is often attributed to arrhythmia syndromes. Of 490 prospectively ascertained sudden cardiac deaths by autopsy in persons aged 1 to 35 years in Australia,<ref name=":1" /> 113 were adjudicated as sudden arrhythmic death syndrome (ie,normal structural heart) and underwent genetic testing. Clinically relevant pathogenic or likely pathogenic variants in cardiac genes were found in 27%; major associated disorders included LQTS, Brugada syndrome, arrhythmogenic right ventricular cardiomyopathy, and CPVT.
			* Another study, 103 sudden cardiac deaths defined by autopsy in persons aged 1 to 44years without known CVD referred from 24 US medical examiners’ offices identified pathogenic or likely pathogenic variants associated with dilated cardiomyopathy, hypertrophic cardiomyopathy, LQTS, and arrhythmogenic right ventricular cardiomyopathy in13%.<ref name=":2" />
			* However, the total number of eligible sudden deaths was not reported, so it is unclear how this applies to all young adults with sudden cardiac death. A single center prospective study in the UK revealed that among 303 referred family members of individuals who had sudden arrhythmic death syndrome, 128 (42%) were diagnosed with inherited cardiac diseases including Brugada syn drome,LQTS,and dilated cardiomyopathy.<ref>Papadakis M, Papatheodorou E,Mellor G, et al. The diagnostic yield of Brugada syndrome after sudden death with normal autopsy.JAmColl Cardiol. 2018;71(11):1204-1214. doi:10.1016/j.jacc. 2018.01.031</ref>

			====== Genetic Testing of Cardiac Arrest Survivors: ======
			Genetic testing of sudden cardiac arrest survivors and additional cardiac screening of family members may detect previously unknown cardiomyopathy, such as dilated cardiomyopathy, hypertrophic cardiomyopathy, or primary arrhythmia syndrome.<ref>Krahn AD, Healey JS, Chauhan V, et al. Systematic assessment of patients with unexplained cardiac arrest: Cardiac Arrest Survivors With Preserved Ejection Fraction Registry (CASPER). Circulation. 2009;120(4):278-285. doi:10.1161/CIRCULATIONAHA.109.853143</ref>,<ref name=":3" />,<ref name=":2" /> Genetic testing of survivors is recommended if the results are likely to aid diagnosis,management, or family screening (classI,level B).<ref>Stiles MK, Wilde AAM, Abrams DJ, et al.2020 APHRS/HRS exper tconsensus statement on the investigation of decedents with sudden unexplained death andpatients with sudden cardiac arrest, and of their families. Heart Rhythm. 2021;18(1):e1-e50. doi:10.1016/j.hrthm.2020.10.010</ref> However, the yield of genetic testing from studies of survivors with clinically unexplained VT/VF targeting arrhythmia and cardiomyopathy genes ranged from 2% to 22%, which is lower than the percentage of pathogenic or likely pathogenic variants in cardiac genes among those who had sudden cardiac death (ie, nonsurvivors).<ref>Mellor G, Laksman ZWM, Tadros R, et al. Genetic testing in the evaluation of unexplained cardiac arrest: from the CASPER(Cardiac Arrest Survivors With Preserved Ejection Fraction Registry). Circ Cardiovasc Genet. 2017;10(3):e001686. doi:10.1161/CIRCGENETICS.116.001686</ref><ref>Visser M, Dooijes D, van der Smagt JJ, et al. Next-generation sequencing of a large gene panel in patients initially diagnosed with idiopathic ventricular fibrillation. Heart Rhythm. 2017;14(7): 1035-1040. doi:10.1016/j.hrthm.2017.01.010</ref><ref>Leinonen JT, Crotti L, Djupsjöbacka A, et al. The genetics underlying idiopathic ventricular fibrillation: a special role for catecholaminergic polymorphic ventricular tachycardia? Int J Cardiol. 2018;250:139-145. doi:10.1016/j.ijcard.2017.10.016</ref><ref>Asatryan B, Schaller A, Seiler J, et al. Usefulness of genetic testing in sudden cardiac arrest survivors with or without previous clinical evidence of heart disease. AmJCardiol. 2019;123 (12):2031-2038. doi:10.1016/j.amjcard.2019.02.061</ref>

Sudden cardiac death post arrest care and prevention

2026-04-05T12:33:04Z

2022 ESC Guidelines for the management of patients with ventricular arrythymias and the prevention of sudden cardiac death [2]

Show changes

Sudden cardiac death other diagnostic studies

2026-04-04T14:03:47Z

Electrophysiology Study

← Older revision		Revision as of 14:03, 4 April 2026
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	===Exercise Testing===		===Exercise Testing===
	* This test is useful in the [[diagnosis]] of [[exercise-induced idiopathic monomorphic ventricular tachycardia]] ([[MVT]]), [[paroxysmal ventricular tachycardia]] ([[PVT]]), and bidirectional [[ventricular tachycardia]] <ref name="pmid30763784">{{cite journal\| author=Giudicessi JR, Ackerman MJ\| title=Exercise testing oversights underlie missed and delayed diagnosis of catecholaminergic polymorphic ventricular tachycardia in young sudden cardiac arrest survivors. \| journal=Heart Rhythm \| year= 2019 \| volume= 16 \| issue= 8 \| pages= 1232-1239 \| pmid=30763784 \| doi=10.1016/j.hrthm.2019.02.012 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30763784 }} </ref> <ref name="pmid33888264">{{cite journal\| author=Roston TM, Kallas D, Davies B, Franciosi S, De Souza AM, Laksman ZW \| display-authors=etal\| title=Burst Exercise Testing Can Unmask Arrhythmias in Patients With Incompletely Penetrant Catecholaminergic Polymorphic Ventricular Tachycardia. \| journal=JACC Clin Electrophysiol \| year= 2021 \| volume= 7 \| issue= 4 \| pages= 437-441 \| pmid=33888264 \| doi=10.1016/j.jacep.2021.02.013 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33888264 }} </ref>.		* This test is useful in the [[diagnosis]] of [[exercise-induced idiopathic monomorphic ventricular tachycardia]] ([[MVT]]), catecholaminergic polymorphic VT(CPVT), [[paroxysmal ventricular tachycardia]] ([[PVT]]), and bidirectional [[ventricular tachycardia]] or LQTS if the QT interval does not shorten with exercise or remains prolonged during the recovery phase<ref name="pmid30763784">{{cite journal\| author=Giudicessi JR, Ackerman MJ\| title=Exercise testing oversights underlie missed and delayed diagnosis of catecholaminergic polymorphic ventricular tachycardia in young sudden cardiac arrest survivors. \| journal=Heart Rhythm \| year= 2019 \| volume= 16 \| issue= 8 \| pages= 1232-1239 \| pmid=30763784 \| doi=10.1016/j.hrthm.2019.02.012 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30763784 }} </ref> <ref name="pmid33888264">{{cite journal\| author=Roston TM, Kallas D, Davies B, Franciosi S, De Souza AM, Laksman ZW \| display-authors=etal\| title=Burst Exercise Testing Can Unmask Arrhythmias in Patients With Incompletely Penetrant Catecholaminergic Polymorphic Ventricular Tachycardia. \| journal=JACC Clin Electrophysiol \| year= 2021 \| volume= 7 \| issue= 4 \| pages= 437-441 \| pmid=33888264 \| doi=10.1016/j.jacep.2021.02.013 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33888264 }} </ref><ref name=":0">Zeppenfeld K,Tfelt-Hansen J, de Riva M, et al; ESC Scientific Document Group.2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. EurHeartJ. 2022;43(40): 3997-4126. doi:10.1093/eurheartj/ehac262</ref><ref>Sy RW, van der Werf C, Chattha IS, et al. Derivation and validation of a simple exercise-based algorithm for prediction of genetic testing in relatives of LQTS probands. Circulation. 2011;124 (20):2187-2194. doi:10.1161/CIRCULATIONAHA.111. 028258</ref>.

