Sudden cardiac death causes: Difference between revisions

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! Incidence of [[SCD]]
! Incidence of [[SCD]]
| 80%|| 10% || 2-4% per year in [[adult]], 4-6% in [[children]] and [[adolescence]]||2%||
| 80%|| 10% || 2-4% per year in [[adult]], 4-6% in [[children]] and [[adolescence]]||2%||20% post operative death after valvular replacement
|-
|-
! Mechanism
! Mechanism
| [[Atherosclerosis]] in [[coronary arteries]] including: 40-86% of patients are 3 vessle disease with stenosis>75%,[[MI]]<50%, Qwave [[MI]]<25%, recent coronary thrombosis 15-64% (plaque, fissure, hemorrhage, thrombosis, healed infarct>50% in autopsy or survivors of [[SCD]], 000000Non atherosclerotic changes including [[coronary emboli]], [[coronary arthritis]], [[coronary dissection]]||[[Myocardial]] stretch, [[neuroendocrine factors]], [[electrolyte abnormality, [[proarrhythmic effect of antiarrhythmic drugs, excessive activation of [[sympathetic]] and [[renin angiotensin system]] || [[Arrhythmia]], abrupt hemodynamic deterioration, [[ischemia]]|| Fatty and fibrofaty myocardial infiltration, patchy [[myocarditis]], apoptosis of [[left ventricle]], [[left ventricular septum]] (50-67%), [[right ventricular]] inflow, outflow tract and apex( [[triangle of dysplasia]])
| [[Atherosclerosis]] in [[coronary arteries]] including: 40-86% of patients are 3 vessle disease with stenosis>75%,[[MI]]<50%, Qwave [[MI]]<25%, recent coronary thrombosis 15-64% (plaque, fissure, hemorrhage, thrombosis, healed infarct>50% in autopsy or survivors of [[SCD]], 000000Non atherosclerotic changes including [[coronary emboli]], [[coronary arthritis]], [[coronary dissection]]||[[Myocardial]] stretch, [[neuroendocrine factors]], [[electrolyte abnormality, [[proarrhythmic effect of antiarrhythmic drugs, excessive activation of [[sympathetic]] and [[renin angiotensin system]] || [[Arrhythmia]], abrupt hemodynamic deterioration, [[ischemia]]|| Fatty and fibrofaty myocardial infiltration, patchy [[myocarditis]], apoptosis of [[left ventricle]], [[left ventricular septum]] (50-67%), [[right ventricular]] inflow, outflow tract and apex( [[triangle of dysplasia]])|| [[Arrhythmia]], [[prosthetic valve dysfunction]],Coexisting [[CAD]]
|-
|-
! Risk factors of [[SCD]]
! Risk factors of [[SCD]]
|  ||  Frequent episodes of non sustain [[VT]], [[syncope]] || Family history of [[SCD]], recurrent [[syncope]], [[sustained VT]], history of [[SCA]], massive [[LVH]], multiple episodes of non sustained [[VT]]
|  ||  Frequent episodes of non sustain [[VT]], [[syncope]] || Family history of [[SCD]], recurrent [[syncope]], [[sustained VT]], history of [[SCA]], massive [[LVH]], multiple episodes of non sustained [[VT]]|| Asymptomatic [[aotric valve disease]] is low risk for [[SCD].Risk factors of [[SCD]] in [[MVP]]: [[myxomatous]] degeneration of the [[valve]], coexisting [[mitral regurgitation]], [[LV dysfunction]]
|-
|-
! Arrhythmia
! Arrhythmia

Revision as of 15:03, 4 February 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Zand, M.D.[2]

Overview

Sudden cardiac arrest may be caused by coronary artery abnormality such as coronary atherosclerosis, acute MI, coronary artery embolism, coronary arteritis , hypertrophy of myocardium such as HCM, hypertensive heart disease, primary or secondary pulmonary hypertension , myocardial disease such as ischemic cardiomyopathy, non-ischemic cardiomyopathy, myocarditis ,valvular heart disease such as aortic stenosis, aortic insufficiency, mitral valve prolapse, endocarditis , congenital heart disease such as congenital septal defect with eisenmenger physiology , abnormality in conducting system such as Wolf-Parkinson-White syndrome , electrical instability such as (CPVT, LQTS)

Causes

Sudden cardiac arrest may be caused by :


Multiplication table
Causes of sudden cardiac death Coronary Artery Disease [[Ideopathic dilated cardiomyopathy] Hypertrophic cardiomyopathy Arrhythmogenic right ventricular cardiomyopathy Valvular Heart Disease Congenital Heart Disease Long QT syndrome WPW syndrome Ideopathic monomorphic [[VT] Ideopathic polymorphic VT Primary VF Sudden unexpected nocturnal death Drugs]]
Incidence of SCD 80% 10% 2-4% per year in adult, 4-6% in children and adolescence 2% 20% post operative death after valvular replacement
Mechanism Atherosclerosis in coronary arteries including: 40-86% of patients are 3 vessle disease with stenosis>75%,MI<50%, Qwave MI<25%, recent coronary thrombosis 15-64% (plaque, fissure, hemorrhage, thrombosis, healed infarct>50% in autopsy or survivors of SCD, 000000Non atherosclerotic changes including coronary emboli, coronary arthritis, coronary dissection Myocardial stretch, neuroendocrine factors, [[electrolyte abnormality, [[proarrhythmic effect of antiarrhythmic drugs, excessive activation of sympathetic and renin angiotensin system Arrhythmia, abrupt hemodynamic deterioration, ischemia Fatty and fibrofaty myocardial infiltration, patchy myocarditis, apoptosis of left ventricle, left ventricular septum (50-67%), right ventricular inflow, outflow tract and apex( triangle of dysplasia) Arrhythmia, prosthetic valve dysfunction,Coexisting CAD
Risk factors of SCD Frequent episodes of non sustain VT, syncope Family history of SCD, recurrent syncope, sustained VT, history of SCA, massive LVH, multiple episodes of non sustained VT Asymptomatic aotric valve disease is low risk for [[SCD].Risk factors of SCD in MVP: myxomatous degeneration of the valve, coexisting mitral regurgitation, LV dysfunction
Arrhythmia VT, VF (75%), bradycardia, asystole(25%) Mechanism of VT: bundle branch reentry tachycardia, terminal event: asystole, [[electromechanical dissociation in advanced LV dysfunction 9 ECG in normal sinus rhythm:inverted T waves in V1-V3, complete, incomplete RBBB, epsilone wave ( terminal notch on QRS complex), VT is LBBB contour






