Sudden Cardiac Dearth ? | Cardiac Arrest ? | Heart Attack vs Cardiac arrest #pstamil
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sudden cardiac arrest, sudden cardiac
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Sudden cardiac death (SCD) is death due to a cardiovascular cause that occurs within one hour of the onset of symptoms. A sudden cardiac arrest occurs when the heart stops beating or is not beating sufficiently to maintain perfusion and life.
Coronary artery disease is the most common cause of sudden cardiac death, accounting for up to 80% of all cases. Cardiomyopathies and genetic channelopathies account for the remaining causes. The most common causes of non-ischemic sudden cardiac death are cardiomyopathy related to obesity, alcoholism, and fibrosis.
In patients younger than 35, the most common cause of sudden cardiac death is a fatal arrhythmia, usually in the context of a structurally normal heart. In patients from birth to 13 years, the primary cause is a congenital abnormality. In patients aged 14 to 24 years, the cause of sudden cardiac death is attributed to hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), congenital coronary anomalies, genetic channelopathies, myocarditis, Wolff-Parkinson-White syndrome, and Marfan syndrome.
Common Causes of Sudden Cardiac Arrest
Ischemic Heart disease
Myocardial infarction
Anomalous coronary origin
coronary spasm
Inherited Channelopathies
Long QT syndrome (LQTS)
Short QT syndrome (SQTS)
Brugada syndrome
Early repolarization syndrome
Catecholaminergic polymorphic ventricular tachycardia (CPVT)
Cardiomyopathies
Alcoholic
Hypertrophic
Idiopathic
Obesity-related
Fibrotic
Arrhythmogenic right ventricular cardiomyopathy (ARVC)
Myocarditis
Heart Failure
Nonpreserved ejection fraction (EF) systolic heart failure (EF less than 35%)
Valve disease
Aortic stenosis
Congenital diseases
Tetraology of Fallot
Before transportation to a hospital, emergency medical services (EMS) or lay people may utilize an automated external defibrillator (AED). Once EMS arrives cardiac monitoring via ECG should occur.
Full cardiac assessment is required for cardiac arrest survivors. The following tests should be completed to establish a cause
ECG
Echocardiogram
Coronary angiography
Exercise test
Electrophysiology testing
Cardiac MRI
Genetic testing if ARVC, Brugada syndrome, CPVT, or LQTS are found
Cardiac biopsy may be considered if no other cause is found
ECG testing helps determine a diagnosis of ischemic heart disease, myocardial infarction, and inherited channelopathies. Echocardiograms evaluate for evidence of heart failure, cardiomyopathy, valvular heart disease, and congenital heart disease. Coronary angiography further evaluates coronary artery disease, congenital coronary anomalies, and coronary spasms. Exercise testing is helpful for diagnosis of ischemic heart disease, LQTS, and CPVT. Electrophysiology studies can detect the suspected arrhythmia. Procainamide can provoke Brugada syndrome regardless of the findings on the initial ECG. Cardiac MRI can detect ARVC, sarcoidosis (fibrotic cardiomyopathy), myocarditis, and myocardial injury from coronary spasms.
Treatment / Management
Treatment for sudden cardiac arrest should be initiated immediately by lay people and EMS. Treatment includes the use of an automated external defibrillator and cardiopulmonary resuscitation (CPR). CPR provides enough oxygen to the brain until a stable electrical rhythm can be established.
After transfer to a hospital, therapeutic hypothermia can be induced to limit neurologic injury and reperfusion injuries. Therapeutic hypothermia is more effective for the management of ventricular tachycardia and ventricular fibrillation but can also be used in PEA and asystole. Limitations to therapeutic hypothermia include a tympanic membrane temperature below 30 degrees at presentation, being comatose before the sudden cardiac arrest, pregnancy, inherited coagulation disorder, and the terminally ill patient.
If a patient survives the out-of-hospital cardiac arrest, long-term treatment is aimed at the underlying cause.
An implantable cardioverter defibrillator (ICD) is used for secondary prevention of sudden cardiac death in any person who has experienced arrhythmia-related syncope or survived sudden cardiac arrest.
