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Sudden cardiac death post arrest care and prevention

2026-04-04T14:32:07Z

Overview

← Older revision		Revision as of 14:32, 4 April 2026
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	*Effective measures for the [[primary prevention]] of [[sudden cardiac death]] ([[SCD]]) in individuals who are at risk of [[SCD]] but have not yet experienced an aborted [[cardiac arrest]] or [[life-threatening arrhythmias]] include [[implantable cardioverter defibrillator]] ([[ICD]]) based on the guideline.		*Effective measures for the [[primary prevention]] of [[sudden cardiac death]] ([[SCD]]) in individuals who are at risk of [[SCD]] but have not yet experienced an aborted [[cardiac arrest]] or [[life-threatening arrhythmias]] include [[implantable cardioverter defibrillator]] ([[ICD]]) based on the guideline.
	*[[Secondary prevention]] strategy following aborted sudden cardiac death include [[revascularization]] in patients with [[ischemic heart disease]] and [[ICD]] implantation in patients with reduced [[left ventricular ejection fraction]] who had an experience of lethal [[arrhythmia]].		*[[Secondary prevention]] strategy following aborted sudden cardiac death include [[revascularization]] in patients with [[ischemic heart disease]] and [[ICD]] implantation in patients with reduced [[left ventricular ejection fraction]] who had an experience of lethal [[arrhythmia]].
	*The optimal approach to prevention of [[SCD]] following [[ST-elevation MI]] ([[STEMI]]) has been evaluated in multiple randomized trials. In general, [[post-STEMI]] [[patients ]]should be treated with evidence-based therapies that have been associated with a reduction in [[SCD]] including [[beta-blockers]], [[ACE-inhibitors]] (or [[ARB]]s in [[patients]] who are [[ACEI]] intolerant) and [[statins]].
	*In [[patients]] who have symptomatic [[congestive heart failure]] ([[CHF]]), an [[aldosterone antagonist]] may be a reasonable additional therapy. Despite the intuitive benefits of [[antiarrhythmic]], [[amiodarone]] and [[sotalol]] have not been shown to reduce all-cause [[mortality]] following [[STEMI]], although [[amiodarone]] may be useful in reducing the frequency of [[shocks]] in [[patients]] with [[ICD]]s who have unacceptably high rates of [[shock]].
	*In general terms, [[ICD placement]] is indicated in those [[patients]] with a reduced [[left ventricular]] [[ejection fraction]] at 40 days [[post-MI]] and/or 3 months following [[revascularization]] ([[PCI]] or [[CABG]]) for [[STEMI]] given the survival benefits in this population.
	*In absence of noncardiac or reversible causes, an implantable cardioverter-defibrillator (ICD) is recommended because of the high risk of recurrent lethal ventricular arrhythmias. Adjunctive therapy (eg, amiodarone, catheter ablation) and lifestyle modifications for certain genetic arrhythmia syndromes may reduce ventricular arrhythmia recurrence after ICD placement.		*In absence of noncardiac or reversible causes, an implantable cardioverter-defibrillator (ICD) is recommended because of the high risk of recurrent lethal ventricular arrhythmias. Adjunctive therapy (eg, amiodarone, catheter ablation) and lifestyle modifications for certain genetic arrhythmia syndromes may reduce ventricular arrhythmia recurrence after ICD placement.

	== Prevention ==		== Prevention ==

			=== Primary prevention: ===
	*Effective measures for the [[primary prevention]] of [[sudden cardiac death]] in individuals who are at risk of [[SCD]] but have not yet experienced an aborted [[cardiac arrest]] or [[life-threatening arrhythmias]] include [[ICD]] implantation based on the guideline.<ref name="Al-KhatibStevenson2018">{{cite journal\|last1=Al-Khatib\|first1=Sana M.\|last2=Stevenson\|first2=William G.\|last3=Ackerman\|first3=Michael J.\|last4=Bryant\|first4=William J.\|last5=Callans\|first5=David J.\|last6=Curtis\|first6=Anne B.\|last7=Deal\|first7=Barbara J.\|last8=Dickfeld\|first8=Timm\|last9=Field\|first9=Michael E.\|last10=Fonarow\|first10=Gregg C.\|last11=Gillis\|first11=Anne M.\|last12=Granger\|first12=Christopher B.\|last13=Hammill\|first13=Stephen C.\|last14=Hlatky\|first14=Mark A.\|last15=Joglar\|first15=José A.\|last16=Kay\|first16=G. Neal\|last17=Matlock\|first17=Daniel D.\|last18=Myerburg\|first18=Robert J.\|last19=Page\|first19=Richard L.\|title=2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death\|journal=Circulation\|volume=138\|issue=13\|year=2018\|issn=0009-7322\|doi=10.1161/CIR.0000000000000549}}</ref>		*Effective measures for the [[primary prevention]] of [[sudden cardiac death]] in individuals who are at risk of [[SCD]] but have not yet experienced an aborted [[cardiac arrest]] or [[life-threatening arrhythmias]] include [[ICD]] implantation based on the guideline.<ref name="Al-KhatibStevenson2018">{{cite journal\|last1=Al-Khatib\|first1=Sana M.\|last2=Stevenson\|first2=William G.\|last3=Ackerman\|first3=Michael J.\|last4=Bryant\|first4=William J.\|last5=Callans\|first5=David J.\|last6=Curtis\|first6=Anne B.\|last7=Deal\|first7=Barbara J.\|last8=Dickfeld\|first8=Timm\|last9=Field\|first9=Michael E.\|last10=Fonarow\|first10=Gregg C.\|last11=Gillis\|first11=Anne M.\|last12=Granger\|first12=Christopher B.\|last13=Hammill\|first13=Stephen C.\|last14=Hlatky\|first14=Mark A.\|last15=Joglar\|first15=José A.\|last16=Kay\|first16=G. Neal\|last17=Matlock\|first17=Daniel D.\|last18=Myerburg\|first18=Robert J.\|last19=Page\|first19=Richard L.\|title=2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death\|journal=Circulation\|volume=138\|issue=13\|year=2018\|issn=0009-7322\|doi=10.1161/CIR.0000000000000549}}</ref>
	*[[Secondary prevention]] strategy following aborted sudden cardiac death include [[revascularization]], [[ICD]] implantation.		*[[Secondary prevention]] strategy following aborted sudden cardiac death include [[revascularization]], [[ICD]] implantation.

