|
|
| (7 intermediate revisions by 2 users not shown) |
| Line 1: |
Line 1: |
| ===Diagnostic Criteria===
| | __NOTOC__ |
| *The diagnosis of sudden cardiac arrest is made when the following diagnostic criteria are met:
| | {{Sudden cardiac death}} |
| :*Absence of a [[palpable pulse]] of the [[heart]]<ref name="Harrison"> [http://books.mcgraw-hill.com/medical/harrisons/ Harrison's Principles of Internal Medicine] 16th Edition, The McGraw-Hill Companies, ISBN 0-07-140235-7</ref>
| | {{CMG}} {{AE}} {{Sara.Zand}} {{EdzelCo}} |
| :*Absent [[carotid pulse]]
| |
| :*[[Gasping respiration]] or NO [[respiration]]
| |
| :*Loss of [[consciousness]] due to [[cerebral hypoperfusion]]
| |
|
| |
|
| {| style="border: 2px solid #4479BA; align="left"
| | ==Overview== |
| ! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Components}}
| | According to the 2017 Association for European Cardiovascular Pathologists guidelines, [[autopsy]] is done whenever [[sudden cardiac death]] ([[SCD]]) is suspected. |
| ! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF|Assessment and findings}}
| |
| |-
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Symptoms
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
| |
| * Symptoms related to [[arrhythmia]]<ref name="ZimetbaumJosephson1998">{{cite journal|last1=Zimetbaum|first1=Peter|last2=Josephson|first2=Mark E.|title=Evaluation of Patients with Palpitations|journal=New England Journal of Medicine|volume=338|issue=19|year=1998|pages=1369–1373|issn=0028-4793|doi=10.1056/NEJM199805073381907}}</ref><ref name="NodaShimizu2005">{{cite journal|last1=Noda|first1=Takashi|last2=Shimizu|first2=Wataru|last3=Taguchi|first3=Atsushi|last4=Aiba|first4=Takeshi|last5=Satomi|first5=Kazuhiro|last6=Suyama|first6=Kazuhiro|last7=Kurita|first7=Takashi|last8=Aihara|first8=Naohiko|last9=Kamakura|first9=Shiro|title=Malignant Entity of Idiopathic Ventricular Fibrillation and Polymorphic Ventricular Tachycardia Initiated by Premature Extrasystoles Originating From the Right Ventricular Outflow Tract|journal=Journal of the American College of Cardiology|volume=46|issue=7|year=2005|pages=1288–1294|issn=07351097|doi=10.1016/j.jacc.2005.05.077}}</ref>
| |
|
| |
|
| : [[Palpitations]], [[lightheadedness]], [[syncope]], [[dyspnea]], [[chest pain]], [[cardiac arrest]]
| | ==Diagnosis Study Of Choice== |
| * Symptoms related to underlying [[heart disease]]: [[Dyspnea]] at rest or on exertion, [[orthopnea]], [[paroxysmal nocturnal dyspnea]], [[chest pain]], [[edema]] | | *According to the 2017 Association for European Cardiovascular Pathologists guidelines, [[autopsy]] is done whenever [[sudden cardiac death]] ([[SCD]]) is suspected. |
| * Precipitating factors: [[Exercise]], [[emotional stress]]
| | * [[Autopsy]] investigates whether: |
| |-
| | ** The mechanism of [[death]]was of mechanical or [[arrhythmic]] in nature |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Past medical history
| | ** The cause of [[SCD]] is of [[hereditary]] in origin requiring the need for [[screening]] and [[counseling]] for the next generations |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" |
| | ** 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> |
| * [[Heart disease]]: [[Coronary]], [[valvular]] ([[mitral valve prolapse]]), [[congenital heart disease]]
| |
| * [[Thyroid disease]] | |
| * [[Acute kidney injury]] | |
| * [[Chronic kidney disease]] | |
| * [[Electrolyte abnormalities]]
| |
| * [[Stroke]],[[embolic events]] | |
| * [[Lung disease]] | |
| * [[Epilepsy]] ([[arrhythmic syncope]] can be misdiagnosed as [[epilepsy]])
| |
| * [[ Alcohol]], [[illicit drug]] use
| |
| * Use of over-the-counter medications caused [[QT prolongation]] and [[torsades de pointes]]
| |
| * [[ Unexplained motor vehicle accident]] | |
