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{{SI}}
{{Sudden cardiac death}}
{{CMG}} {{AE}} {{Sara.Zand}} {{EdzelCo}}
==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]].


{{CMG}}
==Definitions and Diagnosis==


==Cardiac Arrest: Diagnosis==
Cardiac Arrest is an abrupt cessation of pump function (evidenced by absence of a palpable pulse) of the heart that with prompt intervention could be reversed, but without it will lead to death.<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>


Due to inadequate cerebral perfusion, the patient will be [[unconscious]] and will have stopped [[breath]]ing. The main diagnostic criterion to diagnose a cardiac arrest (as opposed to [[respiratory arrest]], which shares many of the same features) is lack of [[circulation]], however there are a number of ways of determining this.
*The [[diagnosis]] of [[SCA]] is made when the following [[diagnostic criteria]] are satisfied:
:*Absence of a [[palpable pulse]] of the [[heart]] due to cessation of pumping function whether with prompt intervention will be reversible <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>
:*Absent [[carotid pulse]]<ref>Flesche CW, Breuer S, Mandel LP, Breivik H, Tarnow J. (1994) The ability of health professionals to check the carotid pulse. ''Circulation'' Vol. 90: I–288.</ref><ref name="pmid9715777">{{cite journal |author=Ochoa FJ, Ramalle-Gómara E, Carpintero JM, García A, Saralegui I |title=Competence of health professionals to check the carotid pulse |journal=Resuscitation |volume=37 |issue=3 |pages=173–5 |year=1998 |month=June |pmid=9715777 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0300957298000550}}</ref><ref name="pmid9259056">{{cite journal |author=Bahr J, Klingler H, Panzer W, Rode H, Kettler D |title=Skills of lay people in checking the carotid pulse |journal=Resuscitation |volume=35 |issue=1 |pages=23–6 |year=1997 |month=August |pmid=9259056 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0300957296010921}}</ref><ref name="pmid16314375">{{cite journal |author= |title=2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care |journal=Circulation |volume=112 |issue=24 Suppl |pages=IV1–203 |year=2005 |month=December |pmid=16314375 |doi=10.1161/CIRCULATIONAHA.105.166550 |url=}}</ref>
:*[[Gasping respiration]] or no [[respiration]]
:*Loss of [[consciousness]] due to [[cerebral hypoperfusion]]


In many cases, lack of [[pulse|carotid pulse]] is the [[gold standard (test)|gold standard]] for diagnosing cardiac arrest, but lack of a pulse (particularly in the peripheral pulses) may be a result of other conditions (e.g. [[shock]]), or simply an error on the part of the rescuer. Studies have shown that rescuers often make a mistake when checking the carotid pulse in an emergency, whether they are healthcare professionals<ref>Flesche CW, Breuer S, Mandel LP, Breivik H, Tarnow J. (1994) The ability of health professionals to check the carotid pulse. ''Circulation'' Vol. 90: I–288.</ref><ref name="pmid9715777">{{cite journal |author=Ochoa FJ, Ramalle-Gómara E, Carpintero JM, García A, Saralegui I |title=Competence of health professionals to check the carotid pulse |journal=Resuscitation |volume=37 |issue=3 |pages=173–5 |year=1998 |month=June |pmid=9715777 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0300957298000550}}</ref> or lay persons.<ref name="pmid9259056">{{cite journal |author=Bahr J, Klingler H, Panzer W, Rode H, Kettler D |title=Skills of lay people in checking the carotid pulse |journal=Resuscitation |volume=35 |issue=1 |pages=23–6 |year=1997 |month=August |pmid=9259056 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0300957296010921}}</ref>
{| style="border: 2px solid #4479BA; align="left"
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Components}}
! 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>