			=== Secondary prevention: ===
			*'''Myocardial Infarcation:''' The optimal approach to prevention of [[SCD]] following [[ST-elevation MI]] ([[STEMI]]) has been evaluated in multiple randomized trials. In general, [[post-STEMI]] [[patients ]]should be treated with evidence-based therapies that have been associated with a reduction in [[SCD]] including [[beta-blockers]], [[ACE-inhibitors]] (or [[ARB]]s in [[patients]] who are [[ACEI]] intolerant) and [[statins]].
			*VF due to acute MI with coronary plaque rupture and/or thrombus (typically <48 hours), risk of a recurrent event is reduced after early revascularization such as percutaneous coronary intervention. Implantable cardioverter-defibrillator (ICD) is not indicated for secondary prevention.<ref name="pmid36017572" />,<ref>Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med. 1997;337(22):1576-1583. doi:10.1056/ NEJM199711273372202</ref>
			*'''Heart failure:''' In [[patients]] who have symptomatic [[congestive heart failure]] ([[CHF]]), an [[aldosterone antagonist]] may be a reasonable additional therapy. Despite the intuitive benefits of [[antiarrhythmic]], [[amiodarone]] and [[sotalol]] have not been shown to reduce all-cause [[mortality]] following [[STEMI]], although [[amiodarone]] may be useful in reducing the frequency of [[shocks]] in [[patients]] with [[ICD]]s who have unacceptably high rates of [[shock]].
			*In general terms, [[ICD placement]] is indicated in those [[patients]] with a reduced [[left ventricular]] [[ejection fraction]] at 40 days [[post-MI]] and/or 3 months following [[revascularization]] ([[PCI]] or [[CABG]]) for [[STEMI]] given the survival benefits in this population.
			*'''Coronary anomalies:''' Surgical intervention is recommended to survivors with coronary anomalies such as congenital left main artery atresia and anomalous aortic origin of a coronary artery to prevent recurrence.<ref name="pmid36017572" /><ref name="Al-KhatibStevenson2018" /><ref>Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC Guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(14):e698-e800.</ref>
			*'''Toxins:''' .If the cardiac arrest involved stimulants or supplements, avoidance of these substances can prevent recurrence. For patients with an event caused by an opioid overdose, counseling, education, and medications to treat opioid use disorder (eg, buprenorphine, methadone, and naltrexone) are recommended to decrease the risk of recurrence.<ref>Dezfulian C, Orkin AM, Maron BA, et al; American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research;and Council on Clinical Cardiology. Opioid-associated out-of-hospital cardiac arrest: distinctive clinical features and implications for health care and public responses: a scientific statement from the American Heart Association. Circulation. 2021;143 (16):e836-e870. doi:10.1161/CIR. 0000000000000958</ref>
			*'''Epilepsy:''' Survivors with a previously undiagnosed seizure disorder should be treated and closely followed up given a more than 20-fold higher risk of sudden unexplained death in persons with epilepsy compared with the general population.<ref>Ficker DM, So EL, Shen WK, et al. Population-based study of the incidence of sudden unexplained death in epilepsy. Neurology. 1998;51 (5):1270-1274. doi:10.1212/WNL.51.5.1270</ref>

	==2022 ESC Guidelines for the management of patients with ventricular arrythymias and the prevention of sudden cardiac death <ref name="pmid36017572">{{cite journal\| author=Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA \| display-authors=etal\| title=2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. \| journal=Eur Heart J \| year= 2022 \| volume= 43 \| issue= 40 \| pages= 3997-4126 \| pmid=36017572 \| doi=10.1093/eurheartj/ehac262 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=36017572 }} </ref>==		==2022 ESC Guidelines for the management of patients with ventricular arrythymias and the prevention of sudden cardiac death <ref name="pmid36017572">{{cite journal\| author=Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA \| display-authors=etal\| title=2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. \| journal=Eur Heart J \| year= 2022 \| volume= 43 \| issue= 40 \| pages= 3997-4126 \| pmid=36017572 \| doi=10.1093/eurheartj/ehac262 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=36017572 }} </ref>==

