Sudden cardiac death: Prevention and Management

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BY DR. HAMEED BASHIR

Sudden cardiac death (SCD) is an unexpected death due to cardiac causes that occurs in a short time period (generally within 1 hour of symptom onset) in a person with known or unknown cardiac disease.

Mechanism of SCD:

Abnormal heart rhythms called arrhythmias is most common mechanism of sudden cardiac arrests. The most common life-threatening arrhythmia is ventricular fibrillation. This is an erratic, disorganized firing of impulses from heart’s ventricles (lower chambers). When this happens, heart is unable to pump blood. Without treatment, person can die within minutes.

Causes:

Coronary artery disease causes most cases (80%) of sudden cardiac death. In people who are younger, congenital (since birth) heart defects or genetic abnormalities in their heart’s electrical system are often the cause. In people age 40 and older, the cause is more often related to coronary artery disease.

RISK FACTORS:

Previous heart attack:

Prior episode of sudden cardiac arrest.

Family history of sudden cardiac arrest or sudden cardiac death.

Personal or family history of certain abnormal heart rhythms, including long QT syndrome, Wolff-Parkinson-White syndrome and ventricular tachycardia.

 Ventricular tachycardia or ventricular fibrillation after a heart attack.

 History of congenital (since birth) heart defects or blood vessel abnormalities.

 History of syncope (fainting episodes of unknown cause).

 Dilated cardiomyopathy

 Hypertrophic cardiomyopathy

 Significant changes in blood levels of potassium and magnesium.

 Obesity

 Diabetes.

 Recreational drug use.

 Taking drugs that are “pro-arrhythmic” may increase the risk for life-threatening arrhythmias.

PREVENTION:

Identification of early symptoms and seeking medical attention is of paramount importance.

Any history of chest pain on exertion should be evaluated. Patients with history of sudden death in family shall undergo screening in the form of 12 lead ECG and 2d echocardiography, to rule out structural heart diseases like HOCM,ARVD, Long QT syndromes etc.

MANAGEMENT OF CARDIAC ARREST:

 Cardiac arrest requires urgent cardio-pulmonary resuscitation and may require defibrillation(shock).

 Once patient is revived, work up for underlying cause is done to treat the conditions leading to cardiac arrest.

(Dr Hamed is a Consultant cardiologist atShri Maharaja Hari Singh (SMHS) hospital)

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