Sudden cardiac death causes

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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]

Overview

Sudden cardiac arrest may be caused by coronary artery abnormality such as coronary atherosclerosis, acute MI, coronary artery embolism, coronary arteritis , hypertrophy of myocardium such as HCM, hypertensive heart disease, primary or secondary pulmonary hypertension , myocardial disease such as ischemic cardiomyopathy, non-ischemic cardiomyopathy, myocarditis ,valvular heart disease such as aortic stenosis, aortic insufficiency, mitral valve prolapse, endocarditis , congenital heart disease such as congenital septal defect with eisenmenger physiology , abnormality in conducting system such as Wolf-Parkinson-White syndrome , electrical instability such as (CPVT, LQTS)

Causes

Sudden cardiac arrest may be caused by :


Multiplication table
Differentaitindg diagnosis of sudden cardiac death Coronary Artery Disease Ideopathic dilated cardiomyopathy Hypertrophic cardiomyopathy Arrhythmogenic right ventricular cardiomyopathy Valvular Heart Disease Congenital Heart Disease Long QT syndrome WPW syndrome Ideopathic monomorphic VT Ideopathic polymorphic VT Primary VF Sudden unexpected nocturnal death Drugs]]
Incidence of SCD Atherosclirosis: 80% 10% 2-4% per year in adult, 4-6% in children and adolescence 2% 20% of post operative death after valvular replacement 1/1000 patient-year follow- up Rare
Mechanism Atherosclerosis in coronary arteries: 3 vessels disease in 40-86% patients with stenosis > 75%, MI < 50%, Qwave MI < 25%, recent coronary thrombosis 15-64% (plaque, fissure, hemorrhage, thrombosis), healed infarct>50% in autopsy or survivors of SCD, Non atherosclerotic changes including coronary emboli, coronary arthritis, coronary dissection in few cases Myocardial stretch, neuroendocrine factors, electrolyte abnormality, proarrhythmic effect of antiarrhythmic drugs, excessive activation of sympathetic and renin angiotensin system Arrhythmia, abrupt hemodynamic deterioration, ischemia Fatty and fibrofaty myocardial infiltration, patchy myocarditis, apoptosis of left ventricle, left ventricular septum (50-67%), right ventricular inflow, outflow tract and apex( triangle of dysplasia) Arrhythmia, prosthetic valve dysfunction,Coexisting CAD Tetralogy of fallot, Transposition of the great arteries, Aortic stenosis, Pulmonary vascular obstruction. SCD is late presentation after surgical repair of complex congenital heart disease Prolongation of repolarization, early after depolarization In 10% of patients, SCD is first presentation. development of AF rapid conduction to the ventricle through accessory pathway caused VF Normal heart structure, Originated from RV outflow tract (more common), or LV outflow tract. SCD is rare Initiation of arrhythmia with coupled premature complex,SCD is more common than monomorphic VT, sporadic or familiar
Risk factors of SCD Frequent episodes of non sustain VT, syncope Family history of SCD, recurrent syncope, sustained VT, history of SCA, massive LVH, multiple episodes of non sustained VT Asymptomatic aotric valve disease is low risk for [[SCD].Risk factors of SCD in MVP: myxomatous degeneration of the valve, coexisting mitral regurgitation, LV dysfunction Risk factors of SCD in TOF: QRS prolongation, dilated RV Incidence of cardiac event in LQTS1, LQTS2> LQTS3 Lethality of cardiac event in LQTS3>LQTS1,LQTS2 Predictors of VF: AF with shortest interval between ventricle beats less than 250 msec Cathecolamine release after stressful emotional or physical event
Arrhythmia VT, VF (75%), bradycardia, asystole(25%) Mechanism of VT: bundle branch reentry tachycardia, terminal event: asystole, [[electromechanical dissociation in advanced LV dysfunction 9 ECG in normal sinus rhythm:inverted T waves in V1-V3, complete, incomplete RBBB, epsilone wave ( terminal notch on QRS complex), VT is LBBB contour Arrhythmia:Torsadepoints, Normal ECG findings: abnormal Twaves contour, Twaves alternance, sinus bradycardia RV outflow tract VT is LBBB contour, inferior axis, Termination with vagal maneuver such as adenosine. LVOT VT or fasciculated VT is RBBB contour with left axis deviation, originated from left posterior septum, Termination with calcium channel blocker SCD in the presence of polymorphic VT and normal LV function without torsadepoints, Termination of cathecolaminergic polymorphic VT (CPVT) with betablocker, No response to betablocker in the presence of ideopathic VF or short coupled of torsadepoints