Sudden cardiac death prognosis

2026-04-04T14:11:53Z

Prognosis of Sudden Cardiac Death

← Older revision		Revision as of 14:11, 4 April 2026
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	* [[Prognosis]] of in-hospital [[cardiac arrest]] is generally better than out-of- hospital [[cardiac arrest]] and the 1-year survival rate of patients who survived to [[hospital]] discharge was approximately 25% in the GWTG-R registry.		* [[Prognosis]] of in-hospital [[cardiac arrest]] is generally better than out-of- hospital [[cardiac arrest]] and the 1-year survival rate of patients who survived to [[hospital]] discharge was approximately 25% in the GWTG-R registry.
	* A retrospective cohort study from the CARES registry reported 101968 out-of-hospital cardiac arrests in the US between 2006 and 2013, approximately 6% of the incidents occurred among individuals between 20 through 39 years; survival rate to hospital discharge ranged from 11%(30-39years) to 16%(20-24years).<ref name=":0">Andersen LW, Bivens MJ,Giberson T,et al. The relationship between age and outcome in out-of-hospital cardiac arrest patients. Resuscitation. 2015;94:49-54. doi:10.1016/j.resuscitation.2015.05. 015</ref> Approximately 85% to 95% of out-of-hospital cardiac arrest survivors were discharged with good neurological outcome, as defined by a Cerebral Performance Categories scale of 1 or 2.<ref name=":0" /> <ref name=":1">Gustafsson L, Rawshani A,Råmunddal T, et al. Characteristics, survival and neurological outcome in out-of-hospital cardiac arrest in young adults in Sweden:a nationwide study. Resusc Plus. 2023;16:100503.doi:10.1016/j.resplu.2023.100503</ref>		* A retrospective cohort study from the CARES registry reported 101968 out-of-hospital cardiac arrests in the US between 2006 and 2013, approximately 6% of the incidents occurred among individuals between 20 through 39 years; survival rate to hospital discharge ranged from 11%(30-39years) to 16%(20-24years).<ref name=":0">Andersen LW, Bivens MJ,Giberson T,et al. The relationship between age and outcome in out-of-hospital cardiac arrest patients. Resuscitation. 2015;94:49-54. doi:10.1016/j.resuscitation.2015.05. 015</ref> Approximately 85% to 95% of out-of-hospital cardiac arrest survivors were discharged with good neurological outcome, as defined by a Cerebral Performance Categories scale of 1 or 2.<ref name=":0" /> <ref name=":1">Gustafsson L, Rawshani A,Råmunddal T, et al. Characteristics, survival and neurological outcome in out-of-hospital cardiac arrest in young adults in Sweden:a nationwide study. Resusc Plus. 2023;16:100503.doi:10.1016/j.resplu.2023.100503</ref>
	* The overall survival rate of young adults experiencing out-of-hospital cardiac arrest was 9% in a US study from 2005 through 2007 involving 665 persons aged 20 through 39 years, and increased to 34.8% for those with bystander-witnessed VT or VF who were more likely to receive prompt initial cardiopulmonary resus citation (CPR) or automated external defibrillator use.<ref>Rea TD, Cook AJ, Stiell IG, et al; Resuscitation Outcomes Consortium Investigators. Predicting survival after out-of-hospital cardiac arrest: role of the Utstein data elements. AnnEmergMed.2010; 55(3):249-257. doi:10.1016/j.annemergmed.2009. 09.018</ref>		* The overall survival rate of young adults experiencing out-of-hospital cardiac arrest was 9% in a US study from 2005 through 2007 involving 665 persons aged 20 through 39 years, and increased to 34.8% for those with bystander-witnessed VT or VF who were more likely to receive prompt initial cardiopulmonary resus citation (CPR) or automated external defibrillator use.<ref name=":2">Rea TD, Cook AJ, Stiell IG, et al; Resuscitation Outcomes Consortium Investigators. Predicting survival after out-of-hospital cardiac arrest: role of the Utstein data elements. AnnEmergMed.2010; 55(3):249-257. doi:10.1016/j.annemergmed.2009. 09.018</ref>
	* In an Australian registry conducted between 2000 and 2009 involving 3912 patients with ages between 16 and 39 years with out-of-hospital cardiac arrest,the survival rate was 8.8%.<ref name=":1" />		* In an Australian registry conducted between 2000 and 2009 involving 3912 patients with ages between 16 and 39 years with out-of-hospital cardiac arrest,the survival rate was 8.8%.<ref name=":1" />

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	==Prognosis of Sudden Cardiac Death==		==Prognosis of Sudden Cardiac Death==
	*Prognosis of in-hospital cardiac arrest is generally better than out-of-hospital [[cardiac arrest]] and the 1-year survival rate of patients who survived to hospital discharge was approximately 25% in the GWTG-R registry.<ref name="ViraniAlonso2020">{{cite journal\|last1=Virani\|first1=Salim S.\|last2=Alonso\|first2=Alvaro\|last3=Benjamin\|first3=Emelia J.\|last4=Bittencourt\|first4=Marcio S.\|last5=Callaway\|first5=Clifton W.\|last6=Carson\|first6=April P.\|last7=Chamberlain\|first7=Alanna M.\|last8=Chang\|first8=Alexander R.\|last9=Cheng\|first9=Susan\|last10=Delling\|first10=Francesca N.\|last11=Djousse\|first11=Luc\|last12=Elkind\|first12=Mitchell S.V.\|last13=Ferguson\|first13=Jane F.\|last14=Fornage\|first14=Myriam\|last15=Khan\|first15=Sadiya S.\|last16=Kissela\|first16=Brett M.\|last17=Knutson\|first17=Kristen L.\|last18=Kwan\|first18=Tak W.\|last19=Lackland\|first19=Daniel T.\|last20=Lewis\|first20=Tené T.\|last21=Lichtman\|first21=Judith H.\|last22=Longenecker\|first22=Chris T.\|last23=Loop\|first23=Matthew Shane\|last24=Lutsey\|first24=Pamela L.\|last25=Martin\|first25=Seth S.\|last26=Matsushita\|first26=Kunihiro\|last27=Moran\|first27=Andrew E.\|last28=Mussolino\|first28=Michael E.\|last29=Perak\|first29=Amanda Marma\|last30=Rosamond\|first30=Wayne D.\|last31=Roth\|first31=Gregory A.\|last32=Sampson\|first32=Uchechukwu K.A.\|last33=Satou\|first33=Gary M.\|last34=Schroeder\|first34=Emily B.\|last35=Shah\|first35=Svati H.\|last36=Shay\|first36=Christina M.\|last37=Spartano\|first37=Nicole L.\|last38=Stokes\|first38=Andrew\|last39=Tirschwell\|first39=David L.\|last40=VanWagner\|first40=Lisa B.\|last41=Tsao\|first41=Connie W.\|title=Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association\|journal=Circulation\|volume=141\|issue=9\|year=2020\|issn=0009-7322\|doi=10.1161/CIR.0000000000000757}}</ref>.Survival after out of hospital cardiac arrest and in hospital cardiac arrest has continued to improve over time according to the guideline.		*Prognosis of in-hospital cardiac arrest is generally better than out-of-hospital [[cardiac arrest]] and the 1-year survival rate of patients who survived to hospital discharge was approximately 25% in the GWTG-R registry.<ref name="ViraniAlonso2020">{{cite journal\|last1=Virani\|first1=Salim S.\|last2=Alonso\|first2=Alvaro\|last3=Benjamin\|first3=Emelia J.\|last4=Bittencourt\|first4=Marcio S.\|last5=Callaway\|first5=Clifton W.\|last6=Carson\|first6=April P.\|last7=Chamberlain\|first7=Alanna M.\|last8=Chang\|first8=Alexander R.\|last9=Cheng\|first9=Susan\|last10=Delling\|first10=Francesca N.\|last11=Djousse\|first11=Luc\|last12=Elkind\|first12=Mitchell S.V.\|last13=Ferguson\|first13=Jane F.\|last14=Fornage\|first14=Myriam\|last15=Khan\|first15=Sadiya S.\|last16=Kissela\|first16=Brett M.\|last17=Knutson\|first17=Kristen L.\|last18=Kwan\|first18=Tak W.\|last19=Lackland\|first19=Daniel T.\|last20=Lewis\|first20=Tené T.\|last21=Lichtman\|first21=Judith H.\|last22=Longenecker\|first22=Chris T.\|last23=Loop\|first23=Matthew Shane\|last24=Lutsey\|first24=Pamela L.\|last25=Martin\|first25=Seth S.\|last26=Matsushita\|first26=Kunihiro\|last27=Moran\|first27=Andrew E.\|last28=Mussolino\|first28=Michael E.\|last29=Perak\|first29=Amanda Marma\|last30=Rosamond\|first30=Wayne D.\|last31=Roth\|first31=Gregory A.\|last32=Sampson\|first32=Uchechukwu K.A.\|last33=Satou\|first33=Gary M.\|last34=Schroeder\|first34=Emily B.\|last35=Shah\|first35=Svati H.\|last36=Shay\|first36=Christina M.\|last37=Spartano\|first37=Nicole L.\|last38=Stokes\|first38=Andrew\|last39=Tirschwell\|first39=David L.\|last40=VanWagner\|first40=Lisa B.\|last41=Tsao\|first41=Connie W.\|title=Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association\|journal=Circulation\|volume=141\|issue=9\|year=2020\|issn=0009-7322\|doi=10.1161/CIR.0000000000000757}}</ref>.Survival after out of hospital cardiac arrest and in hospital cardiac arrest has continued to improve over time according to the guideline.
			*60% to 78% of young adults hospitalized after resuscitation from sudden cardiac arrest do not survive to hospital discharge.<ref>Deasy C, Bray JE, Smith K, Harriss LR, Bernard SA, Cameron P. Out-of-hospital cardiac arrests in young adults in Melbourne,Australia. Resuscitation. 2011;82(7):830-834. doi:10.1016/j.resuscitation.2011. 03.008</ref>,<ref name=":2" />,<ref>Fovaeus H, Holmen J, Mandalenakis Z, Herlitz J, Rawshani A, Castellheim AG.Out-of-hospital cardiac arrest: survival in children and young adults over 30 years,a nationwide registry-based cohort study. Resuscitation. 2024;195:110103. doi:10.1016/ j.resuscitation.2023.110103</ref> This in-hospital mortality rate is similar to that of older adults who were resuscitated to hospitalization (≈65%).<ref>Ricceri S, Salazar JW, Vu AA, Vittinghoff E, Moffatt E, Tseng ZH. Factors predisposing to survival after resuscitation for sudden cardiac arrest. J AmColl Cardiol. 2021;77(19):2353-2362. doi:10.1016/j.jacc.2021.03.299</ref>

Sudden cardiac death definitions and diagnosis

2026-04-04T13:40:25Z

← Older revision		Revision as of 13:40, 4 April 2026
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	__NOTOC__		__NOTOC__
	{{Sudden cardiac death}}		{{Sudden cardiac death}}
	{{CMG}} {{AE}} {{Sara.Zand}} {{EdzelCo}}		{{CMG}} {{AE}} {{Sara.Zand}} {{EdzelCo}} {{Nehal}}
	==Overview==		==Overview==
	*The diagnosis of [[sudden cardiac arrest]] ([[SCA]]) is made when the following diagnostic criteria are met: the absence of a [[palpable pulse]] of the [[heart]] due to abrupt cessation of [[pump function]], absent [[carotid pulse]],[[gasping respiration]] or no [[respiration]], loss of [[consciousness]] due to [[cerebral hypoperfusion]].		*The diagnosis of [[sudden cardiac arrest]] ([[SCA]]) is made when the following diagnostic criteria are met: the absence of a [[palpable pulse]] of the [[heart]] due to abrupt cessation of [[pump function]], absent [[carotid pulse]],[[gasping respiration]] or no [[respiration]], loss of [[consciousness]] due to [[cerebral hypoperfusion]].

Sudden cardiac death prognosis

2026-03-29T05:33:11Z

Natural History of Sudden Cardiac Death

← Older revision		Revision as of 05:33, 29 March 2026
(One intermediate revision by the same user not shown)
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	{{Sudden cardiac death}}		{{Sudden cardiac death}}