| |-
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Medications
| |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | | |
| * [[Antiarrhythmic]] medications
| |
| * Medication with QT prolongation and torsades de pointes effect
| |
| * [[Cocaine]],[[amphetamines]]
| |
| * [[Anabolic steroids]]
| |
| * Medication-medication interaction that could cause [[QT prolongation]] and [[torsades de pointes]]
| |
| |- | |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Family history | |
| | style="padding: 0 5px; background: #F5F5F5; text-align: left;" | | |
| * [[SCD]], [[SCA]], [[unexplained drowning]] in a first-degree relative
| |
| * [[SIDS]], repetitive spontaneous [[pregnancy losses]] concerning [[cardiac channelopathies]]
| |
| * [[IHD]]
| |
| * [[Cardiomyopathy]]: [[Hypertrophic]],[[ dilated]], [[ARVC]]
| |
| * [[Congenital heart disease]]
| |
| * [[ Cardiac channelopathies]]: [[Long QT]], [[Brugada]], [[Short QT]], [[CPVT]]
| |
| * [[Arrhythmias]]: [[conduction disorders]], [[ pacemakers]]/[[ICDs]]
| |
| * [[Neuromuscular disease]] associated with [[cardiomyopathies]]
| |
| * [[Muscular dystrophy]]
| |
| * [[Epilepsy]]
| |
| |-
| |
|
| |
|
| |}
| |
| {{clear}}
| |
|
| |
| === Symptoms ===
| |
| *[[Symptoms]] related to arrhythmia or underlying [[ heart disease]] within one hour before [[ cardiac arrest]] may include the following:<ref name="pmid26720493">{{cite journal |vauthors=Marijon E, Uy-Evanado A, Dumas F, Karam N, Reinier K, Teodorescu C, Narayanan K, Gunson K, Jui J, Jouven X, Chugh SS |title=Warning Symptoms Are Associated With Survival From Sudden Cardiac Arrest |journal=Ann Intern Med |volume=164 |issue=1 |pages=23–9 |date=January 2016 |pmid=26720493 |pmc=5624713 |doi=10.7326/M14-2342 |url=}}</ref>
| |
| :* [[Palpitations]]
| |
| :* [[lightheadedness]]
| |
| :* [[syncope]]
| |
| :* [[dyspnea]]
| |
| :* [[chest pain]]
| |
| :* [[cardiac arrest]]
| |
| :* [[Dyspnea]] at rest or on exertion
| |
| :* [[orthopnea]]
| |
| :* [[paroxysmal nocturnal dyspnea]]
| |
| :* [[chest pain]], [[edema]]
| |
|
| |
| === Physical Examination ===
| |
| *Patients with [[cardiac arrest]] usually appear [[cyanotic]].
| |
| * [[Physical examination]] may be remarkable for:
| |
| :*[[Heart rate]] and [[regularity]], [[blood pressure]]
| |
| :*[[ Jugular venous pressure]]
| |
| :*[[Murmurs]]
| |
| :*[[ Pulses]], [[bruits]]
| |
| :*[[Edema]]
| |
| :*[[Sternotomy scars]]
| |
|
| |
| === Laboratory Findings ===
| |
|
| |
| *An elevated concentration of [[brain natriuretic peptide]] ([[BNP]]) predicts has been shown as the predictor of [[ventricular arrhythmia]] and [[sudden cardiac death]].<ref name="ScottBarry2009">{{cite journal|last1=Scott|first1=Paul A.|last2=Barry|first2=James|last3=Roberts|first3=Paul R.|last4=Morgan|first4=John M.|title=Brain natriuretic peptide for the prediction of sudden cardiac death and ventricular arrhythmias: a meta-analysis|journal=European Journal of Heart Failure|volume=11|issue=10|year=2009|pages=958–966|issn=13889842|doi=10.1093/eurjhf/hfp123}}</ref>
| |
|
| |
| ===Electrocardiogram===
| |
|
| |
| An [[ECG]] may be helpful in the diagnosis of [[Sudden cardiac death]]. Findings on [[ECG]] associated with [[ sudden cardiac arrest]] 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%)
| |
| * Abnormal [[T-wave inversions]] (30%)
| |
| * Prolonged [[QT]] interval (26%)
| |
| * Left/[[right atrial]] abnormality (22%)
| |
| * [[ LVH]] (17%)
| |
| * Abnormal frontal [[QRS axis]] (17%)
| |
| * Delayed [[QRS]]-transition zone in precordial leads (13%)
| |
| * Pathological [[Q waves]] (13%)
| |
| * [[intraventricular conduction delays]] (9%)
| |
| * Multiple [[premature ventricular contractions]] (9%)
| |
| * [[Normal ECG]] (9%)
| |
| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |