Sudden cardiac death electrocardiogram: Difference between revisions
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/* 2022 ESC Guidelines for the management of patients with ventricular arrythymias and the prevention of sudden cardiac death {{cite journal| author=Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA | display-authors=etal| title=2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. | journal=Eur Heart J | year= 2022 | volume= 43 | issue= 40 | pages= 3997-4126 | pmid=36017572 | doi=10.1093/eurheartj/ehac26... |
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{{Sudden cardiac death}} | {{Sudden cardiac death}} | ||
{{CMG}} {{AE}} {{Sara.Zand}} | {{CMG}} {{AE}} {{Sara.Zand}} {{Jose}} {{EdzelCo}} | ||
==Overview== | ==Overview== | ||
An [[ECG]] may be helpful in the diagnosis of [[Sudden cardiac death]]. Findings on [[ECG]] associated with [[ sudden cardiac arrest]] include [[Sinus tachycardia]] (39%), abnormal [[T-wave inversions]] (30%), prolonged [[QT]] interval (26%), left/[[right atrial]] abnormality (22%), [[left ventricular hypertrophy]] (17%), abnormal frontal [[QRS axis]] (17%), delayed [[QRS]]-transition zone in precordial leads (13%), pathological [[Q waves]] (13%), [[intraventricular conduction delays]] (9%), multiple [[premature ventricular contractions]] (9%), normal [[ECG]] (9%). | An [[electrocardiogram]] ([[ECG]]) may be helpful in the diagnosis of [[Sudden cardiac death]]. Findings on [[ECG]] associated with [[ sudden cardiac arrest]] ([[SCA]]) include [[Sinus tachycardia]] (39%), abnormal [[T-wave inversions]] (30%), prolonged [[QT]] interval (26%), left/[[right atrial]] abnormality (22%), [[left ventricular hypertrophy]] (17%), abnormal frontal [[QRS axis]] (17%), delayed [[QRS]]-transition zone in precordial leads (13%), pathological [[Q waves]] (13%), [[intraventricular conduction delays]] (9%), multiple [[premature ventricular contractions]] (9%), normal [[ECG]] (9%). | ||
===Electrocardiogram=== | ===Electrocardiogram=== | ||
An [[ECG]] may be helpful in the diagnosis of [[Sudden cardiac death]]. Findings on [[ECG]] associated with [[ sudden cardiac arrest]] may include:<ref name="JayaramanReinier2018">{{cite journal|last1=Jayaraman|first1=Reshmy|last2=Reinier|first2=Kyndaron|last3=Nair|first3=Sandeep|last4=Aro|first4=Aapo L.|last5=Uy-Evanado|first5=Audrey|last6=Rusinaru|first6=Carmen|last7=Stecker|first7=Eric C.|last8=Gunson|first8=Karen|last9=Jui|first9=Jonathan|last10=Chugh|first10=Sumeet S.|title=Risk Factors of Sudden Cardiac Death in the Young|journal=Circulation|volume=137|issue=15|year=2018|pages=1561–1570|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.117.031262}}</ref> | An [[electrocardiogram]] ([[ECG]]) may be helpful in the diagnosis of [[Sudden cardiac death]]. Findings on [[ECG]] associated with [[ sudden cardiac arrest]] ([[SCA]]) may include:<ref name="JayaramanReinier2018">{{cite journal|last1=Jayaraman|first1=Reshmy|last2=Reinier|first2=Kyndaron|last3=Nair|first3=Sandeep|last4=Aro|first4=Aapo L.|last5=Uy-Evanado|first5=Audrey|last6=Rusinaru|first6=Carmen|last7=Stecker|first7=Eric C.|last8=Gunson|first8=Karen|last9=Jui|first9=Jonathan|last10=Chugh|first10=Sumeet S.|title=Risk Factors of Sudden Cardiac Death in the Young|journal=Circulation|volume=137|issue=15|year=2018|pages=1561–1570|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.117.031262}}</ref> | ||
* [[Sinus tachycardia]] (39%) | * [[Sinus tachycardia]] (39%) | ||
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A recently published case report demonstrated a [[cardiac arrest]] happening due to a very unusual cause. It was triggered by the increased [[parasympathethic tone]] during defecation. The successive changes that were observed on [[ECG]] were in this order: [[prolonged PR interval]], [[2:1 atrioventricular block]], [[sinus bradycardia]] and [[complete heart block]]. These findings supported the occurrence of a central mechanism in this cardiac arrest.<ref name="pmid33464284">{{cite journal| author=Tsushima T, Patel TR, Sahadevan J| title=Unusual Cause of Cardiac Arrest. | journal=JAMA Intern Med | year= 2021 | volume= 181 | issue= 4 | pages= 542-543 | pmid=33464284 | doi=10.1001/jamainternmed.2020.8370 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33464284 }} </ref> | A recently published case report demonstrated a [[cardiac arrest]] happening due to a very unusual cause. It was triggered by the increased [[parasympathethic tone]] during defecation. The successive changes that were observed on [[ECG]] were in this order: [[prolonged PR interval]], [[2:1 atrioventricular block]], [[sinus bradycardia]] and [[complete heart block]]. These findings supported the occurrence of a central mechanism in this cardiac arrest.<ref name="pmid33464284">{{cite journal| author=Tsushima T, Patel TR, Sahadevan J| title=Unusual Cause of Cardiac Arrest. | journal=JAMA Intern Med | year= 2021 | volume= 181 | issue= 4 | pages= 542-543 | pmid=33464284 | doi=10.1001/jamainternmed.2020.8370 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33464284 }} </ref> | ||
==2022 ESC Guidelines for the management of patients with ventricular arrythymias and the prevention of sudden cardiac death <ref name="pmid36017572">{{cite journal| author=Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA | display-authors=etal| title=2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. | journal=Eur Heart J | year= 2022 | volume= 43 | issue= 40 | pages= 3997-4126 | pmid=36017572 | doi=10.1093/eurheartj/ehac262 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=36017572 }} </ref>== | |||
{|class="wikitable" | |||
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| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for evaluation of patients presenting with newly documented ventricular arryhthmia''''' | |||
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| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''''' | |||
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* In [[patients]] with newly documented [[ventricular arrhythmia]] ([[VA]]) (frequent [[premature ventricular contractions]] ([[PVCs]]), [[non-sustained ventricular tachycardia]] ([[NSVT]]), [[sustained monomorphic ventricular tachycardia]] ([[SMVT]]), a baseline 12-lead [[electrocardiogram]] ([[ECG]]) whenever possible, and an [[echocardiogram]] are recommended as first-line evaluation. | |||
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{|class="wikitable" | |||
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| colspan="1" style="text-align:center; background: Silver"|'''Recommendations for evaluation of sudden cardiac arrest survivors''''' | |||
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| colspan="1" style="text-align:center; background:LemonChiffon"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class IIa]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''''' | |||
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* In [[SCA]] survivors, [[brain]]/ [[chest]] [[CT scan]] should be considered when [[patient]] characteristics, [[ECG]], and [[echocardiography]] are not consistent with a [[cardiac]] cause. | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''''' | |||
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* In [[SCA]] survivors, repeated 12-lead [[ECG]]s during stable [[rhythm]] (including high [[precordial]] lead [[ECG]]), as well as continuous [[cardiac monitoring]] are recommended. | |||
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| colspan="1" style="text-align:center; background: Silver"|'''Recommendation for management of relatives of a patient with aarhythmogenic right ventricular cardiomyopathy''''' | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''''' | |||
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* In a [[first-degree relative]] of a [[patient]] with [[ARVC]], [[ECG]] and [[echocardiogram]] are recommended. | |||
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{|class="wikitable" | |||
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| colspan="1" style="text-align:center; background: Silver"|'''Recommendation for management of relatives of a patient with hypertrophic cardiomyopathy''''' | |||
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| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''''' | |||
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* In a [[first-degree relative]] of a [[patient]] with [[HCM]], [[ECG]] and [[echocardiogram]] are recommended. | |||
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{|class="wikitable" | |||
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| colspan="1" style="text-align:center; background: Silver"|'''Recommendation for diagnosis and management of ventricular arryhthmia in neuromuscular diseases''''' | |||
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| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''''' | |||
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* [[Annual]] [[follow-up]] with at least 12-lead [[ECG]] is recommended in [[patients]] with [[muscular dystrophies]], even in the concealed phase of the [[disease]]. | |||
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{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|'''[[2022 ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] ''([[2022 ESC Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''''' | |||
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* Baseline [[familial evaluation]] of [[sudden arrhythmic death syndrome]] ([[SADS]]) decedents is recommended to include taking a [[medical history]] and performing [[physical examination]], standard and high [[precordial lead ECG]], [[echocardiography]], and [[exercise testing]]. | |||
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==2017AHA/ACC/HRS Guideline for management of [[sudden cardiac arrest]] and [[ventricular arrhythmia]]== | ==2017AHA/ACC/HRS Guideline for management of [[sudden cardiac arrest]] and [[ventricular arrhythmia]]== | ||
Latest revision as of 18:48, 22 July 2023
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Sudden cardiac death Microchapters |
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Diagnosis |
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Sudden cardiac death electrocardiogram On the Web |
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American Roentgen Ray Society Images of Sudden cardiac death electrocardiogram |
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Risk calculators and risk factors for Sudden cardiac death electrocardiogram |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] José Eduardo Riceto Loyola Junior, M.D.[3] Edzel Lorraine Co, DMD, MD[4]
Overview
An electrocardiogram (ECG) may be helpful in the diagnosis of Sudden cardiac death. Findings on ECG associated with sudden cardiac arrest (SCA) include Sinus tachycardia (39%), abnormal T-wave inversions (30%), prolonged QT interval (26%), left/right atrial abnormality (22%), left ventricular hypertrophy (17%), abnormal frontal QRS axis (17%), delayed QRS-transition zone in precordial leads (13%), pathological Q waves (13%), intraventricular conduction delays (9%), multiple premature ventricular contractions (9%), normal ECG (9%).