Owing to the inaccuracy in this method of diagnosis, some bodies such as the European Resuscitation Council (ERC) have de-emphasised its importance. The Resuscitation Council (UK), in line with the ERC's recommendations and those of the American Heart Association,<ref name="pmid16314375">{{cite journal |author= |title=2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care |journal=Circulation |volume=112 |issue=24 Suppl |pages=IV1–203 |year=2005 |month=December |pmid=16314375 |doi=10.1161/CIRCULATIONAHA.105.166550 |url=}}</ref> have suggested that the technique should be used only by healthcare professionals with specific training and expertise, and even then that it should be viewed in conjunction with other indicators such as [[agonal respiration]].<ref name="RCUK2005">Resuscitation Council UK (2005). ''Resuscitation Guidelines 2005'' London: Resuscitation Council UK.</ref>
: [[Palpitations]], [[lightheadedness]], [[syncope]], [[dyspnea]], [[chest pain]], [[cardiac arrest]]
* Symptoms related to underlying [[heart disease]]: [[Dyspnea]] at rest or on exertion, [[orthopnea]], [[paroxysmal nocturnal dyspnea]], [[chest pain]], [[edema]]
* Precipitating factors: [[Exercise]], [[emotional stress]]
|-
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | Past medical history
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" |  
* [[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]]
|-


Various other methods for detecting circulation have been proposed. Guidelines following the 2000 International Liaison Committee on Resusciation (ILCOR) recommendations were for rescuers to look for "signs of circulation", but not specifically the pulse <ref name="pmid16314375">{{cite journal |author= |title=2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care |journal=Circulation |volume=112 |issue=24 Suppl |pages=IV1–203 |year=2005 |month=December |pmid=16314375 |doi=10.1161/CIRCULATIONAHA.105.166550 |url=}}</ref>. These signs included coughing, gasping, colour, twitching and movement.<ref> St John Ambulance, St Andrew's Ambulance Association, British Red Cross (2002) (8th Ed.) ''First Aid Manual''. London: Dorling Kindersley </ref> However, in face of evidence that these guidelines were ineffective, the current recommendation of ILCOR is that cardiac arrest should be diagnosed in all casualties who are unconscious and not breathing normally.<ref name="pmid16314375">{{cite journal |author= |title=2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care |journal=Circulation |volume=112 |issue=24 Suppl |pages=IV1–203 |year=2005 |month=December |pmid=16314375 |doi=10.1161/CIRCULATIONAHA.105.166550 |url=}}</ref>
|}


Following initial diagnosis of cardiac arrest, healthcare professionals further categorise the diagnosis based on the [[Electrocardiogram|ECG/EKG]] rhythm. There are 4 rhythms which result in a cardiac arrest. [[Ventricular fibrillation]] (VF/VFib) and Pulseless [[Ventricular tachycardia]] (VT) are both responsive to a [[defibrillator]] and so are colloquially referred to as "Shockable" rhythms, whereas [[Asystole]] and [[Pulseless electrical activity|Pulseless Electrical Activity]] (PEA) are non-shockable. The nature of the presenting hearth rhythm suggests different causes and treatment, and is used to guide the rescuer as to what treatment may be appropriate<ref name="RCUK2005">Resuscitation Council UK (2005). ''Resuscitation Guidelines 2005'' London: Resuscitation Council UK.</ref> (see [[Advanced Life Support]] and [[Advanced Cardiac Life Support]], as well as the causes of arrest (below))
*Following an initial [[diagnosis]] of [[cardiac arrest]], [[healthcare professionals]] further categorize the [[diagnosis]] based on the [[ECG]] [[rhythm]].
*There are 4 [[rhythm]]s that result in a [[cardiac arrest]]. [[Ventricular fibrillation]] ([[VF]]) and [[Pulseless]] [[Ventricular tachycardia]] ([[VTach]]) are both responsive to a [[defibrillator]] and so are colloquially referred to as [[Shockable]] [[rhythm]]s, whereas [[Asystole]] and [[Pulseless electrical activity|Pulseless Electrical Activity]] ([[PEA]]) are non-shockable.  
*The nature of the presenting [[heart]] [[rhythm]] suggests different causes and [[treatment]] and is used to guide the rescuer as to what treatment may be appropriate<ref name="RCUK2005">Resuscitation Council UK (2005). ''Resuscitation Guidelines 2005'' London: Resuscitation Council UK.</ref> (see [[Advanced Life Support]] and [[Advanced Cardiac Life Support]], as well as the causes of arrest (below))
*The table below provides information on the differential diagnosis of [[sudden cardiac death]] in terms of [[ECG]] appearance:
 
