Sudden cardiac death diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Edzel Lorraine Co, DMD, MD[3] Nehal Eid, M.D.[4]
Overview
Clinicians evaluating persons hospitalized after resuscitation from out-of-hospital cardiac arrest should review documented cardiac rhythm from EMS records and the circumstances of arrest, including witness accounts. They should obtain a family history of heart disease for at least 3 generations, syncope, sudden cardiac arrest, or sudden cardiac death and should evaluate for use of QT-prolonging medications, substance use (eg, cocaine, methamphetamine, or ketamine), and supplements (eg, kratom, tianeptine).[1],[2],[3]
In resuscitated sudden cardiac arrest individuals, an emergency workup should be performed, it includes:
- 12-lead electrocardiogram (ECG)
- Toxicology testing
- Bedside neurological assessment
- Neuroimaging (eg, head computed tomography [CT]) after the patient has stabilized.
According to the 2017 Association for European Cardiovascular Pathologists guidelines, autopsy is done whenever sudden cardiac death (SCD) is suspected.
Diagnosis Study Of Choice
- Persons resuscitated from sudden cardiac arrest should undergo evaluation with a basic metabolic profile and serum troponin; urine toxicology test; electrocardiogram; chest x-ray; head-to-pelvis computed tomography; and bedside ultrasound to assess for pericardial tamponade, aortic dissection, or hemorrhage.[4]
- If intial evaluation failed to reveal the arrest cause, we should check for structural heart disease (eg, unsuspected cardiomyopathy) or valvular disease (eg, mitral valve prolapse) that can precipitate sudden cardiac death using transthoracic echocardiography.[4]
- According to the 2017 Association for European Cardiovascular Pathologists guidelines, autopsy is done whenever sudden cardiac death (SCD) is suspected.
- Autopsy investigates whether:
- The mechanism of deathwas of mechanical or arrhythmic in nature
- The cause of SCD is of hereditary in origin requiring the need for screening and counseling for the next generations
- Third person involvement was present [5] [6]
References
- ↑ Shah SA, Szeto AH, Farewell R, et al.Impact of high volume energy drink consumptionon electrocardiographic and blood pressure parameters: a randomized trial. J AmHeartAssoc. 2019;8(11):e011318. doi:10.1161/JAHA.118.011318
- ↑ Post S, Spiller HA, Chounthirath T, Smith GA. Kratom exposures reported to United States poison control centers: 2011-2017. Clin Toxicol (Phila). 2019;57(10):847-854. doi:10.1080/15563650.2019. 1569236
- ↑ Counts CJ, Spadaro AV, Cerbini TA, et al.Notes from the Field: Cluster of severe illness from Neptune’s fix tianeptine linked to synthetic cannabinoids—New Jersey, June-November2023. MMWR Morb Mortal Wkly Rep.2024;73(4):89-90. doi:10.15585/mmwr.mm7304a5
- ↑ 4.0 4.1 Tseng ZH, Nakasuka K. Out-of-Hospital Cardiac Arrest in Apparently Healthy, Young Adults. JAMA. 2025;333(11):981–996. doi:10.1001/jama.2024.27916
- ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID 10.1007/s00428-017-2221-0. doi: 10.1007/s00428-017-2221-0. Check
|pmid=value (help). - ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID 10.1007/s00428-007-0505-5 doi: 10.1007/s00428-007-0505-5 Check
|pmid=value (help).