	{{CMG}} {{AE}} {{Sara.Zand}} {{EdzelCo}}		{{CMG}} {{AE}} {{Sara.Zand}} {{EdzelCo}} {{Nehal}}
	==Overview==		==Overview==
	* [[Sudden cardiac arrest]] ([[SCA]]) occurs due to sudden disturbance in [[cardiac electrical propagation]] or failure of the [[heart]] to pumping the [[blood]] into vital [[organs]].		* [[Sudden cardiac arrest]] ([[SCA]]) occurs due to sudden disturbance in [[cardiac electrical propagation]] or failure of the [[heart]] to pumping the [[blood]] into vital [[organs]].
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	* Prompt [[treatment]] is needed to prevent [[death]] which may occur within minutes to weeks, and prevent serious [[complications]].		* Prompt [[treatment]] is needed to prevent [[death]] which may occur within minutes to weeks, and prevent serious [[complications]].
	* [[Prognosis]] of in-hospital [[cardiac arrest]] is generally better than out-of- hospital [[cardiac arrest]] and the 1-year survival rate of patients who survived to [[hospital]] discharge was approximately 25% in the GWTG-R registry.		* [[Prognosis]] of in-hospital [[cardiac arrest]] is generally better than out-of- hospital [[cardiac arrest]] and the 1-year survival rate of patients who survived to [[hospital]] discharge was approximately 25% in the GWTG-R registry.
			* A retrospective cohort study from the CARES registry reported 101968 out-of-hospital cardiac arrests in the US between 2006 and 2013, approximately 6% of the incidents occurred among individuals between 20 through 39 years; survival rate to hospital discharge ranged from 11%(30-39years) to 16%(20-24years).<ref name=":0">Andersen LW, Bivens MJ,Giberson T,et al. The relationship between age and outcome in out-of-hospital cardiac arrest patients. Resuscitation. 2015;94:49-54. doi:10.1016/j.resuscitation.2015.05. 015</ref> Approximately 85% to 95% of out-of-hospital cardiac arrest survivors were discharged with good neurological outcome, as defined by a Cerebral Performance Categories scale of 1 or 2.<ref name=":0" /> <ref name=":1">Gustafsson L, Rawshani A,Råmunddal T, et al. Characteristics, survival and neurological outcome in out-of-hospital cardiac arrest in young adults in Sweden:a nationwide study. Resusc Plus. 2023;16:100503.doi:10.1016/j.resplu.2023.100503</ref>
			* The overall survival rate of young adults experiencing out-of-hospital cardiac arrest was 9% in a US study from 2005 through 2007 involving 665 persons aged 20 through 39 years, and increased to 34.8% for those with bystander-witnessed VT or VF who were more likely to receive prompt initial cardiopulmonary resus citation (CPR) or automated external defibrillator use.<ref>Rea TD, Cook AJ, Stiell IG, et al; Resuscitation Outcomes Consortium Investigators. Predicting survival after out-of-hospital cardiac arrest: role of the Utstein data elements. AnnEmergMed.2010; 55(3):249-257. doi:10.1016/j.annemergmed.2009. 09.018</ref>
			* In an Australian registry conducted between 2000 and 2009 involving 3912 patients with ages between 16 and 39 years with out-of-hospital cardiac arrest,the survival rate was 8.8%.<ref name=":1" />

	==Natural History of Sudden Cardiac Death==		==Natural History of Sudden Cardiac Death==

Sudden cardiac death post arrest care and prevention

2026-03-29T00:25:26Z

Overview

← Older revision		Revision as of 00:25, 29 March 2026
(One intermediate revision by the same user not shown)
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	__NOTOC__		__NOTOC__
	{{Sudden cardiac death}}		{{Sudden cardiac death}}
	{{CMG}} {{AE}} {{Sara.Zand}} {{EdzelCo}}		{{CMG}} {{AE}} {{Sara.Zand}} {{EdzelCo}} {{Nehal}}

	See also [[Post cardiac arrest syndrome care pathway]]		See also [[Post cardiac arrest syndrome care pathway]]
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	==Overview==		==Overview==
	*Effective measures for the [[primary prevention]] of [[sudden cardiac death]] ([[SCD]]) in individuals who are at risk of [[SCD]] but have not yet experienced an aborted [[cardiac arrest]] or [[life-threatening arrhythmias]] include [[implantable cardioverter defibrillator]] ([[ICD]]) based on the guideline.		*Effective measures for the [[primary prevention]] of [[sudden cardiac death]] ([[SCD]]) in individuals who are at risk of [[SCD]] but have not yet experienced an aborted [[cardiac arrest]] or [[life-threatening arrhythmias]] include [[implantable cardioverter defibrillator]] ([[ICD]]) based on the guideline.
	*[[Secondary prevention]] strategy following aborted sudden cardiac death include [[revascularization]] in patients with [[ischemic heart disease]] and [[ICD]] implantation in patients with reduced [[left ventricular ejection fraction]] who had an experience of lethal [[arrhythmia]].		*[[Secondary prevention]] strategy following aborted sudden cardiac death include [[revascularization]] in patients with [[ischemic heart disease]] and [[ICD]] implantation in patients with reduced [[left ventricular ejection fraction]] who had an experience of lethal [[arrhythmia]].
	*The optimal approach to prevention of [[SCD]] following [[ST-elevation MI]] ([[STEMI]]) has been evaluated in multiple randomized trials. In general, [[post-STEMI]] [[patients ]]should be treated with evidence-based therapies that have been associated with a reduction in [[SCD]] including [[beta-blockers]], [[ACE-inhibitors]] (or [[ARB]]s in [[patients]] who are [[ACEI]] intolerant) and [[statins]].		*The optimal approach to prevention of [[SCD]] following [[ST-elevation MI]] ([[STEMI]]) has been evaluated in multiple randomized trials. In general, [[post-STEMI]] [[patients ]]should be treated with evidence-based therapies that have been associated with a reduction in [[SCD]] including [[beta-blockers]], [[ACE-inhibitors]] (or [[ARB]]s in [[patients]] who are [[ACEI]] intolerant) and [[statins]].
	*In [[patients]] who have symptomatic [[congestive heart failure]] ([[CHF]]), an [[aldosterone antagonist]] may be a reasonable additional therapy. Despite the intuitive benefits of [[antiarrhythmic]], [[amiodarone]] and [[sotalol]] have not been shown to reduce all-cause [[mortality]] following [[STEMI]], although [[amiodarone]] may be useful in reducing the frequency of [[shocks]] in [[patients]] with [[ICD]]s who have unacceptably high rates of [[shock]].		*In [[patients]] who have symptomatic [[congestive heart failure]] ([[CHF]]), an [[aldosterone antagonist]] may be a reasonable additional therapy. Despite the intuitive benefits of [[antiarrhythmic]], [[amiodarone]] and [[sotalol]] have not been shown to reduce all-cause [[mortality]] following [[STEMI]], although [[amiodarone]] may be useful in reducing the frequency of [[shocks]] in [[patients]] with [[ICD]]s who have unacceptably high rates of [[shock]].
	*In general terms, [[ICD placement]] is indicated in those [[patients]] with a reduced [[left ventricular]] [[ejection fraction]] at 40 days [[post-MI]] and/or 3 months following [[revascularization]] ([[PCI]] or [[CABG]]) for [[STEMI]] given the survival benefits in this population.		*In general terms, [[ICD placement]] is indicated in those [[patients]] with a reduced [[left ventricular]] [[ejection fraction]] at 40 days [[post-MI]] and/or 3 months following [[revascularization]] ([[PCI]] or [[CABG]]) for [[STEMI]] given the survival benefits in this population.
			*In absence of noncardiac or reversible causes, an implantable cardioverter-defibrillator (ICD) is recommended because of the high risk of recurrent lethal ventricular arrhythmias. Adjunctive therapy (eg, amiodarone, catheter ablation) and lifestyle modifications for certain genetic arrhythmia syndromes may reduce ventricular arrhythmia recurrence after ICD placement.