{| border="3"
|+
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Disease Name}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Causes}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| ECG Characteristics}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| ECG view}}
|-
! style="padding: 5px 5px; background: #DCDCDC; " align="left"| '''[[Ventricular tachycardia]]''' <ref name="AjijolaTung2014">{{cite journal|last1=Ajijola|first1=Olujimi A.|last2=Tung|first2=Roderick|last3=Shivkumar|first3=Kalyanam|title=Ventricular tachycardia in ischemic heart disease substrates|journal=Indian Heart Journal|volume=66|year=2014|pages=S24–S34|issn=00194832|doi=10.1016/j.ihj.2013.12.039}}</ref><ref name="Meja LopezMalhotra2019">{{cite journal|last1=Meja Lopez|first1=Eliany|last2=Malhotra|first2=Rohit|title=Ventricular Tachycardia in Structural Heart Disease|journal=Journal of Innovations in Cardiac Rhythm Management|volume=10|issue=8|year=2019|pages=3762–3773|issn=21563977|doi=10.19102/icrm.2019.100801}}</ref><ref name="CoughtrieBehr2017">{{cite journal|last1=Coughtrie|first1=Abigail L|last2=Behr|first2=Elijah R|last3=Layton|first3=Deborah|last4=Marshall|first4=Vanessa|last5=Camm|first5=A John|last6=Shakir|first6=Saad A W|title=Drugs and life-threatening ventricular arrhythmia risk: results from the DARE study cohort|journal=BMJ Open|volume=7|issue=10|year=2017|pages=e016627|issn=2044-6055|doi=10.1136/bmjopen-2017-016627}}</ref><ref name="El-Sherif2001">{{cite journal|last1=El-Sherif|first1=Nabil|title=Mechanism of Ventricular Arrhythmias in the Long QT Syndrome: On Hermeneutics|journal=Journal of Cardiovascular Electrophysiology|volume=12|issue=8|year=2001|pages=973–976|issn=1045-3873|doi=10.1046/j.1540-8167.2001.00973.x}}</ref><ref name="de RivaWatanabe2015">{{cite journal|last1=de Riva|first1=Marta|last2=Watanabe|first2=Masaya|last3=Zeppenfeld|first3=Katja|title=Twelve-Lead ECG of Ventricular Tachycardia in Structural Heart Disease|journal=Circulation: Arrhythmia and Electrophysiology|volume=8|issue=4|year=2015|pages=951–962|issn=1941-3149|doi=10.1161/CIRCEP.115.002847}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Ischemic heart disease]]
*Illicit drug use such as [[cocaine]] and [[methamphetamine]]
*[[Structural heart diseases]]
*[[Electrolyte disturbances]]
*[[Congestive heart failure]]
*[[Myocarditis]]
*[[Obstructive sleep apnea]]
*[[Pulmonary artery catheter]]
*[[Long QT syndrome]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Ventricular tachycardia]] ([[VTach]] originates from a [[ventricular]] focus.
* Lasts more than 30 seconds.
* [[Broad QRS complex]]es: rate of >90 BPM.
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
[[File:Capture V tach.PNG|center|300px]]<ref> ECG found in of https://en.ecgpedia.org/index.php?title=Main_Page </ref>
|-
! style="padding: 5px 5px; background: #DCDCDC; " align="left"| '''[[Ventricular fibrillation]]''' <ref name="pmid19252119">{{cite journal |vauthors=Koplan BA, Stevenson WG |title=Ventricular tachycardia and sudden cardiac death |journal=Mayo Clin. Proc. |volume=84 |issue=3 |pages=289–97 |date=March 2009 |pmid=19252119 |pmc=2664600 |doi=10.1016/S0025-6196(11)61149-X |url=}}</ref><ref name="pmid28222965">{{cite journal |vauthors=Maury P, Sacher F, Rollin A, Mondoly P, Duparc A, Zeppenfeld K, Hascoet S |title=Ventricular arrhythmias and sudden death in tetralogy of Fallot |journal=Arch Cardiovasc Dis |volume=110 |issue=5 |pages=354–362 |date=May 2017 |pmid=28222965 |doi=10.1016/j.acvd.2016.12.006 |url=}}</ref><ref name="pmid1638716">{{cite journal |vauthors=Saumarez RC, Camm