	===Provocative Diagnostic Tests===		===Provocative Diagnostic Tests===
Line 22:		Line 22:
	===Electrophysiology Study===		===Electrophysiology Study===
	*This study includes measurement of programmed electrical stimulation (PES), baseline intervals ([[His-ventricuar interval]] and [[atrial-His interval]]) and [[electroanatomical mapping]] for [[diagnosis]] and [[therapy]] <ref name="pmid1907984">{{cite journal\| author=Bourke JP, Richards DA, Ross DL, Wallace EM, McGuire MA, Uther JB\| title=Routine programmed electrical stimulation in survivors of acute myocardial infarction for prediction of spontaneous ventricular tachyarrhythmias during follow-up: results, optimal stimulation protocol and cost-effective screening. \| journal=J Am Coll Cardiol \| year= 1991 \| volume= 18 \| issue= 3 \| pages= 780-8 \| pmid=1907984 \| doi=10.1016/0735-1097(91)90802-g \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1907984 }} </ref> <ref name="pmid25150471">{{cite journal\| author=Gatzoulis KA, Tsiachris D, Arsenos P, Archontakis S, Dilaveris P, Vouliotis A \| display-authors=etal\| title=Prognostic value of programmed ventricular stimulation for sudden death in selected high risk patients with structural heart disease and preserved systolic function. \| journal=Int J Cardiol \| year= 2014 \| volume= 176 \| issue= 3 \| pages= 1449-51 \| pmid=25150471 \| doi=10.1016/j.ijcard.2014.08.068 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25150471 }} </ref> <ref name="pmid23588627">{{cite journal\| author=Gatzoulis KA, Vouliotis AI, Tsiachris D, Salourou M, Archontakis S, Dilaveris P \| display-authors=etal\| title=Primary prevention of sudden cardiac death in a nonischemic dilated cardiomyopathy population: reappraisal of the role of programmed ventricular stimulation. \| journal=Circ Arrhythm Electrophysiol \| year= 2013 \| volume= 6 \| issue= 3 \| pages= 504-12 \| pmid=23588627 \| doi=10.1161/CIRCEP.113.000216 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23588627 }} </ref> <ref name="pmid11816631">{{cite journal\| author=Brilakis ES, Shen WK, Hammill SC, Hodge DO, Rea RF, Lexvold NY \| display-authors=etal\| title=Role of programmed ventricular stimulation and implantable cardioverter defibrillators in patients with idiopathic dilated cardiomyopathy and syncope. \| journal=Pacing Clin Electrophysiol \| year= 2001 \| volume= 24 \| issue= 11 \| pages= 1623-30 \| pmid=11816631 \| doi=10.1046/j.1460-9592.2001.01623.x \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11816631 }} </ref> <ref name="pmid15358027">{{cite journal\| author=Brembilla-Perrot B, Suty-Selton C, Beurrier D, Houriez P, Nippert M, de la Chaise AT \| display-authors=etal\| title=Differences in mechanisms and outcomes of syncope in patients with coronary disease or idiopathic left ventricular dysfunction as assessed by electrophysiologic testing. \| journal=J Am Coll Cardiol \| year= 2004 \| volume= 44 \| issue= 3 \| pages= 594-601 \| pmid=15358027 \| doi=10.1016/j.jacc.2004.03.075 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15358027 }} </ref> <ref name="pmid11401129">{{cite journal\| author=Schmitt C, Barthel P, Ndrepepa G, Schreieck J, Plewan A, Schömig A \| display-authors=etal\| title=Value of programmed ventricular stimulation for prophylactic internal cardioverter-defibrillator implantation in postinfarction patients preselected by noninvasive risk stratifiers. \| journal=J Am Coll Cardiol \| year= 2001 \| volume= 37 \| issue= 7 \| pages= 1901-7 \| pmid=11401129 \| doi=10.1016/s0735-1097(01)01246-3 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11401129 }} </ref>.		*This study includes measurement of programmed electrical stimulation (PES), baseline intervals ([[His-ventricuar interval]] and [[atrial-His interval]]) and [[electroanatomical mapping]] for [[diagnosis]] and [[therapy]] <ref name="pmid1907984">{{cite journal\| author=Bourke JP, Richards DA, Ross DL, Wallace EM, McGuire MA, Uther JB\| title=Routine programmed electrical stimulation in survivors of acute myocardial infarction for prediction of spontaneous ventricular tachyarrhythmias during follow-up: results, optimal stimulation protocol and cost-effective screening. \| journal=J Am Coll Cardiol \| year= 1991 \| volume= 18 \| issue= 3 \| pages= 780-8 \| pmid=1907984 \| doi=10.1016/0735-1097(91)90802-g \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1907984 }} </ref> <ref name="pmid25150471">{{cite journal\| author=Gatzoulis KA, Tsiachris D, Arsenos P, Archontakis S, Dilaveris P, Vouliotis A \| display-authors=etal\| title=Prognostic value of programmed ventricular stimulation for sudden death in selected high risk patients with structural heart disease and preserved systolic function. \| journal=Int J Cardiol \| year= 2014 \| volume= 176 \| issue= 3 \| pages= 1449-51 \| pmid=25150471 \| doi=10.1016/j.ijcard.2014.08.068 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25150471 }} </ref> <ref name="pmid23588627">{{cite journal\| author=Gatzoulis KA, Vouliotis AI, Tsiachris D, Salourou M, Archontakis S, Dilaveris P \| display-authors=etal\| title=Primary prevention of sudden cardiac death in a nonischemic dilated cardiomyopathy population: reappraisal of the role of programmed ventricular stimulation. \| journal=Circ Arrhythm Electrophysiol \| year= 2013 \| volume= 6 \| issue= 3 \| pages= 504-12 \| pmid=23588627 \| doi=10.1161/CIRCEP.113.000216 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23588627 }} </ref> <ref name="pmid11816631">{{cite journal\| author=Brilakis ES, Shen WK, Hammill SC, Hodge DO, Rea RF, Lexvold NY \| display-authors=etal\| title=Role of programmed ventricular stimulation and implantable cardioverter defibrillators in patients with idiopathic dilated cardiomyopathy and syncope. \| journal=Pacing Clin Electrophysiol \| year= 2001 \| volume= 24 \| issue= 11 \| pages= 1623-30 \| pmid=11816631 \| doi=10.1046/j.1460-9592.2001.01623.x \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11816631 }} </ref> <ref name="pmid15358027">{{cite journal\| author=Brembilla-Perrot B, Suty-Selton C, Beurrier D, Houriez P, Nippert M, de la Chaise AT \| display-authors=etal\| title=Differences in mechanisms and outcomes of syncope in patients with coronary disease or idiopathic left ventricular dysfunction as assessed by electrophysiologic testing. \| journal=J Am Coll Cardiol \| year= 2004 \| volume= 44 \| issue= 3 \| pages= 594-601 \| pmid=15358027 \| doi=10.1016/j.jacc.2004.03.075 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15358027 }} </ref> <ref name="pmid11401129">{{cite journal\| author=Schmitt C, Barthel P, Ndrepepa G, Schreieck J, Plewan A, Schömig A \| display-authors=etal\| title=Value of programmed ventricular stimulation for prophylactic internal cardioverter-defibrillator implantation in postinfarction patients preselected by noninvasive risk stratifiers. \| journal=J Am Coll Cardiol \| year= 2001 \| volume= 37 \| issue= 7 \| pages= 1901-7 \| pmid=11401129 \| doi=10.1016/s0735-1097(01)01246-3 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11401129 }} </ref>.
			*In case of normally structured heart and ECG inconclusive of arrythmic syndrome, it is required to further evaluate the condition with electrophysiological study (EPS),sodium channel blocker challenge, or stress ECG testing may be performed. Because delta waves in Wolff-Parkinson-White syndrome and Brugada pattern may not be apparent initially on ECGs after resuscitation, an EPS can identify and treat accessory path ways responsible for cardiac arrest.<ref>Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: executive summary: a Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.Heart Rhythm.2018;15(10):e190-e252. doi:10.1016/j.hrthm. 2017.10.035</ref> A sodium channel blocker challenge during EPS involves administration of drugs such as flecainide, ajmaline, and pilsicainide to unmask a type 1 Brugada ECG pattern.<ref name=":0" />