	== Prevention ==		== Prevention ==

Sudden cardiac death definitions and diagnosis

2026-03-29T00:12:06Z

Definitions and Diagnosis

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	==Definitions and Diagnosis==		==Definitions and Diagnosis==

			* The case definitions of sudden cardiac death vary based on the use of death certificates,<ref>GillumRF.Sudden coronary death in the United States: 1980-1985. Circulation. 1989;79(4):756-765. doi:10.1161/01.CIR.79.4.756</ref> <ref>Escobedo LG, Zack MM. Comparison of sudden and nonsudden coronary deaths in the United States. Circulation. 1996;93(11):2033-2036. doi:10. 1161/01.CIR.93.11.2033</ref> <ref>Zheng ZJ, Croft JB, Giles WH, Mensah GA. Sudden cardiac death in the United States,1989 to 1998. Circulation. 2001;104(18):2158-2163. doi:10.1161/hc4301.098254</ref> <ref name=":0">Kitamura T, Iwami T, Nichol G, et al; Utstein OsakaProject. Reduction in incidence and fatality of out-of-hospital cardiac arrest in females of the reproductive age. Eur Heart J. 2010;31(11):1365-1372. doi:10.1093/eurheartj/ehq059</ref> reviews of EMS<ref name=":0" /> or hospital records<ref>Escobedo LG,Zack MM.Comparison of sudden and nonsudden coronary deaths in the United States. Circulation. 1996;93(11):2033-2036. doi:10. 1161/01.CIR.93.11.2033</ref>,<ref>Nichol G,Rumsfeld J,Eigel B,et al; American Heart Association Emergency Cardiovascular Care Committee;American Heart Association Council on Cardiopulmonary, Perioperative, and Critical Care; American Heart Association Council on Cardiovascular Nursing; American Heart Association Council on Clinical Cardiology; Quality of Care and Outcomes Research Interdisciplinary Working Group.Essential features of designating out-of-hospital cardiac arrest as a reportable event: a scientific statement from the American Heart Association Emergency Cardiovascular Care Committee;Council on Cardiopulmonary, Perioperative, and Critical Care; Council on Cardiovascular Nursing; Council on Clinical Cardiology; and Quality of Care and Outcomes ResearchInterdisciplinary Working Group. Circulation. 2008;117(17):2299-2308. doi:10.1161/ CIRCULATIONAHA.107.189472</ref> <ref>Bonny A,Tibazarwa K,Mbouh S,et al; Pan African Society of Cardiology (PASCAR) Task Force on Sudden Cardiac Death.Epidemiology of sudden cardiac death in Cameroon:the first population-based cohort survey in sub-Saharan Africa. Int J Epidemiol. 2017;46(4):1230-1238. doi:10.1093/ije/dyx043</ref><ref>Meyer L,Stubbs B,Fahrenbruch C,et al. Incidence, causes, and survival trends from cardiovascular-related sudden cardiac arrest in children and young adults 0to35 years of age: a30-year review. Circulation. 2012;126(11):1363-1372. doi:10.1161/CIRCULATIONAHA.111.076810</ref><ref>Zhang J,Zhou X,Xing Q,et al.Epidemiological investigation of sudden cardiac death in multiethnic Xinjiang Uyghur autonomous region in Northwest China. BMC Public Health. 2019;19(1):116. doi:10. 1186/s12889-019-6435-8</ref> or whether the cases met the criteria of epidemiological definitions (eg, World Health Organization),<ref>Sudden cardiac death.Report of a WHO scientific group. World Health Organ Tech Rep Ser. 1985;726:5-25.</ref>society definitions (eg, Cardiac Arrest Registry to EnhanceSurvival [CARES]),<ref>McNally B, Stokes A, Crouch A, Kellermann AL, Group CS; CARESSurveillanceGroup. CARES: Cardiac Arrest Registry to Enhance Survival. Ann Emerg Med. 2009;54(5):674-683.e2.doi:10.1016/j. annemergmed.2009.03.018</ref> outcomes of clinical trials,<ref>Chatterjee NA,Moorthy MV,Pester J,et al; PRE-DETERMINE Study Group.Sudden death in patients with coronary heart disease without severe systolic dysfunction. JAMA Cardiol. 2018;3 (7):591-600. doi:10.1001/jamacardio.2018.1049</ref><ref>Olgin JE, Pletcher MJ, Vittinghoff E, et al; VEST Investigators. Wearable cardioverter-defibrillator after myocardial infarction. N Engl J Med. 2018;379 (13):1205-1215. doi:10.1056/NEJMoa1800781</ref> or the definition required in pathology-based studies.<ref>Tseng ZH,Olgin JE,Vittinghoff E, et al. Prospective countywide surveillance and autopsy characterization of sudden cardiac death: POST SCD study.Circulation. 2018;137(25):2689-2700. doi:10.1161/CIRCULATIONAHA.117.033427</ref><ref>Wu Q, Zhang L, Zheng J,et al.Forensic pathological study of 1656 cases of sudden cardiac death in southern China. Medicine (Baltimore). 2016;95(5):e2707. doi:10.1097/MD.0000000000002707</ref><ref>Bagnall RD,Weintraub RG,Ingles J,et al. A prospective study of sudden cardiac death among children and young adults. NEnglJMed.2016;374 (25):2441-2452. doi:10.1056/NEJMoa1510687</ref>
			* Sudden cardiac death is typically presumed to be of cardiac etiology because most individuals who died from sudden cardiac death do not have autopsies to confirm the underlying cause.<ref>Marijon E,Narayanan K,Smith K,et al.The Lancet Commission to reduce the global burden of sudden cardiac death: a call for multidisciplinary action. Lancet. 2023;402(10405):883-936. doi:10.1016/S0140-6736(23)00875-9</ref>
			* A person resuscitated from an out-of-hospital cardiac arrest to hospitalization is classified as having resuscitated out-of-hospital cardiac arrest,regardless of subsequent in-hospital death or survival to discharge, the latter of whom are sudden cardiac arrest survivors.

