Sudden cardiac death causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Cardiac arrest is synonymous with Clinical death. All disease processes leading to death have a period of (potentially) reversible cardiac arrest: the causes of arrest are, therefore, numerous. However, many of these conditions, rather than causing an arrest themselves, promote one of the "reversible causes" (see below), which then triggers the arrest (e.g. Choking leads to Hypoxia which in turn leads to an arrest). In some cases, the underlying mechanism cannot be overcome, leading to an unsuccessful resuscitation.

Among adults, ischemic heart disease is the predominant cause of arrest.[1] At autopsy 30% of victims show signs of recent myocardial infarction. Other cardiac conditions potentially leading to arrest include structural abnormalities, arrhythmias and cardiomyopathies. Non-cardiac causes include infections, overdoses, trauma and cancer, in addition to many others.

Causes

In a patient with sudden death, a thorough evaluation of potential causes is essential to exclude preventable causes of recurrence.

Reversible Causes

Cardiopulmonary resuscitation (CPR), including adjunctive measures such as defibrillation, intubation and drug administration, is the standard of care for initial treatment of cardiac arrest. However, most cardiac arrests occur for a reason, and unless that reason can be found and overcome, CPR is often ineffective, or if it does result in a return of spontaneous circulation, this is short lived. [2]. As highlighted above, a variety of disease processes can lead to a cardiac arrest, however they usually boil down to one or more of the "Hs and Ts" (see below).

H's

T's

Complete Differential Diagnosis for Sudden Cardiac Death

Complete Differential Diagnosis for Sudden Non-Cardiac Death

Causes of Sudden Death Including Sudden Cardiac Death by Organ System

Cardiovascular

Amyloid cardiopathy, Congestive heart failure, Ventricular rupture,

* Ischemic

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

* Pericardial

Cardiac tamponade,

* Myocardial

Asymmetric septal hypertrophy , ST Elevation Myocardial Infarction, Dilated cardiomyopathy, Giant cell myocarditis , Hypertrophic cardiomyopathy, Kugel-Stoloff syndrome , Myocardial infarction, Myocarditis, Rupture of the papillary muscles,

* Endocardial/Valvular

Mitral valve prolapse, Valvular Heart Disease,

* Conduction/Arrhythmia

Arrhythmogenic right ventricular cardiomyopathy, Arrhythmogenic right ventricular dysplasia, Brugada syndrome, Complete atrioventricular block, Jervell and Lange-Nielsen Syndrome, Prolonged Q-T Interval Syndrome, Multifocal ventricular premature beats , Naxos disease , Romano-Ward syndrome , Sick sinus syndrome, Short QT syndrome , Sinus node disease, Stokes-Adams Syndrome, Sudden Arrhythmia Death Syndrome, Wolf-Parkinson-White syndrome,

* Vascular

Acute aortic insufficiency, Acute coronary syndrome, Aortic dissection, Aortic stenosis, Aorto-ventricular tunnel, Arteritis, Coronary artery disease, Coronary arteries - congenital malformation , Ruptured abdominal aortic aneurysm,

Congenital/Developmental

Congenital heart disease, Congenital heart block , Congenital Long QT syndrome, Noncompaction Cardiomyopathy, Sudden Infant Death Syndrome, Uhl anomaly

Chemical / poisoning

Snake bite

Dermatologic No underlying causes
Drug Side Effect caspofungin acetate, Clozapine, Drug allergy, drug overdose, pramipexole, prednisolone
Ear Nose Throat No underlying causes
Endocrine

Catecholaminergic polymorphic ventricular tachycardia, Diabetic ketoacidosis - typically from undiagnosed diabetes, Thyrotoxicosis,

Environmental Hypothermia,
Gastroenterologic

Appendicitis, Gastrointestinal bleeding, Retroperitoneal bleed,

Genetic

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

Hematologic No underlying causes
Iatrogenic Transfusion reaction
Infectious Disease

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

Musculoskeletal / Ortho No underlying causes
Neurologic

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

Nutritional / Metabolic

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

Obstetric/Gynecologic

Amniotic fluid syndrome , Childbirth hemorrhage,

Oncologic

Atrial myxoma, familial

Opthalmologic No underlying causes
Overdose / Toxicity

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

Psychiatric No underlying causes
Pulmonary

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

Renal / Electrolyte

Hypercalcemia, Hypokalemia, Hyperkalemia,

Rheum / Immune / Allergy

Amyloidosis, Anaphylaxis, Myasthenia gravis, Sarcoidosis,

Sexual No underlying causes
Trauma

Commotio cordis, Homicide, Motor Vehicle accident

Urologic No underlying causes
Miscellaneous

Shock, Asphyxia, Insect bite Sepsis syndrome, Shock

Causes of Sudden Death Including Sudden Cardiac Death in Alphabetical Order

References

  1. Eisenberg MS, Mengert TJ (April 2001). "Cardiac resuscitation". N. Engl. J. Med. 344 (17): 1304–13. PMID 11320390.
  2. Resuscitation Council UK (2005). Resuscitation Guidelines 2005 London: Resuscitation Council UK.

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