	===Genetic testing===		===Genetic testing===

Sudden cardiac death diagnostic study of choice

2026-04-04T13:50:54Z

References

← Older revision		Revision as of 13:50, 4 April 2026
Line 4:		Line 4:

	==Overview==		==Overview==
			Clinicians evaluating persons hospitalized after resuscitation from out-of-hospital cardiac arrest should review documented cardiac rhythm from EMS records and the circumstances of arrest, including witness accounts. They should obtain a family history of heart disease for at least 3 generations, syncope, sudden cardiac arrest, or sudden cardiac death and should evaluate for use of QT-prolonging medications, substance use (eg, cocaine, methamphetamine, or ketamine), and supplements (eg, kratom, tianeptine).<ref>Shah SA, Szeto AH, Farewell R, et al.Impact of high volume energy drink consumptionon electrocardiographic and blood pressure parameters: a randomized trial. J AmHeartAssoc. 2019;8(11):e011318. doi:10.1161/JAHA.118.011318</ref>,<ref>Post S, Spiller HA, Chounthirath T, Smith GA. Kratom exposures reported to United States poison control centers: 2011-2017. Clin Toxicol (Phila). 2019;57(10):847-854. doi:10.1080/15563650.2019. 1569236</ref>,<ref>Counts CJ, Spadaro AV, Cerbini TA, et al.Notes from the Field: Cluster of severe illness from Neptune’s fix tianeptine linked to synthetic cannabinoids—New Jersey, June-November2023. MMWR Morb Mortal Wkly Rep.2024;73(4):89-90. doi:10.15585/mmwr.mm7304a5</ref>

	In resuscitated sudden cardiac arrest individuals, an emergency workup should be performed, it includes:		In resuscitated sudden cardiac arrest individuals, an emergency workup should be performed, it includes:

Line 14:		Line 16:

	==Diagnosis Study Of Choice==		==Diagnosis Study Of Choice==
			*Persons resuscitated from sudden cardiac arrest should undergo evaluation with a basic metabolic profile and serum troponin; urine toxicology test; electrocardiogram; chest x-ray; head-to-pelvis computed tomography; and bedside ultrasound to assess for pericardial tamponade, aortic dissection, or hemorrhage.<ref name=":0">Tseng ZH, Nakasuka K. Out-of-Hospital Cardiac Arrest in Apparently Healthy, Young Adults. JAMA. 2025;333(11):981–996. doi:10.1001/jama.2024.27916</ref>
			*If intial evaluation failed to reveal the arrest cause, we should check for structural heart disease (eg, unsuspected cardiomyopathy) or valvular disease (eg, mitral valve prolapse) that can precipitate sudden cardiac death using transthoracic echocardiography.<ref name=":0" />
	*According to the 2017 Association for European Cardiovascular Pathologists guidelines, [[autopsy]] is done whenever [[sudden cardiac death]] ([[SCD]]) is suspected.		*According to the 2017 Association for European Cardiovascular Pathologists guidelines, [[autopsy]] is done whenever [[sudden cardiac death]] ([[SCD]]) is suspected.
	* [[Autopsy]] investigates whether:		* [[Autopsy]] investigates whether:
Line 19:		Line 23:
	** The cause of [[SCD]] is of [[hereditary]] in origin requiring the need for [[screening]] and [[counseling]] for the next generations		** The cause of [[SCD]] is of [[hereditary]] in origin requiring the need for [[screening]] and [[counseling]] for the next generations
	** Third person involvement was present <ref name="pmiddoi: 10.1007/s00428-017-2221-0.">{{cite journal\| author=Schmoldt A, Benthe HF, Haberland G\| title=Digitoxin metabolism by rat liver microsomes. \| journal=Biochem Pharmacol \| year= 1975 \| volume= 24 \| issue= 17 \| pages= 1639-41 \| pmid=doi: 10.1007/s00428-017-2221-0. \| doi= \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref> <ref name="pmiddoi: 10.1007/s00428-007-0505-5">{{cite journal\| author=Schmoldt A, Benthe HF, Haberland G\| title=Digitoxin metabolism by rat liver microsomes. \| journal=Biochem Pharmacol \| year= 1975 \| volume= 24 \| issue= 17 \| pages= 1639-41 \| pmid=doi: 10.1007/s00428-007-0505-5 \| doi= \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref>		** Third person involvement was present <ref name="pmiddoi: 10.1007/s00428-017-2221-0.">{{cite journal\| author=Schmoldt A, Benthe HF, Haberland G\| title=Digitoxin metabolism by rat liver microsomes. \| journal=Biochem Pharmacol \| year= 1975 \| volume= 24 \| issue= 17 \| pages= 1639-41 \| pmid=doi: 10.1007/s00428-017-2221-0. \| doi= \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref> <ref name="pmiddoi: 10.1007/s00428-007-0505-5">{{cite journal\| author=Schmoldt A, Benthe HF, Haberland G\| title=Digitoxin metabolism by rat liver microsomes. \| journal=Biochem Pharmacol \| year= 1975 \| volume= 24 \| issue= 17 \| pages= 1639-41 \| pmid=doi: 10.1007/s00428-007-0505-5 \| doi= \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref>
	*Clinicians evaluating persons hospitalized after resuscitation from out-of-hospital cardiac arrest should review documented cardiac rhythm from EMS records and the circumstances of arrest, including witness accounts. They should obtain a family history of heart disease for at least 3 generations, syncope, sudden cardiac arrest, or sudden cardiac death and should evaluate for use of QT-prolonging medications, substance use (eg, cocaine, methamphetamine, or ketamine), and supplements (eg, kratom, tianeptine).<ref>Shah SA, Szeto AH, Farewell R, et al.Impact of high volume energy drink consumptionon electrocardiographic and blood pressure parameters: a randomized trial. J AmHeartAssoc. 2019;8(11):e011318. doi:10.1161/JAHA.118.011318</ref>,<ref>Post S, Spiller HA, Chounthirath T, Smith GA. Kratom exposures reported to United States poison control centers: 2011-2017. Clin Toxicol (Phila). 2019;57(10):847-854. doi:10.1080/15563650.2019. 1569236</ref>,<ref>Counts CJ, Spadaro AV, Cerbini TA, et al.Notes from the Field: Cluster of severe illness from Neptune’s fix tianeptine linked to synthetic cannabinoids—New Jersey, June-November2023. MMWR Morb Mortal Wkly Rep.2024;73(4):89-90. doi:10.15585/mmwr.mm7304a5</ref>		*
	*Persons resuscitated from sudden cardiac arrest should undergo evaluation with a basic metabolic profile and serum troponin; urine toxicology test; electrocardiogram; chest x-ray; head-to-pelvis computed tomography; and bedside ultrasound to assess for pericardial tamponade, aortic dissection, or hemorrhage.<ref name=":0">Tseng ZH, Nakasuka K. Out-of-Hospital Cardiac Arrest in Apparently Healthy, Young Adults. JAMA. 2025;333(11):981–996. doi:10.1001/jama.2024.27916</ref>
	*If intial evaluation failed to reveal the arrest cause, we should check for structural heart disease (eg, unsuspected cardiomyopathy) or valvular disease (eg, mitral valve prolapse) that can precipitate sudden cardiac death using transthoracic echocardiography.<ref name=":0" />

