View source for Sudden cardiac death

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==Overview==

The term '''sudden cardiac death''' refers to [[natural death]] from cardiac causes, heralded by abrupt loss of [[consciousness]] within one hour of the onset of acute symptoms.<ref>Myerburg, Robert J. "Cardiac Arrest and Sudden Cardiac Death" in ''Heart Disease: A Textbook of Cardiovascular Medicine,'' 7th edition.  Philadelphia: WB Saunders, 2005.</ref>  Other forms of sudden death may be noncardiac in origin.  Examples of this include respiratory arrest (such as due to airway obstruction, which may be seen in cases of [[choking]] or [[asphyxiation]]), toxicity or poisoning, [[anaphylaxis]], or trauma.<ref>[http://poptop.hypermart.net/sudden.html Sudden Unexpected Death: Causes and Contributing Factors] on poptop.hypermart.net.</ref>

It is important to make a distinction between this term and the related term '''[[cardiac arrest]]''', which refers to cessation of cardiac pump function which may be reversible (i.e., may not be fatal).  The phrase '''Sudden Cardiac Death''' is a [[public health]] concept incorporating the features of ''natural'', ''rapid'', and ''unexpected''.  It does not specifically refer to the mechanism or cause of death.  Although the most frequent underlying cause of Sudden Cardiac Death is [[Coronary Artery Disease]], other categories of causes are listed below.

== Complete Differential Diagnosis for Sudden Cardiac Death == 
*Acute [[Cardiac tamponade]]
*After [[ST Elevation Myocardial Infarction]]
*[[Aortic dissection]]
*[[Aortic stenosis]]
*[[Apoplexy]]
*[[Arrhythmogenic right ventricular dysplasia]]
*[[Arteritis]]
*[[Asphyxia]]
*[[Cardiomyopathy]] including:
Myocardial diseases and [[heart failure]], including
:* [[Arrhythmogenic right ventricular cardiomyopathy]]
:* [[Hypertrophic cardiomyopathy]]
:* [[Dilated cardiomyopathy]]
:* [[Myocardial infarction]]
:* [[Noncompaction Cardiomyopathy]]
* [[Commotio cordis]]
*Complete [[atrioventricular block]]
* [[Congenital heart disease]]
*[[Congestive heart failure]]
*[[Coronary artery disease]]
*[[Drugs]]
*[[Hypoxia]]
*[[Hypercapnia]]
*[[Hypercalcemia]]
*[[Hyperkalemia]]
*[[Hypokalemia]]
*[[Mitral valve prolapse]]
*Myocardial Disease
*[[Pickwickian Syndrome]]
* Primary electrophysiological abnormalities, such as
:* [[Long QT syndrome]], both [[congenital]] and acquired
:* [[Sick sinus syndrome]]
:* [[Brugada syndrome]]
:* [[Catecholaminergic polymorphic ventricular tachycardia]]
*[[Prolonged Q-T Interval Syndrome]]
*[[Pulmonary embolism]]
*Rupture of the [[papillary muscles]]
*[[Shock]]
*[[Status asthmaticus]]
*[[Stokes-Adams Syndrome]]
*[[Sudden Infant Death Syndrome]]
*[[Tension pneumothorax]]
*[[Thyrotoxicosis]]
* Toxic/metabolic disturbances
*[[Valvular Heart Disease]]
*Ventricular rupture
*[[Wolf-Parkinson-White syndrome]]

==Prevention==
===ACC / AHA Guidelines- Recommendations for Implantable Cardioverter Defibrillators (DO NOT EDIT) <ref name="pmid18483207">{{cite journal |author=Epstein AE, DiMarco JP, Ellenbogen KA, ''et al'' |title=ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons |journal=Circulation |volume=117 |issue=21 |pages=e350-408 |year=2008 |month=May |pmid=18483207 |doi:10.1161/CIRCUALTIONAHA.108.189742 |url=}}</ref>===
{{cquote|  
===Class I===

1. [[ICD therapy]] is indicated in patients who are survivors of [[cardiac arrest]] due to [[VF]] or hemodynamically unstable sustained [[VT]] after evaluation to define the cause of the event and to exclude any completely reversible causes. (Level of Evidence: A)

2. [[ICD therapy]] is indicated in patients with structural [[heart disease]] and spontaneous sustained [[VT]], whether hemodynamically stable or unstable. (Level of Evidence: B)

3. [[ICD therapy]] is indicated in patients with [[syncope]] of undetermined origin with clinically relevant, hemodynamically significant sustained [[VT]] or [[VF]] induced at electrophysiological study. (Level of Evidence: B)

4. [[ICD therapy]] is indicated in patients with [[LVEF]] less than 35% due to prior [[MI]] who are at least 40 days post-MI and are in NYHA functional Class II or III. (Level of Evidence: A)