AJ, Panagos A, Gill JS, Stewart JT, de Belder MA, Simpson IA, McKenna WJ |title=Ventricular fibrillation in hypertrophic cardiomyopathy is associated with increased fractionation of paced right ventricular electrograms |journal=Circulation |volume=86 |issue=2 |pages=467–74 |date=August 1992 |pmid=1638716 |doi=10.1161/01.cir.86.2.467 |url=}}</ref><ref name="BektasSoyuncu2012">{{cite journal|last1=Bektas|first1=Firat|last2=Soyuncu|first2=Secgin|title=Hypokalemia-induced Ventricular Fibrillation|journal=The Journal of Emergency Medicine|volume=42|issue=2|year=2012|pages=184–185|issn=07364679|doi=10.1016/j.jemermed.2010.05.079}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Coronary ischemia|Acute coronary ischemia]]
*[[cardiomyopathy|Cardiomyopathies]]
*[[Congenital heart disease]]
*[[Myocardial infarction]]
*[[Heart surgery]]
*[[Electrolyte abnormalities]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Poorly identifiable [[QRS complexes]] and absent [[P waves]]
* The [[heart rate]] is >300 BPM
*[[Rhythm]] is irregular
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
[[File:Capture VF.PNG|center|300px]]<ref> ECG found in https://en.ecgpedia.org/index.php?title=Main_Page </ref>
|-
! style="padding: 5px 5px; background: #DCDCDC; " align="left"| '''[[Ventricular flutter]]''' <ref name="ThiesBoos2000">{{cite journal|last1=Thies|first1=Karl-Christian|last2=Boos|first2=Karin|last3=Müller-Deile|first3=Kai|last4=Ohrdorf|first4=Wolfgang|last5=Beushausen|first5=Thomas|last6=Townsend|first6=Peter|title=Ventricular flutter in a neonate—severe electrolyte imbalance caused by urinary tract infection in the presence of urinary tract malformation|journal=The Journal of Emergency Medicine|volume=18|issue=1|year=2000|pages=47–50|issn=07364679|doi=10.1016/S0736-4679(99)00161-4}}</ref><ref name="KosterWellens1976">{{cite journal|last1=Koster|first1=Rudolph W.|last2=Wellens|first2=Hein J.J.|title=Quinidine-induced ventricular flutter and fibrillation without digitalis therapy|journal=The American Journal of Cardiology|volume=38|issue=4|year=1976|pages=519–523|issn=00029149|doi=10.1016/0002-9149(76)90471-9}}</ref><ref name="pmid250503">{{cite journal |vauthors=Dhurandhar RW, Nademanee K, Goldman AM |title=Ventricular tachycardia-flutter associated with disopyramide therapy: a report of three cases |journal=Heart Lung |volume=7 |issue=5 |pages=783–7 |date=1978 |pmid=250503 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Electrolyte disturbances]]
*[[Medications]] such as:
**[[Disopyramide]]
**[[Quinidine]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*The [[ECG]] shows:
**A typical [[sinusoidal]] pattern
**Frequency of 300 bpm
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
[[File:Capture Ven Flu.PNG|center|300px]]<ref> ECG found in https://en.ecgpedia.org/index.php?title=Main_Page </ref>
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="left" | '''[[Asystole]]''' <ref name="ACLS_2003_H_T">''ACLS: Principles and Practice''. p. 71-87. Dallas: American Heart Association, 2003. ISBN 0-87493-341-2.</ref><ref name="ACLS_2003_EP_HT">''ACLS for Experienced Providers''. p. 3-5. Dallas: American Heart Association, 2003. ISBN 0-87493-424-9.</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Hypovolemia]]
*[[Hypoxia (medical)|Hypoxia]]
*[[Acidosis]]
*[[Hypothermia|Hypothermia]]
*[[Hyperkalemia|Hyperkalemia]] or [[Hypokalemia|Hypokalemia]]
*[[Hypoglycemia|Hypoglycemia]]
*[[Cardiac tamponade|Cardiac Tamponade]]
*[[Tension pneumothorax|Tension pneumothorax]]
*[[Thrombosis|Thrombosis]]
*[[Myocardial infarction]]
*[[Thrombosis|Thrombosis]]