	==References==		==References==

Sudden cardiac death echocardiography and ultrasound

2026-04-04T13:46:53Z

Echocardiography

← Older revision		Revision as of 13:46, 4 April 2026
Line 18:		Line 18:
	* [[Tamponade]]		* [[Tamponade]]
	* [[ Aorta dissection]] <ref name="ParkerSalerno2018">{{cite journal\|last1=Parker\|first1=Brian K.\|last2=Salerno\|first2=Alexis\|last3=Euerle\|first3=Brian D.\|title=The Use of Transesophageal Echocardiography During Cardiac Arrest Resuscitation: A Literature Review\|journal=Journal of Ultrasound in Medicine\|volume=38\|issue=5\|year=2018\|pages=1141–1151\|issn=0278-4297\|doi=10.1002/jum.14794}}</ref>		* [[ Aorta dissection]] <ref name="ParkerSalerno2018">{{cite journal\|last1=Parker\|first1=Brian K.\|last2=Salerno\|first2=Alexis\|last3=Euerle\|first3=Brian D.\|title=The Use of Transesophageal Echocardiography During Cardiac Arrest Resuscitation: A Literature Review\|journal=Journal of Ultrasound in Medicine\|volume=38\|issue=5\|year=2018\|pages=1141–1151\|issn=0278-4297\|doi=10.1002/jum.14794}}</ref>
			* Mitral valve prolapse<ref>Han HC, Ha FJ, Teh AW, et al.Mitral valve prolapse and sudden cardiac death:a systematic review. JAmHeartAssoc.2018;7(23):e010584.doi: 10.1161/JAHA.118.010584</ref>

Sudden cardiac death diagnostic study of choice

2026-04-04T13:43:27Z

Diagnosis Study Of Choice

← Older revision		Revision as of 13:43, 4 April 2026
Line 21:		Line 21:
	*Clinicians evaluating persons hospitalized after resuscitation from out-of-hospital cardiac arrest should review documented cardiac rhythm from EMS records and the circumstances of arrest, including witness accounts. They should obtain a family history of heart disease for at least 3 generations, syncope, sudden cardiac arrest, or sudden cardiac death and should evaluate for use of QT-prolonging medications, substance use (eg, cocaine, methamphetamine, or ketamine), and supplements (eg, kratom, tianeptine).<ref>Shah SA, Szeto AH, Farewell R, et al.Impact of high volume energy drink consumptionon electrocardiographic and blood pressure parameters: a randomized trial. J AmHeartAssoc. 2019;8(11):e011318. doi:10.1161/JAHA.118.011318</ref>,<ref>Post S, Spiller HA, Chounthirath T, Smith GA. Kratom exposures reported to United States poison control centers: 2011-2017. Clin Toxicol (Phila). 2019;57(10):847-854. doi:10.1080/15563650.2019. 1569236</ref>,<ref>Counts CJ, Spadaro AV, Cerbini TA, et al.Notes from the Field: Cluster of severe illness from Neptune’s fix tianeptine linked to synthetic cannabinoids—New Jersey, June-November2023. MMWR Morb Mortal Wkly Rep.2024;73(4):89-90. doi:10.15585/mmwr.mm7304a5</ref>		*Clinicians evaluating persons hospitalized after resuscitation from out-of-hospital cardiac arrest should review documented cardiac rhythm from EMS records and the circumstances of arrest, including witness accounts. They should obtain a family history of heart disease for at least 3 generations, syncope, sudden cardiac arrest, or sudden cardiac death and should evaluate for use of QT-prolonging medications, substance use (eg, cocaine, methamphetamine, or ketamine), and supplements (eg, kratom, tianeptine).<ref>Shah SA, Szeto AH, Farewell R, et al.Impact of high volume energy drink consumptionon electrocardiographic and blood pressure parameters: a randomized trial. J AmHeartAssoc. 2019;8(11):e011318. doi:10.1161/JAHA.118.011318</ref>,<ref>Post S, Spiller HA, Chounthirath T, Smith GA. Kratom exposures reported to United States poison control centers: 2011-2017. Clin Toxicol (Phila). 2019;57(10):847-854. doi:10.1080/15563650.2019. 1569236</ref>,<ref>Counts CJ, Spadaro AV, Cerbini TA, et al.Notes from the Field: Cluster of severe illness from Neptune’s fix tianeptine linked to synthetic cannabinoids—New Jersey, June-November2023. MMWR Morb Mortal Wkly Rep.2024;73(4):89-90. doi:10.15585/mmwr.mm7304a5</ref>
	*Persons resuscitated from sudden cardiac arrest should undergo evaluation with a basic metabolic profile and serum troponin; urine toxicology test; electrocardiogram; chest x-ray; head-to-pelvis computed tomography; and bedside ultrasound to assess for pericardial tamponade, aortic dissection, or hemorrhage.<ref name=":0">Tseng ZH, Nakasuka K. Out-of-Hospital Cardiac Arrest in Apparently Healthy, Young Adults. JAMA. 2025;333(11):981–996. doi:10.1001/jama.2024.27916</ref>		*Persons resuscitated from sudden cardiac arrest should undergo evaluation with a basic metabolic profile and serum troponin; urine toxicology test; electrocardiogram; chest x-ray; head-to-pelvis computed tomography; and bedside ultrasound to assess for pericardial tamponade, aortic dissection, or hemorrhage.<ref name=":0">Tseng ZH, Nakasuka K. Out-of-Hospital Cardiac Arrest in Apparently Healthy, Young Adults. JAMA. 2025;333(11):981–996. doi:10.1001/jama.2024.27916</ref>
	*if intial evaluation failed to reveal the arrest cause, we should check for structural heart disease (eg, unsuspected cardiomyopathy) or valvular disease (eg, mitral valve prolapse) that can precipitate sudden cardiac death using transthoracic echocardiography.<ref name=":0" />		*If intial evaluation failed to reveal the arrest cause, we should check for structural heart disease (eg, unsuspected cardiomyopathy) or valvular disease (eg, mitral valve prolapse) that can precipitate sudden cardiac death using transthoracic echocardiography.<ref name=":0" />

	==References==		==References==

Sudden cardiac death electrocardiogram

2026-04-04T13:38:49Z

← Older revision		Revision as of 13:38, 4 April 2026
Line 1:		Line 1:
	__NOTOC__		__NOTOC__
	{{Sudden cardiac death}}		{{Sudden cardiac death}}
	{{CMG}} {{AE}} {{Sara.Zand}} {{Jose}} {{EdzelCo}}		{{CMG}} {{AE}} {{Sara.Zand}} {{Jose}} {{EdzelCo}} {{Nehal}}

	==Overview==		==Overview==

Sudden cardiac death echocardiography and ultrasound

2026-04-04T12:32:24Z

← Older revision		Revision as of 12:32, 4 April 2026
Line 1:		Line 1:
	__NOTOC__		__NOTOC__
	{{Sudden cardiac death}}		{{Sudden cardiac death}}
	{{CMG}} {{AE}} {{Sara.Zand}} {{EdzelCo}}		{{CMG}} {{AE}} {{Sara.Zand}} {{EdzelCo}} {{Nehal}}

