Sudden Cardiac Death

Chapter: Sudden Cardiac Death
McMaster Section Editor(s): P.J. Devereaux
Section Editor(s) in Interna Szczeklika: Andrzej Budaj, Wiktoria Leśniak
McMaster Author(s): Juan Gabriel Acosta Velez, Guy Amit
Author(s) in Interna Szczeklika: Maria Trusz-Gluza, Wiktoria Leśniak
Additional Information

Definition, EtiologyTop

Sudden cardiac death (SCD) is defined as death due to cardiac causes preceded by a sudden loss of consciousness in a patient in whom a change in clinical status heralding cardiac arrest was observed ≤1 hour prior to SCD.

Causes: SCD is usually triggered by malignant ventricular arrhythmias that may be caused by ischemic heart disease (IHD), any type of cardiomyopathy, congenital heart disease, or genetic channelopathy. IHD is the most common cause (in 80% of patients). Severe left ventricular dysfunction significantly increases the risk of SCD.

PreventionTop

1. Prevention of ischemia in IHD patients.

2. Prevention of specific triggers according to the disorders listed above (eg, QT-prolonging drugs in patients with long QT syndrome).

3. Placement of an implantable cardioverter-defibrillator (ICD) for prevention of SCD is recommended in high-risk patients with life expectancy >1 year and good functional status, in jurisdictions where the device is available. High-risk patients include:

1) Patients ≥40 days after myocardial infarction (MI) with a left ventricular ejection fraction (LVEF) ≤35%.

2) Patients with dilated nonischemic cardiomyopathy with an LVEF ≤35% and New York Heart Association (NYHA) class II or III heart failure (Table. New York Heart Association (NYHA)…).

TreatmentTop

ICD implantation in survivors of SCD unless a reversible cause (eg, acute phase of MI, drug-related QT prolongation, bradycardia-induced polymorphic ventricular tachycardia) or noncardiac cause is documented.

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