	*The [[diagnosis]] of [[SCA]] is made when the following [[diagnostic criteria]] are satisfied:		*The [[diagnosis]] of [[SCA]] is made when the following [[diagnostic criteria]] are satisfied:

Industrial and organizational psychology

2026-03-28T17:39:31Z

Workforce well-being

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	Workforce wellbeing has been described as a combination states, "job satisfaction, work engagement, and lower burnout"<ref name="BroeckVansteenkisteWitte2010">{{cite journal \| last1 = Broeck \| first1 = Anja \| last2 = Vansteenkiste \| first2 = Maarten \| last3 = Witte \| first3 = Hans \| last4 = Soenens \| first4 = Bart \| last5 = Lens \| first5 = Willy \| title = Capturing autonomy, competence, and relatedness at work: Construction and initial validation of the Work-related Basic Need Satisfaction scale \| journal = Journal of Occupational and Organizational Psychology \| date = December 2010 \| volume = 83 \| issue = 4 \| pages = 981–1002 \| issn = 0963-1798 \| doi = 10.1348/096317909X481382 \| pmid = \| url = }}</ref>.		Workforce wellbeing has been described as a combination states, "job satisfaction, work engagement, and lower burnout"<ref name="BroeckVansteenkisteWitte2010">{{cite journal \| last1 = Broeck \| first1 = Anja \| last2 = Vansteenkiste \| first2 = Maarten \| last3 = Witte \| first3 = Hans \| last4 = Soenens \| first4 = Bart \| last5 = Lens \| first5 = Willy \| title = Capturing autonomy, competence, and relatedness at work: Construction and initial validation of the Work-related Basic Need Satisfaction scale \| journal = Journal of Occupational and Organizational Psychology \| date = December 2010 \| volume = 83 \| issue = 4 \| pages = 981–1002 \| issn = 0963-1798 \| doi = 10.1348/096317909X481382 \| pmid = \| url = }}</ref>.

			* [[Well-being\|Well-being]]
	* [[Flourishing(psychology)\|Flourishing]]		* [[Flourishing(psychology)\|Flourishing]]
	* [[Thriving (psychology)\|Thriving]]		* [[Thriving (psychology)\|Thriving]]
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	Outcomes of these states are discussed in the separate "Outcomes" section below this.		Outcomes of these states are discussed in the separate "Outcomes" section below this.

			===Workforce well-being ===
			The National Academies in 2019 and 2024 defined Professional well-being is a “function of being satisfied with one’s job, finding meaning in work, feeling engaged at work, having a high-quality working life, and finding professional fulfillment in work."<ref name = "NA2019">{{cite book \| vauthors=Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being, National Academy of Medicine, National Academies of Sciences, Engineering, and Medicine \| date=2 December 2019 \| title=Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being \| publisher=National Academies Press \| url=https://www.nationalacademies.org/publications/25521 \| doi=10.17226/25521 \| isbn=978-0-309-49547-9}}</ref><ref name="NA2024">{{cite book \| vauthors=Action Collaborative on Clinician Well-Being and Resilience, National Academy of Medicine \| veditors=((Dzau, V. J.)), ((Kirch, D.)), ((Murthy, V.)), ((Nasca, T.)) \| date=28 February 2024 \| title=National Plan for Health Workforce Well-Being \| publisher=National Academies Press \| url=https://www.nationalacademies.org/publications/26744 \| doi=10.17226/26744 \| isbn=978-0-309-69467-4}}
			</ref>

			Earlier, in 1999, Danna summarized literature to date but did not synthesize a final definition<ref name="i345">{{cite journal \| last1=Danna \| first1=Karen \| last2=Griffin \| first2=Ricky W. \| title=Health and Well-Being in the Workplace: A Review and Synthesis of the Literature \| journal=Journal of Management \| volume=25 \| issue=3 \| date=1999 \| issn=0149-2063 \| doi=10.1177/014920639902500305 \| pages=357–384 \| url=https://journals.sagepub.com/doi/10.1177/014920639902500305 \| access-date=2026-03-28}}</ref>

	===Flourishing===		===Flourishing===

Malaria prevention

2026-03-15T20:31:00Z

Challenges against preventive measures

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	**Spraying insecticides inside houses		**Spraying insecticides inside houses
	**Draining standing water where mosquitoes lay their eggs		**Draining standing water where mosquitoes lay their eggs


			===Challenges against preventive measures===
			*Vector Control:
			Mosquitos are developing resistance to insecticides particularly the pyrethroid compounds and this is very prevalent in Sub-Saharan Africa.resistance to pyrethroids, organochlorines ,carbamates and organophosphate compounds is well known in many regions.
			To overcome this obstacle the use of bed nets treated with multiple chemical compounds is recommended in areas with known resistance.
			Furthermore it is identified that there is a shift in the feeding behaviours of the vectors which poses a challenge by reducing the efficacy of indoor residual spraying and insecticide-treated bed nets.
			Lack of effective strategy that targets biting mosquitoes is another challenge.

			*Human and Zoonotic reservoirs:
			One of the biggest challenges to malaria control and prevention programs is asymptomatic infection as this serves as a major reservoir for ongoing transmission.The use of mass drug administration to eliminate the reservoir of infection in humans can be considered in regions in which malaria is endemic but the reduction in transmission is not sustained when the mass drug administration is discontinued.
			P.Knowlesi has zoonotic reservoirs which presents challenges of its own that require new control interventions to achieve eradication.