	==Overview==		==Overview==

Sudden cardiac death diagnostic study of choice

2026-04-04T12:16:33Z

Overview

← Older revision		Revision as of 12:16, 4 April 2026
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	** The cause of [[SCD]] is of [[hereditary]] in origin requiring the need for [[screening]] and [[counseling]] for the next generations		** The cause of [[SCD]] is of [[hereditary]] in origin requiring the need for [[screening]] and [[counseling]] for the next generations
	** Third person involvement was present <ref name="pmiddoi: 10.1007/s00428-017-2221-0.">{{cite journal\| author=Schmoldt A, Benthe HF, Haberland G\| title=Digitoxin metabolism by rat liver microsomes. \| journal=Biochem Pharmacol \| year= 1975 \| volume= 24 \| issue= 17 \| pages= 1639-41 \| pmid=doi: 10.1007/s00428-017-2221-0. \| doi= \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref> <ref name="pmiddoi: 10.1007/s00428-007-0505-5">{{cite journal\| author=Schmoldt A, Benthe HF, Haberland G\| title=Digitoxin metabolism by rat liver microsomes. \| journal=Biochem Pharmacol \| year= 1975 \| volume= 24 \| issue= 17 \| pages= 1639-41 \| pmid=doi: 10.1007/s00428-007-0505-5 \| doi= \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref>		** Third person involvement was present <ref name="pmiddoi: 10.1007/s00428-017-2221-0.">{{cite journal\| author=Schmoldt A, Benthe HF, Haberland G\| title=Digitoxin metabolism by rat liver microsomes. \| journal=Biochem Pharmacol \| year= 1975 \| volume= 24 \| issue= 17 \| pages= 1639-41 \| pmid=doi: 10.1007/s00428-017-2221-0. \| doi= \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref> <ref name="pmiddoi: 10.1007/s00428-007-0505-5">{{cite journal\| author=Schmoldt A, Benthe HF, Haberland G\| title=Digitoxin metabolism by rat liver microsomes. \| journal=Biochem Pharmacol \| year= 1975 \| volume= 24 \| issue= 17 \| pages= 1639-41 \| pmid=doi: 10.1007/s00428-007-0505-5 \| doi= \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref>
			*Clinicians evaluating persons hospitalized after resuscitation from out-of-hospital cardiac arrest should review documented cardiac rhythm from EMS records and the circumstances of arrest, including witness accounts. They should obtain a family history of heart disease for at least 3 generations, syncope, sudden cardiac arrest, or sudden cardiac death and should evaluate for use of QT-prolonging medications, substance use (eg, cocaine, methamphetamine, or ketamine), and supplements (eg, kratom, tianeptine).<ref>Shah SA, Szeto AH, Farewell R, et al.Impact of high volume energy drink consumptionon electrocardiographic and blood pressure parameters: a randomized trial. J AmHeartAssoc. 2019;8(11):e011318. doi:10.1161/JAHA.118.011318</ref>,<ref>Post S, Spiller HA, Chounthirath T, Smith GA. Kratom exposures reported to United States poison control centers: 2011-2017. Clin Toxicol (Phila). 2019;57(10):847-854. doi:10.1080/15563650.2019. 1569236</ref>,<ref>Counts CJ, Spadaro AV, Cerbini TA, et al.Notes from the Field: Cluster of severe illness from Neptune’s fix tianeptine linked to synthetic cannabinoids—New Jersey, June-November2023. MMWR Morb Mortal Wkly Rep.2024;73(4):89-90. doi:10.15585/mmwr.mm7304a5</ref>
	*Persons resuscitated from sudden cardiac arrest should undergo evaluation with a basic metabolic profile and serum troponin; urine toxicology test; electrocardiogram; chest x-ray; head-to-pelvis computed tomography; and bedside ultrasound to assess for pericardial tamponade, aortic dissection, or hemorrhage.<ref name=":0">Tseng ZH, Nakasuka K. Out-of-Hospital Cardiac Arrest in Apparently Healthy, Young Adults. JAMA. 2025;333(11):981–996. doi:10.1001/jama.2024.27916</ref>		*Persons resuscitated from sudden cardiac arrest should undergo evaluation with a basic metabolic profile and serum troponin; urine toxicology test; electrocardiogram; chest x-ray; head-to-pelvis computed tomography; and bedside ultrasound to assess for pericardial tamponade, aortic dissection, or hemorrhage.<ref name=":0">Tseng ZH, Nakasuka K. Out-of-Hospital Cardiac Arrest in Apparently Healthy, Young Adults. JAMA. 2025;333(11):981–996. doi:10.1001/jama.2024.27916</ref>
	*if intial evaluation failed to reveal the arrest cause, we should check for structural heart disease (eg, unsuspected cardiomyopathy) or valvular disease (eg, mitral valve prolapse) that can precipitate sudden cardiac death using transthoracic echocardiography.<ref name=":0" />		*if intial evaluation failed to reveal the arrest cause, we should check for structural heart disease (eg, unsuspected cardiomyopathy) or valvular disease (eg, mitral valve prolapse) that can precipitate sudden cardiac death using transthoracic echocardiography.<ref name=":0" />

Sudden cardiac death electrocardiogram

2026-04-04T12:14:59Z

Brugada syndrome:

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	===Electrocardiogram===		===Electrocardiogram===
	An [[electrocardiogram]] ([[ECG]]) may be helpful in the diagnosis of [[Sudden cardiac death]]. Findings on [[ECG]] associated with [[ sudden cardiac arrest]] ([[SCA]]) may include:<ref name="JayaramanReinier2018">{{cite journal\|last1=Jayaraman\|first1=Reshmy\|last2=Reinier\|first2=Kyndaron\|last3=Nair\|first3=Sandeep\|last4=Aro\|first4=Aapo L.\|last5=Uy-Evanado\|first5=Audrey\|last6=Rusinaru\|first6=Carmen\|last7=Stecker\|first7=Eric C.\|last8=Gunson\|first8=Karen\|last9=Jui\|first9=Jonathan\|last10=Chugh\|first10=Sumeet S.\|title=Risk Factors of Sudden Cardiac Death in the Young\|journal=Circulation\|volume=137\|issue=15\|year=2018\|pages=1561–1570\|issn=0009-7322\|doi=10.1161/CIRCULATIONAHA.117.031262}}</ref>		An [[electrocardiogram]] ([[ECG]]) may be helpful in the diagnosis of [[Sudden cardiac death]].

			Findings on [[ECG]] associated with [[ sudden cardiac arrest]] ([[SCA]]) may include:<ref name="JayaramanReinier2018">{{cite journal\|last1=Jayaraman\|first1=Reshmy\|last2=Reinier\|first2=Kyndaron\|last3=Nair\|first3=Sandeep\|last4=Aro\|first4=Aapo L.\|last5=Uy-Evanado\|first5=Audrey\|last6=Rusinaru\|first6=Carmen\|last7=Stecker\|first7=Eric C.\|last8=Gunson\|first8=Karen\|last9=Jui\|first9=Jonathan\|last10=Chugh\|first10=Sumeet S.\|title=Risk Factors of Sudden Cardiac Death in the Young\|journal=Circulation\|volume=137\|issue=15\|year=2018\|pages=1561–1570\|issn=0009-7322\|doi=10.1161/CIRCULATIONAHA.117.031262}}</ref>

	* [[Sinus tachycardia]] (39%)		* [[Sinus tachycardia]] (39%)
	* Abnormal [[T-wave inversions]] (30%)		* Abnormal [[T-wave inversions]] (30%)
	* Prolonged [[QT]] interval (26%)		* Prolonged [[QT]] interval
			* Long QT syndrome (26%) (present in 13% of young adults resuscitated from sudden cardiac arrest)<ref name=":0">Krahn AD, Healey JS, Chauhan V, et al. Systematic assessment of patients with unexplained cardiac arrest: Cardiac Arrest Survivors With Preserved Ejection Fraction Registry (CASPER). Circulation. 2009;120(4):278-285. doi:10.1161/CIRCULATIONAHA.109.853143</ref>
	* Left/[[right atrial]] abnormality (22%)		* Left/[[right atrial]] abnormality (22%)
	* [[ LVH]] (17%)		* [[ LVH]] (17%)
	* Abnormal frontal [[QRS axis]] (17%)		* Abnormal frontal [[QRS axis]] (17%)
	* Delayed [[QRS]]-transition zone in precordial leads (13%)		* Delayed [[QRS]]-transition zone in precordial leads (13%)
	* Pathological [[Q waves]] (13%)		* Pathological [[Q waves]] (13%)
	* [[intraventricular conduction delays]] (9%)		* [[intraventricular conduction delays]] (9%)
			* Wolff-Parkinson-White syndrome(5%-12% of young adults with cardiac arrest)<ref name=":0" />,<ref>van der Werf C, Hofman N, Tan HL, et al. Diagnostic yield in sudden unexplained death and aborted cardiac arrest in the young: the experience of a tertiary referral center in the Netherlands. Heart Rhythm.2010;7(10):1383-1389. doi:10.1016/j. hrthm.2010.05.036</ref>
			* Arrhythmogenic right ventricular cardiomyopathy(10% of young adults with cardiac arrest)<ref name=":0" />
			* Brugada syndrome (<1%).<ref>Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006.Circulation. 2009;119 (8):1085-1092. doi:10.1161/CIRCULATIONAHA.108.804617</ref>
	* Multiple [[premature ventricular contractions]] (9%)		* Multiple [[premature ventricular contractions]] (9%)
	* Normal [[ECG]] (9%)		* Normal [[ECG]] (9%)
			* If the ECG shows STEMI or unstable arrhythmia, the patient should be referred for emergency coronary angiography followed by revascularization in case of acute ischemia.

	A recently published case report demonstrated a [[cardiac arrest]] happening due to a very unusual cause. It was triggered by the increased [[parasympathethic tone]] during defecation. The successive changes that were observed on [[ECG]] were in this order: [[prolonged PR interval]], [[2:1 atrioventricular block]], [[sinus bradycardia]] and [[complete heart block]]. These findings supported the occurrence of a central mechanism in this cardiac arrest.<ref name="pmid33464284">{{cite journal\| author=Tsushima T, Patel TR, Sahadevan J\| title=Unusual Cause of Cardiac Arrest. \| journal=JAMA Intern Med \| year= 2021 \| volume= 181 \| issue= 4 \| pages= 542-543 \| pmid=33464284 \| doi=10.1001/jamainternmed.2020.8370 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33464284 }} </ref>		A recently published case report demonstrated a [[cardiac arrest]] happening due to a very unusual cause. It was triggered by the increased [[parasympathethic tone]] during defecation. The successive changes that were observed on [[ECG]] were in this order: [[prolonged PR interval]], [[2:1 atrioventricular block]], [[sinus bradycardia]] and [[complete heart block]]. These findings supported the occurrence of a central mechanism in this cardiac arrest.<ref name="pmid33464284">{{cite journal\| author=Tsushima T, Patel TR, Sahadevan J\| title=Unusual Cause of Cardiac Arrest. \| journal=JAMA Intern Med \| year= 2021 \| volume= 181 \| issue= 4 \| pages= 542-543 \| pmid=33464284 \| doi=10.1001/jamainternmed.2020.8370 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33464284 }} </ref>


			Repeating 12 lead ECGs are important during evaluation because ECG wave forms, particularly type 1 waveform in Brugada syndrome<ref>Curcio A, Mazzanti A, Bloise R, et al.Clinical presentation and outcome of Brugada syndrome diagnosed with the new 2013 criteria. JCardiovasc Electrophysiol. 2016;27(8):937-943. doi:10.1111/jce. 12997</ref> and the QTinterval, may show day-to-day and circadian variation<ref>Jeyaraj D, Haldar SM, Wan X, et al.Circadian rhythms govern cardiac repolarization and arrhythmogenesis. Nature. 2012;483(7387):96-99. doi:10.1038/nature10852</ref> and variation after the initial resuscitation due to ischemia, autonomic fluctuations, and electrolyte derangements (eg, hypokalemia, hypomagnesemia) after sudden cardiac arrest.<ref>Salerno DM, Asinger RW, Elsperger J, Ruiz E, Hodges M. Frequency of hypokalemia after successfully resuscitated out-of-hospital cardiac arrest compared with that in transmural acute myocardial infarction. Am J Cardiol. 1987;59(1):84 88. doi:10.1016/S0002-9149(87)80075-9</ref>

			== Long QT syndrome: ==
			Patients should be evaluated for LQTS, if the corrected QT interval remains at 460 milliseconds or longer for females or 450 milliseconds or longer for males<ref>Vink AS, Neumann B, Lieve KVV, et al. Determination and interpretation of the QT interval. Circulation. 2018;138(21):2345-2358. doi:10.1161/CIRCULATIONAHA.118.033943</ref> beyond 6 days after resuscitation.<ref>Cohen RB, Dai M, Aizer A, et al. QT interval dynamics and triggers for QTprolongation immediately following cardiac arrest. Resuscitation. 2021;162:171-179. doi:10.1016/j.resuscitation.2021.02. 029</ref> It is the most common arrhythmia syndrome causing sudden cardiac arrest.<ref name=":0" /> In patients with LQTS, a prolonged QT interval results in the end of the T wave often exceeding half of the RR interval,along with broad,biphasic,or notched T waves with beat-to-beat alternans.<ref>Krahn AD, Laksman Z, Sy RW, et al.Congenital long QT syndrome.JACCClinElectrophysiol. 2022;8 (5):687-706. doi:10.1016/j.jacep.2022.02.017</ref> In a study of 647 untreated patients older than 28 years with LQTS, 13% experienced out-of-hospital cardiac arrest or sudden death before age 40 years.<ref>Priori SG, Schwartz PJ, Napolitano C, et al. Risk stratification in the long-QT syndrome. N Engl J Med. 2003;348(19):1866-1874. doi:10.1056/ NEJMoa022147</ref> LQTS can be either congenital or acquired, most commonly due to drugs such as antiarrhythmics,antipsychotics,antidepressants,or antibiotics (a continuously updated list can be found at https://crediblemeds.org/). However, some acquired LQTS cases may have underlying congenital LQTS unmasked by drugs or other predisposing factors such as electrolyte abnormalities (hypokalemia, hypomagnesemia, and hypocalcemia) or bradyarrhythmias. Evaluation for acquired LQTS should be reassessed after resolution of these factors.<ref>Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al; ESC Scientific Document Group. 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. EurHeartJ. 2022;43(40): 3997-4126. doi:10.1093/eurheartj/ehac262</ref>