5. [[ICD therapy]] is indicated in patients with [[nonischemic DCM]] who have an [[LVEF]] less than or equal to 35% and who are in NYHA functional Class II or III. (Level of Evidence: B)

6. [[ICD therapy]] is indicated in patients with [[LV dysfunction]] due to prior [[MI]] who are at least 40 days post-MI, have an [[LVEF]] less than 30%, and are in NYHA functional Class I. (Level of Evidence: A)

7. [[ICD therapy]] is indicated in patients with [[nonsustained VT]] due to prior [[MI]], [[LVEF]] less than 40%, and [[inducible VF]] or [[sustained VT]] at electrophysiological study. (Level of Evidence: B)

===Class IIa===

1. [[ICD implantation]] is reasonable for patients with unexplained [[syncope]], significant [[LV dysfunction]], and [[nonischemic DCM]]. (Level of Evidence: C) 

2. [[ICD implantation]] is reasonable for patients with [[sustained VT]] and normal or near-normal [[ventricular function]]. (Level of Evidence: C) 

3. [[ICD implantation]] is reasonable for patients with [[HCM]] who have 1 or more major{dagger} risk factors for [[SCD]]. (Level of Evidence: C) 

4. [[ICD implantation]] is reasonable for the prevention of [[SCD]] in patients with [[ARVD/C]] who have 1 or more risk factors for [[SCD]]. (Level of Evidence: C) 

5. [[ICD implantation]] is reasonable to reduce [[SCD]] in patients with [[long-QT syndrome]] who are experiencing [[syncope]] and/or [[VT]] while receiving [[beta blockers]]. (Level of Evidence: B)

6. [[ICD implantation]] is reasonable for non hospitalized patients awaiting [[transplant]]ation. (Level of Evidence: C) 

7. [[ICD implantation]] is reasonable for patients with [[Brugada syndrome]] who have had [[syncope]]. (Level of Evidence: C)

8. [[ICD implantation]] is reasonable for patients with [[Brugada syndrome]] who have documented [[VT]] that has not resulted in [[cardiac arrest]]. (Level of Evidence: C) 

9. [[ICD implantation]] is reasonable for patients with [[catecholaminergic polymorphic VT]] who have syncope and/or documented sustained [[VT]] while receiving [[beta blockers]]. (Level of Evidence: C) 

10. [[ICD implantation]] is reasonable for patients with [[cardiac sarcoidosis]], [[giant cell myocarditis]], or [[Chagas disease]]. (Level of Evidence: C) 

===Class IIb===

1. [[ICD therapy]] may be considered in patients with nonischemic [[heart disease]] who have an [[LVEF]] of less than or equal to 35% and who are in NYHA functional Class I. (Level of Evidence: C) 

2. [[ICD therapy]] may be considered for patients with [[long-QT syndrome]] and risk factors for [[SCD]]. (Level of Evidence: B)

3. [[ICD therapy]] may be considered in patients with [[syncope]] and advanced structural heart disease in whom thorough invasive and noninvasive investigations have failed to define a cause. (Level of Evidence: C) 

4. [[ICD therapy]] may be considered in patients with a [[familial cardiomyopathy]] associated with sudden death. (Level of Evidence: C) 

5. [[ICD therapy]] may be considered in patients with [[LV]] noncompaction. (Level of Evidence: C)

===Class III===

1. [[ICD therapy]] is not indicated for patients who do not have a reasonable expectation of survival with an acceptable functional status for at least 1 year, even if they meet [[ICD implantation]] criteria specified in the Class I, IIa, and IIb recommendations above. (Level of Evidence: C) 

2. [[ICD therapy]] is not indicated for patients with incessant [[VT]] or [[VF]]. (Level of Evidence: C) 

3. [[ICD therapy]] is not indicated in patients with significant [[psychiatric illness]]es that may be aggravated by device implantation or that may preclude systematic follow-up. (Level of Evidence: C) 

4. [[ICD therapy]] is not indicated for NYHA Class IV patients with [[drug-refractory congestive heart failure]] who are not candidates for [[cardiac transplantation]] or [[CRT-D]]. (Level of Evidence: C)

5. [[ICD therapy]] is not indicated for [[syncope]] of undetermined cause in a patient without [[inducible ventricular tachyarrhythmias]] and without structural [[heart disease]]. (Level of Evidence: C)

6. [[ICD therapy]] is not indicated when [[VF]] or [[VT]] is amenable to surgical or catheter ablation (e.g., [[atrial arrhythmias]] associated with the [[Wolff-Parkinson-White syndrome]], [[RV]] or [[LV]] [[outflow tract VT]], [[idiopathic VT]], or [[fascicular VT]] in the absence of structural [[heart disease]]). (Level of Evidence: C) 