*[[Pulmonary embolism]]
*[[Cardiogenic shock]]
*Degeneration of the [[sinoatrial]] or [[atrioventricular]] nodes
*[[Ischemic stroke]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* There is no electrical activity in the asystole
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
[[Image:Lead II rhythm generated asystole.JPG|center|300px]]<ref> ECG found in https://en.ecgpedia.org/index.php?title=Main_Page </ref>
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="left" | '''[[Pulseless electrical activity]]''' <ref name="ECC_2005_7.2">"2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Part 7.2: Management of Cardiac Arrest." ''Circulation'' 2005; '''112''': IV-58 - IV-66.</ref><ref>Foster B, Twelve Lead Electrocardiography, 2nd edition, 2007</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Hypovolemia]]
*[[Hypoxia]]
*Hydrogen ions ([[Acidosis]])
*[[Hypothermia]]
*[[Electrolyte disturbances]]
*[[Hypoglycemia]]
*[[Tablets]] or [[Toxins]] (Drug overdose) such as [[beta blockers]], [[tricyclic antidepressants]], or [[calcium channel blockers]]
*[[Tamponade]]
*[[Tension pneumothorax]]
*[[Thrombosis]] ([[Myocardial infarction]])
*[[Thrombosis]] ([[Pulmonary embolism]])
*[[Trauma]] ([[Hypovolemia]] from [[blood loss]])
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Several ppattern are possible including:
**[[Normal sinus rhythm]]
**[[Sinus tachycardia]], with discernible [[P waves]] and [[QRS complexes]]
**[[Bradycardia]], with or without [[P waves]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
[[File:Capture PEA.PNG|center|300px]]<ref> ECG found in wikimedia Commons </ref>
|-
! style="padding: 5px 5px; background: #DCDCDC;" align="left" |'''[[Torsade de Pointes]]''' <ref name="pmid28674475">{{cite journal |vauthors=Li M, Ramos LG |title=Drug-Induced QT Prolongation And Torsades de Pointes |journal=P T |volume=42 |issue=7 |pages=473–477 |date=July 2017 |pmid=28674475 |pmc=5481298 |doi= |url=}}</ref><ref name="SharainMay2015">{{cite journal|last1=Sharain|first1=Korosh|last2=May|first2=Adam M.|last3=Gersh|first3=Bernard J.|title=Chronic Alcoholism and the Danger of Profound Hypomagnesemia|journal=The American Journal of Medicine|volume=128|issue=12|year=2015|pages=e17–e18|issn=00029343|doi=10.1016/j.amjmed.2015.06.051}}</ref><ref name="pmid11330748">{{cite journal |vauthors=Khan IA |title=Twelve-lead electrocardiogram of torsades de pointes |journal=Tex Heart Inst J |volume=28 |issue=1 |pages=69 |date=2001 |pmid=11330748 |pmc=101137 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* *[[Electrolyte disturbances]]
*[[Medications]] such as:
**[[Amiodarone]]
**[[Azithromycin]]
**[[Clozapine]]
**[[Famotidine]]
**[[Flecainide]]
**[[Foscarnet]]
**[[Levofloxacin]]
**[[Lithium]]
**[[Mirtazapine]]
**[[Quetiapine]]
**[[Risperidone]]
**[[Tacrolimus]]
**[[Tamoxifen]]
**[[Ziprasidone]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
# Paroxysms of [[VTach]] with irregular RR intervals.
# A [[ventricular]] [[rate]] between 200 and 250 beats per minute.
# Two or more cycles of [[QRS complex]]es with alternating polarity.
# Changing the amplitude of the [[QRS complexes]] in each cycle in a sinusoidal fashion.
# Prolongation of the [[QT interval]].
# Is often initiated by a [[PVC]] with a long coupling interval, R on T phenomenon.
# There are usually 5 to 20 complexes in each cycle.
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
[[File:Capture Tors De P.PNG|center|300px]]<ref> ECG found in https://en.ecgpedia.org/index.php?title=Main_Page </ref>
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}