Medication is targeted at the underlying cause of sudden cardiac arrest.
Sudden cardiac death (SCD) is death due to a cardiovascular cause that occurs within one hour of the onset of symptoms. A sudden cardiac arrest occurs when the heart stops beating or is not beating sufficiently to maintain perfusion and life.
Coronary artery disease is the most common cause of sudden cardiac death, accounting for up to 80% of all cases. Cardiomyopathies and genetic channelopathies account for the remaining causes. The most common causes of non-ischemic sudden cardiac death are cardiomyopathy related to obesity, alcoholism, and fibrosis.
In patients younger than 35, the most common cause of sudden cardiac death is a fatal arrhythmia, usually in the context of a structurally normal heart. In patients from birth to 13 years, the primary cause is a congenital abnormality. In patients aged 14 to 24 years, the cause of sudden cardiac death is attributed to hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), congenital coronary anomalies, genetic channelopathies, myocarditis, Wolff-Parkinson-White syndrome, and Marfan syndrome.
Common Causes of Sudden Cardiac Arrest
Ischemic Heart disease
Myocardial infarction
Anomalous coronary origin
coronary spasm
Inherited Channelopathies
Long QT syndrome (LQTS)
Short QT syndrome (SQTS)
Brugada syndrome
Early repolarization syndrome
Catecholaminergic polymorphic ventricular tachycardia (CPVT)
Cardiomyopathies
Alcoholic
Hypertrophic
Idiopathic
Obesity-related
Fibrotic
Arrhythmogenic right ventricular cardiomyopathy (ARVC)
Myocarditis
Heart Failure
Nonpreserved ejection fraction (EF) systolic heart failure (EF less than 35%)
Valve disease
Aortic stenosis
Congenital diseases
Tetraology of Fallot
Before transportation to a hospital, emergency medical services (EMS) or lay people may utilize an automated external defibrillator (AED). Once EMS arrives cardiac monitoring via ECG should occur.
Full cardiac assessment is required for cardiac arrest survivors. The following tests should be completed to establish a cause
ECG
Echocardiogram
Coronary angiography
Exercise test
Electrophysiology testing
Cardiac MRI
Genetic testing if ARVC, Brugada syndrome, CPVT, or LQTS are found
Cardiac biopsy may be considered if no other cause is found
ECG testing helps determine a diagnosis of ischemic heart disease, myocardial infarction, and inherited channelopathies. Echocardiograms evaluate for evidence of heart failure, cardiomyopathy, valvular heart disease, and congenital heart disease. Coronary angiography further evaluates coronary artery disease, congenital coronary anomalies, and coronary spasms. Exercise testing is helpful for diagnosis of ischemic heart disease, LQTS, and CPVT. Electrophysiology studies can detect the suspected arrhythmia. Procainamide can provoke Brugada syndrome regardless of the findings on the initial ECG. Cardiac MRI can detect ARVC, sarcoidosis (fibrotic cardiomyopathy), myocarditis, and myocardial injury from coronary spasms.
Treatment / Management
Treatment for sudden cardiac arrest should be initiated immediately by lay people and EMS. Treatment includes the use of an automated external defibrillator and cardiopulmonary resuscitation (CPR). CPR provides enough oxygen to the brain until a stable electrical rhythm can be established.
After transfer to a hospital, therapeutic hypothermia can be induced to limit neurologic injury and reperfusion injuries. Therapeutic hypothermia is more effective for the management of ventricular tachycardia and ventricular fibrillation but can also be used in PEA and asystole. Limitations to therapeutic hypothermia include a tympanic membrane temperature below 30 degrees at presentation, being comatose before the sudden cardiac arrest, pregnancy, inherited coagulation disorder, and the terminally ill patient.
If a patient survives the out-of-hospital cardiac arrest, long-term treatment is aimed at the underlying cause.
An implantable cardioverter defibrillator (ICD) is used for secondary prevention of sudden cardiac death in any person who has experienced arrhythmia-related syncope or survived sudden cardiac arrest.
Medication is targeted at the underlying cause of sudden cardiac arrest.
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