			== Brugada syndrome: ==
			In Brugada syndrome, type 1 pattern (ie,coved shape of ST segment) in leads V1 and V2 can sometimes be recorded when these leads are moved to the second or third intercostal spaces instead of the typical fourth intercostal space.<ref>Zeppenfeld K,Tfelt-Hansen J, de Riva M, et al; ESC Scientific Document Group. 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. EurHeartJ. 2022;43(40): 3997-4126. doi:10.1093/eurheartj/ehac262</ref> In preexcitation syndromes (ie,Wolff-Parkinson-White), the observed delta waves are a marker for potential atrioventricular reentrant tachycardia or VF via preexcited atrial fibrillation.<ref>Pappone C, Vicedomini G, Manguso F, et al. Wolff-Parkinson-White syndrome in the era of catheter ablation: insights from a registry study of 2169 patients. Circulation. 2014;130(10):811-819. doi:10.1161/CIRCULATIONAHA.114.011154</ref> In some cases of arrhythmogenic right ventricular cardiomyopathy, epsilon waves that represent delayed right ventricular conduction can be observed in the ST segment in the right precordial leads.<ref>Marcus FI, Fontaine GH, Guiraudon G, et al. Right ventricular dysplasia: a report of 24 adult cases. Circulation. 1982;65(2):384-398. doi:10.1161/ 01.CIR.65.2.384</ref>

	==2022 ESC Guidelines for the management of patients with ventricular arrythymias and the prevention of sudden cardiac death <ref name="pmid36017572">{{cite journal\| author=Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA \| display-authors=etal\| title=2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. \| journal=Eur Heart J \| year= 2022 \| volume= 43 \| issue= 40 \| pages= 3997-4126 \| pmid=36017572 \| doi=10.1093/eurheartj/ehac262 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=36017572 }} </ref>==		==2022 ESC Guidelines for the management of patients with ventricular arrythymias and the prevention of sudden cardiac death <ref name="pmid36017572">{{cite journal\| author=Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA \| display-authors=etal\| title=2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. \| journal=Eur Heart J \| year= 2022 \| volume= 43 \| issue= 40 \| pages= 3997-4126 \| pmid=36017572 \| doi=10.1093/eurheartj/ehac262 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=36017572 }} </ref>==

Sudden cardiac death diagnostic study of choice

2026-04-04T10:00:39Z

Overview

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	==Overview==		==Overview==
			In resuscitated sudden cardiac arrest individuals, an emergency workup should be performed, it includes:

			# 12-lead electrocardiogram (ECG)
			# Toxicology testing
			# Bedside neurological assessment
			# Neuroimaging (eg, head computed tomography [CT]) after the patient has stabilized.

	According to the 2017 Association for European Cardiovascular Pathologists guidelines, [[autopsy]] is done whenever [[sudden cardiac death]] ([[SCD]]) is suspected.		According to the 2017 Association for European Cardiovascular Pathologists guidelines, [[autopsy]] is done whenever [[sudden cardiac death]] ([[SCD]]) is suspected.

Sudden cardiac death epidemiology and demographics

2026-04-04T09:29:56Z

Age

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	===Age===		===Age===
	* There is a low [[incidence]] of [[SCD]] in [[infants]] and [[children]] which is approximately 1 per 100,000 person-years.		* There is a low [[incidence]] of [[SCD]] in [[infants]] and [[children]] which is approximately 1 per 100,000 person-years.
			* In adults younger than 40 years, the worldwide incidence of presumed sudden cardiac death is 4.2 to 7.8 per 100000 person-years.<ref name=":1">Zhang J, Zhou X, Xing Q,et al.Epidemiological investigation of sudden cardiac death in multiethnic Xinjiang Uyghur autonomousregion in Northwest China. BMCPublicHealth. 2019;19(1):116. doi:10. 1186/s12889-019-6435-8</ref><ref name=":2">Tseng ZH, Olgin JE, Vittinghoff E, et al. Prospective countywide surveillance and autopsy characterization of sudden cardiac death: POST SCDstudy.Circulation. 2018;137(25):2689-2700. doi:10.1161/CIRCULATIONAHA.117.033427</ref><ref name=":3">Empana JP, Lerner I, Valentin E, et al; ESCAPE-NET Investigators. Incidence of sudden cardiac death in the EuropeanUnion.JAmColl Cardiol. 2022;79(18):1818-1827. doi:10.1016/j.jacc. 2022.02.041</ref><ref name=":4">Hua W, Zhang LF, Wu YF, et al.Incidence of sudden cardiac death in China:analysis of 4 regional populations. J Am Coll Cardiol. 2009;54 (12):1110-1118. doi:10.1016/j.jacc.2009.06.016</ref><ref name=":5">Hendrix A, Vaartjes I, Mosterd A, et al. Regional differences in incidence of sudden cardiac death in the young.NethJMed.2010;68(6):274-279.</ref>
			* In adults aged 40 through 49 years, the worldwide incidence of presumed sudden cardiac death is 23 to 34 per 100000 person-years.<ref name=":1" /><ref name=":2" /><ref name=":3" /><ref name=":4" /><ref name=":5" />
	* The [[incidence]] of [[SCD]] in middle-aged people (50 to 60 years old) is around 50 per 1000,000 person-years.		* The [[incidence]] of [[SCD]] in middle-aged people (50 to 60 years old) is around 50 per 1000,000 person-years.
	* Among people in their eight decade of life, [[incidence]] of [[SCD]] approximates about 200 per 100,000 person-years <ref name="pmid24610738">{{cite journal\| author=Stecker EC, Reinier K, Marijon E, Narayanan K, Teodorescu C, Uy-Evanado A \| display-authors=etal\| title=Public health burden of sudden cardiac death in the United States. \| journal=Circ Arrhythm Electrophysiol \| year= 2014 \| volume= 7 \| issue= 2 \| pages= 212-7 \| pmid=24610738 \| doi=10.1161/CIRCEP.113.001034 \| pmc=4041478 \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24610738 }} </ref>.		* Among people in their eight decade of life, [[incidence]] of [[SCD]] approximates about 200 per 100,000 person-years <ref name="pmid24610738">{{cite journal\| author=Stecker EC, Reinier K, Marijon E, Narayanan K, Teodorescu C, Uy-Evanado A \| display-authors=etal\| title=Public health burden of sudden cardiac death in the United States. \| journal=Circ Arrhythm Electrophysiol \| year= 2014 \| volume= 7 \| issue= 2 \| pages= 212-7 \| pmid=24610738 \| doi=10.1161/CIRCEP.113.001034 \| pmc=4041478 \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24610738 }} </ref>.
			* Among autopsy studies of persons younger than age 30 years who had sudden cardiac death, the most common cause was sudden arrhythmic death syndrome with normal heart on postmort emexamination (36%-49%).<ref name=":6">Bagnall RD, Weintraub RG, Ingles J, et al. A prospective study of sudden cardiac death among children and young adults. NEnglJMed.2016;374 (25):2441-2452. doi:10.1056/NEJMoa1510687</ref><ref name=":7">Wisten A, Krantz P, Stattin EL. Sudden cardiac death among the young in Sweden from 2000 to 2010: an autopsy-based study. Europace.2017;19 (8):1327-1334.</ref>
			* The proportion of cases attributable to CAD increased with age, from 6% to 14% in persons younger than 30 years and to 19% to 46% in persons aged 30 years or older.<ref name=":6" />,<ref name=":7" />,<ref name="pmid21131293" />,<ref>Lynge TH, Nielsen JL, Risgaard B, van der Werf C, Winkel BG, Tfelt-Hansen J. Causes of sudden cardiac death according to age and sex in persons aged1-49 years. HeartRhythm.2023;20(1):61-68. doi:10.1016/j.hrthm.2022.08.036</ref>
			* Unexpected myocarditis is another relatively common underlying cause of sudden cardiac death in young adults.<ref name=":6" />,<ref name=":7" />,<ref name="pmid21131293" />
			* Autopsy-confirmed dilated cardiomyopathy was more frequently identified among individuals who were older than 30 years (10%) than individuals who were younger than 30 years (5%).<ref name=":6" />,<ref name=":7" />
			* Autopsy-based studies of individuals with sudden cardiac death aged 18 to 50 years reported that 65% to 78% had at least one known cardiovascular disease (CVD) risk factor (ie, hypertension, diabetes,dyslipidemia,obesity,smoking) before death.<ref name=":2" />,<ref>Vähätalo J, Holmström L, Pakanen L, et al. Coronary artery disease as the cause of sudden cardiac death among victims <50 years of age.Am J Cardiol. 2021;147:33-38. doi:10.1016/j.amjcard. 2021.02.012</ref> In these studies, compared with the reported prevalence of individual risk factors in the general US population among those aged 20 through 44 years,<ref>Aggarwal R, Yeh RW, Joynt Maddox KE, Wadhera RK. Cardiovascular risk factor prevalence, treatment, and control in us adults aged 20 to 44 years, 2009 to March 2020.JAMA.2023;329(11): 899-909.doi:10.1001/jama.2023.2307</ref> the reported prevalence of hypertension and diabetes was higher among those with sudden cardiac death (22%-24% vs 12% and 12% - 19% vs 4%, respectively).