{{WH}}
[[Category:Cardiology]]
{{WS}}
[[Category:Public health]]
[[Category:Electrophysiology]]
[[Category:Emergency medicine]]

Latest revision as of 19:28, 19 July 2023

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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]

Overview

Definitions and Diagnosis

Components Assessment and findings
Symptoms
Palpitations, lightheadedness, syncope, dyspnea, chest pain, cardiac arrest
Past medical history
Medications
Family history
Disease Name Causes ECG Characteristics ECG view
Ventricular tachycardia [9][10][11][12][13]
[14]
Ventricular fibrillation [15][16][17][18]
[19]
Ventricular flutter [20][21][22]
[23]
Asystole [24][25]
  • There is no electrical activity in the asystole
[26]
Pulseless electrical activity [27][28]
[29]
Torsade de Pointes [30][31][32]
  1. Paroxysms of VTach with irregular RR intervals.
  2. A ventricular rate between 200 and 250 beats per minute.
  3. Two or more cycles of QRS complexes with alternating polarity.
  4. Changing the amplitude of the QRS complexes in each cycle in a sinusoidal fashion.
  5. Prolongation of the QT interval.
  6. Is often initiated by a PVC with a long coupling interval, R on T phenomenon.
  7. There are usually 5 to 20 complexes in each cycle.
[33]

