Sudden cardiac death overview
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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 death is a natural, rapid, unexpected death secondary to cardiac cause or mechanism. Sudden cardiac arrest is defined as the unexpected cessation of pumping blood into vital organs due to electrical disturbance in the pathway of SA node, AV node, Hiss Purkinje fibers or pumping failure due to conditions such as cardiogenic shock, massive pulmonary thromboembolism,fulminant myocarditis, ruptured left ventricular free wall. Without any intervention for immediate restoration of the circulation, biologic death or sudden cardiac death will happen minutes to weeks after cardiac arrest. Sudden cardiac death is responsible for 50% of cardiac death annually in the united state. In-hospital cardiac arrest happens in 290,000 adults annually in the united states. The most common cause of sudden cardiac death is coronary artery disease and atherosclerosis process. The presence of underlying disorders such as malignancy or liver disease at the time of cardiac arrest makes the condition worst. Patients with acute myocardial infarction and in-hospital cardiac arrest with shockable rhythm have a better prognosis. Post cardiopulmonary resuscitation state management should be focused on neurologic complications, hemodynamic stability, and respiratory support.
Historical perspective
There is no historical perspective available about sudden cardiac death.
Classification
There are some definitions related to cardiac arrest including Sudden cardiac death which is defined as sudden and unexpected death within one hour of being symptomatic such as palpitation, chest pain, shrtness of breath or within 24 hours in an asymptomatic patient due to arrhythmia or hemodynamic instability.Sudden cardiac arrest is suddenly cessation of cardiac activity,unresponsive patient with gasping respiration or no respiratory movement and unpalpable pulses due to cardiac etiology such as arrhythmia, pump failure. Aborted cardiac arrest is explained as unexpected circulatory collapse within one hour of being symptomatic, which is reversible after successful cardiopulmonary resuscitation. SIDS (sudden infant death syndrome) is sudden death when there is normal structural heart without any specific findings in autopsy or toxicology.
Pathophysiology
The pathogenesis of cardiac arrest is characterized by the myocardial inflammatory process in the setting of atherosclerosis, structural heart disease, genetic disorders, and environmental factors. The SCN5A, KCNH2, KCNQ1, RYR2, MYBPC3, PKP2, DSP genes mutation are associated with the development of inherited causes of cardiac arrest and sudden cardiac death.
Causes
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)
Definition and diagnosis
The diagnosis of sudden cardiac arrest 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.