	===Gender===		===Gender===

	*commonly affected with [[sudden cardiac death]] than [[women]] in all age groups.<ref name="EckartShry2011">{{cite journal\|last1=Eckart\|first1=Robert E.\|last2=Shry\|first2=Eric A.\|last3=Burke\|first3=Allen P.\|last4=McNear\|first4=Jennifer A.\|last5=Appel\|first5=David A.\|last6=Castillo-Rojas\|first6=Laudino M.\|last7=Avedissian\|first7=Lena\|last8=Pearse\|first8=Lisa A.\|last9=Potter\|first9=Robert N.\|last10=Tremaine\|first10=Ladd\|last11=Gentlesk\|first11=Philip J.\|last12=Huffer\|first12=Linda\|last13=Reich\|first13=Stephen S.\|last14=Stevenson\|first14=William G.\|title=Sudden Death in Young Adults\|journal=Journal of the American College of Cardiology\|volume=58\|issue=12\|year=2011\|pages=1254–1261\|issn=07351097\|doi=10.1016/j.jacc.2011.01.049}}</ref>		*Men commonly affected with [[sudden cardiac death]] than [[women]] in all age groups.<ref name="EckartShry2011">{{cite journal\|last1=Eckart\|first1=Robert E.\|last2=Shry\|first2=Eric A.\|last3=Burke\|first3=Allen P.\|last4=McNear\|first4=Jennifer A.\|last5=Appel\|first5=David A.\|last6=Castillo-Rojas\|first6=Laudino M.\|last7=Avedissian\|first7=Lena\|last8=Pearse\|first8=Lisa A.\|last9=Potter\|first9=Robert N.\|last10=Tremaine\|first10=Ladd\|last11=Gentlesk\|first11=Philip J.\|last12=Huffer\|first12=Linda\|last13=Reich\|first13=Stephen S.\|last14=Stevenson\|first14=William G.\|title=Sudden Death in Young Adults\|journal=Journal of the American College of Cardiology\|volume=58\|issue=12\|year=2011\|pages=1254–1261\|issn=07351097\|doi=10.1016/j.jacc.2011.01.049}}</ref>
			*In a study of sudden cardiac death in young adults (n =2006,median age, 28 years), CAD was more common in males (44%) than in females (27%), whereas unspecified cardiomyopathy (5% males vs 7% females, P = .04), myocarditis (9% males vs 14% females,P < .001), and valvular heart disease (2% males vs 7% females,P < .001) were more common in young females.<ref>Ha FJ, Han HC, Sanders P, et al. Sudden cardiac death in the young:incidence, trends, and risk factors in a nationwide study. Circ Cardiovasc Qual Outcomes. 2020;13(10):e006470.doi:10.1161/ CIRCOUTCOMES.119.006470</ref>

	===Race===		===Race===
	*[[Black]] individuals are more likely to develop [[cardiac arrest]].<ref name="BeckerHan1993">{{cite journal\|last1=Becker\|first1=Lance B.\|last2=Han\|first2=Ben H.\|last3=Meyer\|first3=Peter M.\|last4=Wright\|first4=Fred A.\|last5=Rhodes\|first5=Karin V.\|last6=Smith\|first6=David W.\|last7=Barrett\|first7=John\|title=Racial Differences in the Incidence of Cardiac Arrest and Subsequent Survival\|journal=New England Journal of Medicine\|volume=329\|issue=9\|year=1993\|pages=600–606\|issn=0028-4793\|doi=10.1056/NEJM199308263290902}}</ref>		*[[Black]] individuals are more likely to develop [[cardiac arrest]].<ref name="BeckerHan1993">{{cite journal\|last1=Becker\|first1=Lance B.\|last2=Han\|first2=Ben H.\|last3=Meyer\|first3=Peter M.\|last4=Wright\|first4=Fred A.\|last5=Rhodes\|first5=Karin V.\|last6=Smith\|first6=David W.\|last7=Barrett\|first7=John\|title=Racial Differences in the Incidence of Cardiac Arrest and Subsequent Survival\|journal=New England Journal of Medicine\|volume=329\|issue=9\|year=1993\|pages=600–606\|issn=0028-4793\|doi=10.1056/NEJM199308263290902}}</ref>
			*Incidence of presumed sudden cardiac death among adults younger than 40 years in Cameroon was higher at 12 to 42 per 100000 person-years.<ref>Bonny A,Tibazarwa K, Mbouh S, et al; PanAfrican Society of Cardiology (PASCAR) Task Force on Sudden Cardiac Death.Epidemiology of sudden cardiac death in Cameroon:the first population-based cohort survey in sub-Saharan Africa. Int J Epidemiol. 2017;46(4):1230-1238. doi:10.1093/ije/dyx043</ref>
			*In a US study from 1999 through 2015 (n = 31492), Black individuals younger than 34 years had a higher incidence of presumed sudden cardiac deaths (1.88 per 100000 person-years in 2015) than Hispanic individuals (0.66 per 100000 person-years),and White individuals (1.17 per 100000 person-years),<ref>El-AssaadI, Al-Kindi SG, Aziz PF. Trends of out-of-hospital sudden cardiac death among children and youngadults. Pediatrics. 2017;140(6): e20171438. doi:10.1542/peds.2017-1438</ref> which may be due to inequitable access to care <ref>Noonan AS, Velasco-Mondragon HE, Wagner FA. Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Rev. 2016;37:12. doi:10. 1186/s40985-016-0025-4</ref> and racial disparities among out-of hospital resuscitation attempts.
			*White individuals were more likely to receive bystander CPR after a witnessed cardiac arrest and postresuscitation care than were Black and Hispanic persons in several US based studies.<ref>Toy J, Bosson N, Schlesinger S,Gausche-Hill M. Racial and ethnic disparities in the provision of bystander CPR after witnessed out-of-hospital cardiac arrest in the United States. Resuscitation. 2023;190:109901. doi:10.1016/j.resuscitation.2023. 109901</ref><ref>Casey SD, Mumma BE.Sex,race,and insurance status differences in hospital treatment and outcomes following out-of-hospital cardiac arrest. Resuscitation. 2018;126:125-129. doi:10.1016/j. resuscitation.2018.02.027</ref>

	==References==		==References==

Sudden cardiac versus non-cardiac death

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References

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Acute lymphoblastic leukemia medical therapy

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Flowchart:

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 *Maintenance treatment
 *Follow-up therapy
 ==Induction chemotherapy==