References

  1. ↑ Harrison's Principles of Internal Medicine 16th Edition, The McGraw-Hill Companies, ISBN 0-07-140235-7
  2. ↑ Flesche CW, Breuer S, Mandel LP, Breivik H, Tarnow J. (1994) The ability of health professionals to check the carotid pulse. Circulation Vol. 90: I–288.
  3. ↑ Ochoa FJ, Ramalle-Gómara E, Carpintero JM, García A, Saralegui I (1998). "Competence of health professionals to check the carotid pulse". Resuscitation. 37 (3): 173–5. PMID 9715777. Unknown parameter |month= ignored (help)
  4. ↑ Bahr J, Klingler H, Panzer W, Rode H, Kettler D (1997). "Skills of lay people in checking the carotid pulse". Resuscitation. 35 (1): 23–6. PMID 9259056. Unknown parameter |month= ignored (help)
  5. ↑ "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 112 (24 Suppl): IV1–203. 2005. doi:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375. Unknown parameter |month= ignored (help)
  6. ↑ Zimetbaum, Peter; Josephson, Mark E. (1998). "Evaluation of Patients with Palpitations". New England Journal of Medicine. 338 (19): 1369–1373. doi:10.1056/NEJM199805073381907. ISSN 0028-4793.
  7. ↑ Noda, Takashi; Shimizu, Wataru; Taguchi, Atsushi; Aiba, Takeshi; Satomi, Kazuhiro; Suyama, Kazuhiro; Kurita, Takashi; Aihara, Naohiko; Kamakura, Shiro (2005). "Malignant Entity of Idiopathic Ventricular Fibrillation and Polymorphic Ventricular Tachycardia Initiated by Premature Extrasystoles Originating From the Right Ventricular Outflow Tract". Journal of the American College of Cardiology. 46 (7): 1288–1294. doi:10.1016/j.jacc.2005.05.077. ISSN 0735-1097.
  8. ↑ Resuscitation Council UK (2005). Resuscitation Guidelines 2005 London: Resuscitation Council UK.
  9. ↑ Ajijola, Olujimi A.; Tung, Roderick; Shivkumar, Kalyanam (2014). "Ventricular tachycardia in ischemic heart disease substrates". Indian Heart Journal. 66: S24–S34. doi:10.1016/j.ihj.2013.12.039. ISSN 0019-4832.
  10. ↑ Meja Lopez, Eliany; Malhotra, Rohit (2019). "Ventricular Tachycardia in Structural Heart Disease". Journal of Innovations in Cardiac Rhythm Management. 10 (8): 3762–3773. doi:10.19102/icrm.2019.100801. ISSN 2156-3977.
  11. ↑ Coughtrie, Abigail L; Behr, Elijah R; Layton, Deborah; Marshall, Vanessa; Camm, A John; Shakir, Saad A W (2017). "Drugs and life-threatening ventricular arrhythmia risk: results from the DARE study cohort". BMJ Open. 7 (10): e016627. doi:10.1136/bmjopen-2017-016627. ISSN 2044-6055.
  12. ↑ El-Sherif, Nabil (2001). "Mechanism of Ventricular Arrhythmias in the Long QT Syndrome: On Hermeneutics". Journal of Cardiovascular Electrophysiology. 12 (8): 973–976. doi:10.1046/j.1540-8167.2001.00973.x. ISSN 1045-3873.
  13. ↑ de Riva, Marta; Watanabe, Masaya; Zeppenfeld, Katja (2015). "Twelve-Lead ECG of Ventricular Tachycardia in Structural Heart Disease". Circulation: Arrhythmia and Electrophysiology. 8 (4): 951–962. doi:10.1161/CIRCEP.115.002847. ISSN 1941-3149.
  14. ↑ ECG found in of https://en.ecgpedia.org/index.php?title=Main_Page
  15. ↑ Koplan BA, Stevenson WG (March 2009). "Ventricular tachycardia and sudden cardiac death". Mayo Clin. Proc. 84 (3): 289–97. doi:10.1016/S0025-6196(11)61149-X. PMC 2664600. PMID 19252119.
  16. ↑ Maury P, Sacher F, Rollin A, Mondoly P, Duparc A, Zeppenfeld K, Hascoet S (May 2017). "Ventricular arrhythmias and sudden death in tetralogy of Fallot". Arch Cardiovasc Dis. 110 (5): 354–362. doi:10.1016/j.acvd.2016.12.006. PMID 28222965.
  17. ↑ Saumarez RC, Camm AJ, Panagos A, Gill JS, Stewart JT, de Belder MA, Simpson IA, McKenna WJ (August 1992). "Ventricular fibrillation in hypertrophic cardiomyopathy is associated with increased fractionation of paced right ventricular electrograms". Circulation. 86 (2): 467–74. doi:10.1161/01.cir.86.2.467. PMID 1638716.
  18. ↑ Bektas, Firat; Soyuncu, Secgin (2012). "Hypokalemia-induced Ventricular Fibrillation". The Journal of Emergency Medicine. 42 (2): 184–185. doi:10.1016/j.jemermed.2010.05.079. ISSN 0736-4679.
  19. ↑ ECG found in https://en.ecgpedia.org/index.php?title=Main_Page
  20. ↑ Thies, Karl-Christian; Boos, Karin; Müller-Deile, Kai; Ohrdorf, Wolfgang; Beushausen, Thomas; Townsend, Peter (2000). "Ventricular flutter in a neonate—severe electrolyte imbalance caused by urinary tract infection in the presence of urinary tract malformation". The Journal of Emergency Medicine. 18 (1): 47–50. doi:10.1016/S0736-4679(99)00161-4. ISSN 0736-4679.
  21. ↑ Koster, Rudolph W.; Wellens, Hein J.J. (1976). "Quinidine-induced ventricular flutter and fibrillation without digitalis therapy". The American Journal of Cardiology. 38 (4): 519–523. doi:10.1016/0002-9149(76)90471-9. ISSN 0002-9149.
  22. ↑ Dhurandhar RW, Nademanee K, Goldman AM (1978). "Ventricular tachycardia-flutter associated with disopyramide therapy: a report of three cases". Heart Lung. 7 (5): 783–7. PMID 250503.
  23. ↑ ECG found in https://en.ecgpedia.org/index.php?title=Main_Page
  24. ↑ ACLS: Principles and Practice. p. 71-87. Dallas: American Heart Association, 2003. ISBN 0-87493-341-2.
  25. ↑ ACLS for Experienced Providers. p. 3-5. Dallas: American Heart Association, 2003. ISBN 0-87493-424-9.
  26. ↑ ECG found in https://en.ecgpedia.org/index.php?title=Main_Page
  27. ↑ "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Part 7.2: Management of Cardiac Arrest." Circulation 2005; 112: IV-58 - IV-66.
  28. ↑ Foster B, Twelve Lead Electrocardiography, 2nd edition, 2007
  29. ↑ ECG found in wikimedia Commons
  30. ↑ Li M, Ramos LG (July 2017). "Drug-Induced QT Prolongation And Torsades de Pointes". P T. 42 (7): 473–477. PMC 5481298. PMID 28674475.
  31. ↑ Sharain, Korosh; May, Adam M.; Gersh, Bernard J. (2015). "Chronic Alcoholism and the Danger of Profound Hypomagnesemia". The American Journal of Medicine. 128 (12): e17–e18. doi:10.1016/j.amjmed.2015.06.051. ISSN 0002-9343.
  32. ↑ Khan IA (2001). "Twelve-lead electrocardiogram of torsades de pointes". Tex Heart Inst J. 28 (1): 69. PMC 101137. PMID 11330748.
  33. ↑ ECG found in https://en.ecgpedia.org/index.php?title=Main_Page
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