	==Policy Implementation and Access to Anti-Malarial Drugs in Developing Countries==		==Policy Implementation and Access to Anti-Malarial Drugs in Developing Countries==

Mitral regurgitation natural history

2026-03-14T06:10:40Z

Overview

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	==Overview==		==Overview==
	The natural history of mitral regurgitation (MR) may follow one of two patterns, acute or chronic. Chronic MR can be either compensated or decompensated. The natural history and prognosis of MR depend on the underlying etiology and the degree of severity of the valvular abnormality. Mild MR is associated with few if any complications. However, when severe, MR may lead to development of [[pulmonary edema]], [[pulmonary hypertension]], and [[right heart failure]].		Mitral regurgitation results in chronic volume overload of the left ventricle, leading initially to compensatory eccentric hypertrophy and ventricular dilation that maintain forward stroke volume<ref name=":0">Gaasch WH, Meyer TE. Left ventricular response to mitral regurgitation: implications for management. Circulation. 2008 Nov 25;118(22):2298-303. [https://pubmed.ncbi.nlm.nih.gov/19029478/ doi: 10.1161/CIRCULATIONAHA.107.755942.] PMID: 19029478.</ref> The natural history of mitral regurgitation (MR) may follow one of two patterns, acute or chronic. Chronic MR can be either compensated or decompensated. The natural history and prognosis of MR depend on the underlying etiology and the degree of severity of the valvular abnormality. Mild MR is associated with few if any complications. However, when severe, MR may lead to development of [[pulmonary edema]], [[pulmonary hypertension]], and [[right heart failure]].

	==Natural History==		==Natural History==
	The natural history of MR may follow one of two patterns, acute or chronic. In acute MR, the volume and pressure overload in the left atrium is transmitted backward into the pulmonary vasculature leading to sudden onset of [[dyspnea]], [[PND]], [[orthopnea]] and [[rales]]. Chronic MR can be either compensated or decompensated. During the chronic compensated phase of MR, ~~compensatory changes in~~ the [[left ventricle]] and [[left atrium]] maintain ~~the~~ forward cardiac output ~~of the left ventricle, and minimize the signs~~ and ~~symptoms of~~ pulmonary congestion ~~that occur in the acute phase of the disease~~. ~~Individuals in the chronic compensated phase may be~~ asymptomatic ~~and have~~ normal exercise tolerance~~. An individual~~ may ~~remain in the compensated phase of mitral regurgitation~~ for years, ~~but will eventually develop~~ left ventricular dysfunction, ~~the hallmark for~~ the chronic decompensated phase of mitral regurgitation. Once the patient transitions into the decompensated phase, there may not be recovery of left ventricular funtion following operative repair or replacement of the [[mitral valve]]. The decompensated stage is defined on the basis of a decompensated ventricular function. At this stage, the patients are at risk for a poor results of valve replacement.		The natural history of MR may follow one of two patterns, acute or chronic. In acute MR, the volume and pressure overload in the left atrium is transmitted backward into the pulmonary vasculature leading to sudden onset of [[dyspnea]], [[PND]], [[orthopnea]] and [[rales]].Chronic mitral regurgitation produces increased left ventricular preload and reduced afterload, resulting in a compliant dilated ventricle with increased end-diastolic volume and stroke volume<ref name=":0" />. Chronic MR can be either compensated or decompensated.During the chronic compensated phase of mitral regurgitation, adaptive enlargement of the left ventricle and left atrium helps maintain forward cardiac output and reduces pulmonary congestion. Patients are often asymptomatic with normal exercise tolerance, and this phase may persist for many years. Left ventricular dilation with eccentric hypertrophy preserves systolic function, and the left ventricular ejection fraction typically remains >60%<ref name=":0" />. Over time, however, progressive ventricular dysfunction may develop, marking transition to the chronic decompensated phase of mitral regurgitation. Once the patient transitions into the decompensated phase, there may not be recovery of left ventricular funtion following operative repair or replacement of the [[mitral valve]]. The decompensated stage is defined on the basis of a decompensated ventricular function. At this stage, the patients are at risk for a poor results of valve replacement. Recognition of mitral regurgitation prior to the onset of myocardial dysfunction is critical because irreversible myocardial injury may occur before the development of symptoms<ref name=":0" />.

	==Complications==		==Complications==
	~~Mild MR is associated with few if any~~ complications. ~~However~~, ~~when severe~~, MR may lead to ~~development~~ of (~~in alphabetical order~~):		Chronic volume overload in mitral regurgitation leads to structural remodeling of the left ventricle and left atrium, predisposing patients to complications such as atrial fibrillation, pulmonary hypertension, and right-sided heart dysfunction<ref name=":0" />. Persistent left atrial volume overload results in left atrial enlargement and atrial fibrosis, which increases the risk of atrial fibrillation<ref>Eguchi K, Ohtaki E, Matsumura T, Tanaka K, Tohbaru T, Iguchi N, Misu K, Asano R, Nagayama M, Sumiyoshi T, Kasegawa H, Hosoda S. Pre-operative atrial fibrillation as the key determinant of outcome of mitral valve repair for degenerative mitral regurgitation. Eur Heart J. 2005 Sep;26(18):1866-72. [https://pubmed.ncbi.nlm.nih.gov/15845559/ doi: 10.1093/eurheartj/ehi272.] Epub 2005 Apr 21. PMID: 15845559.</ref>. In addition, elevated left atrial pressures may lead to pulmonary hypertension, which can progressively contribute to right ventricular dysfunction<ref>Barbieri A, Bursi F, Grigioni F, Tribouilloy C, Avierinos JF, Michelena HI, Rusinaru D, Szymansky C, Russo A, Suri R, Bacchi Reggiani ML, Branzi A, Modena MG, Enriquez-Sarano M; Mitral Regurgitation International DAtabase (MIDA) Investigators. Prognostic and therapeutic implications of pulmonary hypertension complicating degenerative mitral regurgitation due to flail leaflet: a multicenter long-term international study. Eur Heart J. 2011 Mar;32(6):751-9. [https://pubmed.ncbi.nlm.nih.gov/20829213/ doi: 10.1093/eurheartj/ehq294]. Epub 2010 Sep 8. PMID: 20829213.</ref>.
	*[[Atrial fibrillation]]
	*[[Cardiogenic Shock]]
	*[[Endocarditis]]
	*[[Pulmonary edema]]
	*[[Pulmonary hypertension]]
	*[[Right heart failure]]
	*[[Thromboembolism]]-[~~[Stroke]~~]

	==Prognosis==		==Prognosis==