  • Causes of acquired Long QT syndrome include the following:




Causes of Sudden Death Including Sudden Cardiac Death by Organ System

Cardiovascular

Amyloid cardiopathy, Congestive heart failure, Ventricular rupture,

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

  • Pericardial

Cardiac tamponade,

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 aortic stenosis/insufficiency, Mitral valve disruption, Endocarditis, Prosthetic valve dysfunction,

Arrhythmogenic right ventricular cardiomyopathy, Arrhythmogenic right ventricular dysplasia, Brugada syndrome, 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,

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 aortic or pulmonary valve stenosis, Congenital septal defect with eisenmenger physiology, Congenital heart block , Congenital Long QT syndrome, Noncompaction Cardiomyopathy, Sudden Infant Death Syndrome, Uhl anomaly

Snake bite

No underlying causes
  • Drug Side Effect
Agalsidase beta, Articaine, caspofungin acetate, Clozapine, cytomegalovirus immune globulin, Drug allergy, drug overdose, Dornase Alfa, ferumoxytol, Flucytosine, galsulfase, Iodixanol, laronidase, Lincomycin Hydrochloride, Polidocanol, Potassium bicarbonate, pramipexole, prednisolone, Ramucirumab, Calcium gluconate, Dextran, Tiagabine
No underlying causes

Diabetic ketoacidosis - typically from undiagnosed diabetes, Thyrotoxicosis,

  • Environmental
Hypothermia,
  • Gastroenterologic

Appendicitis, Gastrointestinal bleeding, Retroperitoneal bleed,

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

No underlying causes
  • Iatrogenic
Transfusion reaction

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

No underlying causes

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

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

Amniotic fluid syndrome , Childbirth hemorrhage,

Atrial myxoma, familial

No underlying causes
  • Overdose / Toxicity

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

No underlying causes

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

Hypercalcemia, Hypokalemia, Hyperkalemia,

Amyloidosis, Anaphylaxis, Myasthenia gravis, Sarcoidosis,

No underlying causes

Commotio cordis, Homicide, Motor Vehicle accident

No underlying causes
  • Miscellaneous

Shock, Asphyxia, Insect bite Sepsis syndrome, Shock

Differentiating sudden cardiac death from non-cardiac causes

Cardiac causes of sudden death

Non cardiac causes of sudden death:

References

  1. Mehta, Davendra; Curwin, Jay; Gomes, J. Anthony; Fuster, Valentin (1997). "Sudden Death in Coronary Artery Disease". Circulation. 96 (9): 3215–3223. doi:10.1161/01.CIR.96.9.3215. ISSN 0009-7322.
  2. Eisenberg MS, Mengert TJ (2001). "Cardiac resuscitation". N. Engl. J. Med. 344 (17): 1304–13. PMID 11320390. Unknown parameter |month= ignored (help)
  3. . doi:10.1080/2F20961790.2019.1595352. Missing or empty |title= (help)
  4. 4.0 4.1 Basso, Cristina; Perazzolo Marra, Martina; Rizzo, Stefania; De Lazzari, Manuel; Giorgi, Benedetta; Cipriani, Alberto; Frigo, Anna Chiara; Rigato, Ilaria; Migliore, Federico; Pilichou, Kalliopi; Bertaglia, Emanuele; Cacciavillani, Luisa; Bauce, Barbara; Corrado, Domenico; Thiene, Gaetano; Iliceto, Sabino (2015). "Arrhythmic Mitral Valve Prolapse and Sudden Cardiac Death". Circulation. 132 (7): 556–566. doi:10.1161/CIRCULATIONAHA.115.016291. ISSN 0009-7322.
  5. Yap, Sing-Chien; Harris, Louise (2014). "Sudden cardiac death in adults with congenital heart disease". Expert Review of Cardiovascular Therapy. 7 (12): 1605–1620. doi:10.1586/erc.09.153. ISSN 1477-9072.

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