  • Causes of acquired Long QT syndrome include the following:




Causes of Sudden Death Including Sudden Cardiac Death by Organ System

Cardiovascular

Amyloid cardiopathy, Congestive heart failure, Ventricular rupture,

Hypoxia, Coronary thrombosis, Coronary vasospasm, Coronary artery aneurysm, Prinzmetal's variant angina ,

  • Pericardial

Cardiac tamponade,

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 aortic stenosis/insufficiency, Mitral valve disruption, Endocarditis, Prosthetic valve dysfunction,

Arrhythmogenic right ventricular cardiomyopathy, Arrhythmogenic right ventricular dysplasia, Brugada syndrome, 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,

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 aortic or pulmonary valve stenosis, Congenital septal defect with eisenmenger physiology, Congenital heart block , Congenital Long QT syndrome, Noncompaction Cardiomyopathy, Sudden Infant Death Syndrome, Uhl anomaly

Snake bite

No underlying causes
  • Drug Side Effect
Agalsidase beta, Articaine, caspofungin acetate, Clozapine, cytomegalovirus immune globulin, Drug allergy, drug overdose, Dornase Alfa, ferumoxytol, Flucytosine, galsulfase, Iodixanol, laronidase, Lincomycin Hydrochloride, Polidocanol, Potassium bicarbonate, pramipexole, prednisolone, Ramucirumab, Calcium gluconate, Dextran, Tiagabine
No underlying causes

Diabetic ketoacidosis - typically from undiagnosed diabetes, Thyrotoxicosis,

  • Environmental
Hypothermia,
  • Gastroenterologic

Appendicitis, Gastrointestinal bleeding, Retroperitoneal bleed,

Brugada syndrome, 3-methylglutaconic aciduria, type 1, Familial dilated cardiomyopathy , Familial hypertrophic cardiomyopathy 1, Hyperbilirubinemia transient, familial neonatal, Marfan syndrome , Timothy syndrome

No underlying causes
  • Iatrogenic
Transfusion reaction

Flu mainly in the elderly, infants, infirm or chronically ill, Neurocysticercosis , Lyme disease

No underlying causes

Apoplexy, Encephalitis, Intracranial hemmorhage, Meningitis, Stroke, Subarachnoid hemorrhage,

3-methylglutaconic aciduria, type 1, Alpha-ketoglutarate dehydrogenase deficiency , Food allergy

Amniotic fluid syndrome , Childbirth hemorrhage,

Atrial myxoma, familial

No underlying causes
  • Overdose / Toxicity

Opioid overdose , Oxycontin overdose, Pain killer overdose , Sleeping pill overdose

No underlying causes

Hypercapnia, Pickwickian Syndrome, Pulmonary embolism, Tension pneumothorax, Status asthmaticus

Hypercalcemia, Hypokalemia, Hyperkalemia,

Amyloidosis, Anaphylaxis, Myasthenia gravis, Sarcoidosis,

No underlying causes

Commotio cordis, Homicide, Motor Vehicle accident

No underlying causes
  • Miscellaneous

Shock, Asphyxia, Insect bite Sepsis syndrome, Shock

Differentiating sudden cardiac death from non-cardiac causes

Cardiac causes of sudden death

Non cardiac causes of sudden death:

References

  1. Mehta, Davendra; Curwin, Jay; Gomes, J. Anthony; Fuster, Valentin (1997). "Sudden Death in Coronary Artery Disease". Circulation. 96 (9): 3215–3223. doi:10.1161/01.CIR.96.9.3215. ISSN 0009-7322.
  2. Eisenberg MS, Mengert TJ (2001). "Cardiac resuscitation". N. Engl. J. Med. 344 (17): 1304–13. PMID 11320390. Unknown parameter |month= ignored (help)
  3. . doi:10.1080/2F20961790.2019.1595352. Missing or empty |title= (help)
  4. 4.0 4.1 Basso, Cristina; Perazzolo Marra, Martina; Rizzo, Stefania; De Lazzari, Manuel; Giorgi, Benedetta; Cipriani, Alberto; Frigo, Anna Chiara; Rigato, Ilaria; Migliore, Federico; Pilichou, Kalliopi; Bertaglia, Emanuele; Cacciavillani, Luisa; Bauce, Barbara; Corrado, Domenico; Thiene, Gaetano; Iliceto, Sabino (2015). "Arrhythmic Mitral Valve Prolapse and Sudden Cardiac Death". Circulation. 132 (7): 556–566. doi:10.1161/CIRCULATIONAHA.115.016291. ISSN 0009-7322.
  5. Yap, Sing-Chien; Harris, Louise (2014). "Sudden cardiac death in adults with congenital heart disease". Expert Review of Cardiovascular Therapy. 7 (12): 1605–1620. doi:10.1586/erc.09.153. ISSN 1477-9072.

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