7. [[ICD therapy]] is not indicated for patients with [[ventricular tachyarrhythmias]] due to a completely reversible disorder in the absence of structural [[heart disease]] (e.g., [[electrolyte imbalance]], [[drugs]], or [[trauma]]). (Level of Evidence: B)}}

===ACC / AHA Guidelines- Recommendations for Implantable Cardioverter-Defibrillators in Pediatric Patients and Patients With Congenital Heart Disease (DO NOT EDIT) <ref name="pmid18483207">{{cite journal |author=Epstein AE, DiMarco JP, Ellenbogen KA, ''et al'' |title=ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons |journal=Circulation |volume=117 |issue=21 |pages=e350-408 |year=2008 |month=May |pmid=18483207 |doi:10.1161/CIRCUALTIONAHA.108.189742 |url=}}</ref>===
{{cquote|  
===Class I===

1. [[ICD implantation]] is indicated in the survivor of [[cardiac arrest]] after evaluation to define the cause of the event and to exclude any reversible causes. (Level of Evidence: B)

2. [[ICD implantation]] is indicated for patients with [[symptomatic sustained VT]] in association with [[congenital heart disease]] who have undergone hemodynamic and electrophysiological evaluation. [[Catheter ablation]] or surgical repair may offer possible alternatives in carefully selected patients. (Level of Evidence: C)

===Class IIa===

1. [[ICD implantation]] is reasonable for patients with [[congenital heart disease]] with [[recurrent syncope]] of undetermined origin in the presence of either [[ventricular dysfunction]] or [[inducible ventricular arrhythmia]]s at electrophysiological study. (Level of Evidence: B)

===Class IIb===

1. [[ICD implantation]] may be considered for patients with [[recurrent syncope]] associated with complex [[congenital heart disease]] and [[advanced systemic ventricular dysfunction]] when thorough invasive and noninvasive investigations have failed to define a cause. (Level of Evidence: C)

===Class III===

1. All Class III recommendations found in Section 3, "Indications for Implantable Cardioverter-Defibrillator Therapy," apply to pediatric patients and patients with [[congenital heart disease]], and [[ICD implantation]] is not indicated in these patient populations. (Level of Evidence: C) }}

==Sources==
*ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons <ref name="pmid18483207">{{cite journal |author=Epstein AE, DiMarco JP, Ellenbogen KA, ''et al'' |title=ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons |journal=Circulation |volume=117 |issue=21 |pages=e350-408 |year=2008 |month=May |pmid=18483207 |doi:10.1161/CIRCUALTIONAHA.108.189742 |url=}}</ref>
*ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines) <ref name="pmid12379588">{{cite journal |author=Gregoratos G, Abrams J, Epstein AE, ''et al'' |title=ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines) |journal=Circulation |volume=106 |issue=16 |pages=2145-61 |year=2002 |month=October |pmid=12379588 |doi:10.1161/01.CIR.0000035996.46455.09 |url=}}</ref>
*ACC/AHA Guidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Executive Summary--a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation) <ref name="pmid9570207">{{cite journal |author=Gregoratos G, Cheitlin MD, Conill A, ''et al'' |title=ACC/AHA Guidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Executive Summary--a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation) |journal=Circulation |volume=97 |issue=13 |pages=1325-35 |year=1998 |month=April |pmid=9570207}}</ref>

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

==External links==
*[http://hcm.stanfordhospital.com/ Information from the Stanford Hypertrophic Cardiomyopathy Center]
*[http://www.aral.org.uk/html/sudden_cardiac_arrest.html/ Arrhythmia Alliance] Sudden Cardiac Arrest Page

==Additional resources==
* [http://en.ecgpedia.org ECGpedia: Course for interpretation of ECG]
* [http://www.anaesthetist.com/icu/organs/heart/ecg/ The whole ECG - A basic ECG primer]
* [http://www.ecglibrary.com 12-lead ECG library]
* [http://www.ecgsim.org Simulation tool to demonstrate and study the relation between the electric activity of the heart and the ECG]
* [http://heartcenter.seattlechildrens.org/what_to_expect/electrocardiogram.asp ECG information from Children's Hospital Heart Center, Seattle]
* [http://www.regionalpci-stemi.org/id10.html ECG Challenge from the ACC D2B Initiative]
* [http://0-www.nhlbi.nih.gov.innopac.up.ac.za:80/health/dci/Diseases/ekg/ekg_what.html National Heart, Lung, and Blood Institute, Diseases and Conditions Index]
* [http://www.ecglibrary.com/ecghist.html A history of electrocardiography]
* [http://www.health.gov.mt/impaedcard/issue/issue1/ipc00103.htm EKG Interpretations in infants and children]

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

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