Electrocardiogram
An electrocardiogram (ECG) may be helpful in the diagnosis of Sudden cardiac death. Findings on ECG associated with sudden cardiac arrest (SCA) may include:[1]
- Sinus tachycardia (39%)
- Abnormal T-wave inversions (30%)
- Prolonged QT interval (26%)
- Left/right atrial abnormality (22%)
- LVH (17%)
- Abnormal frontal QRS axis (17%)
- Delayed QRS-transition zone in precordial leads (13%)
- Pathological Q waves (13%)
- intraventricular conduction delays (9%)
- Multiple premature ventricular contractions (9%)
- Normal ECG (9%)
A recently published case report demonstrated a cardiac arrest happening due to a very unusual cause. It was triggered by the increased parasympathethic tone during defecation. The successive changes that were observed on ECG were in this order: prolonged PR interval, 2:1 atrioventricular block, sinus bradycardia and complete heart block. These findings supported the occurrence of a central mechanism in this cardiac arrest.[2]
2022 ESC Guidelines for the management of patients with ventricular arrythymias and the prevention of sudden cardiac death [3]
| Recommendations for evaluation of patients presenting with newly documented ventricular arryhthmia |
| Class I (Level of Evidence: C) |
|
| Recommendations for evaluation of sudden cardiac arrest survivors |
| Class IIa (Level of Evidence: C) |
| Class I (Level of Evidence: B) |
|
| Recommendation for management of relatives of a patient with aarhythmogenic right ventricular cardiomyopathy |
| Class I (Level of Evidence: C) |
|
| Recommendation for management of relatives of a patient with hypertrophic cardiomyopathy |
| Class I (Level of Evidence: C) |
|
| Recommendation for diagnosis and management of ventricular arryhthmia in neuromuscular diseases |
| Class I (Level of Evidence: C) |
| Class I (Level of Evidence: B) |
|
2017AHA/ACC/HRS Guideline for management of sudden cardiac arrest and ventricular arrhythmia
| Class I (Level of Evidence: B) |
|
| Class of recommendation | Level of evidence | Recommendation for ECG and exercise tredmile test |
|---|---|---|
| 1 | B | In patients with wide complex tachycardia and hemodynamically stable, 12 leads ECG should be obtained |
| 1 | B | Exercise stress test should be obtained in patients suspected arrhythmia-related exercise such as ischemic heart disease or cathecolaminergic polymorphic ventricular tachycardia |
| 1 | B | In patients with documented ventricular arrhythmia, 12 leads ECG should be obtained during sinus rhythm for evaluation of underlying heart disease |
References
- ↑ Jayaraman, Reshmy; Reinier, Kyndaron; Nair, Sandeep; Aro, Aapo L.; Uy-Evanado, Audrey; Rusinaru, Carmen; Stecker, Eric C.; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S. (2018). "Risk Factors of Sudden Cardiac Death in the Young". Circulation. 137 (15): 1561–1570. doi:10.1161/CIRCULATIONAHA.117.031262. ISSN 0009-7322.
- ↑ Tsushima T, Patel TR, Sahadevan J (2021). "Unusual Cause of Cardiac Arrest". JAMA Intern Med. 181 (4): 542–543. doi:10.1001/jamainternmed.2020.8370. PMID 33464284 Check
|pmid=value (help). - ↑ Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA; et al. (2022). "2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death". Eur Heart J. 43 (40): 3997–4126. doi:10.1093/eurheartj/ehac262. PMID 36017572 Check
|pmid=value (help). - ↑ Al-Khatib, Sana M.; Stevenson, William G.; Ackerman, Michael J.; Bryant, William J.; Callans, David J.; Curtis, Anne B.; Deal, Barbara J.; Dickfeld, Timm; Field, Michael E.; Fonarow, Gregg C.; Gillis, Anne M.; Granger, Christopher B.; Hammill, Stephen C.; Hlatky, Mark A.; Joglar, José A.; Kay, G. Neal; Matlock, Daniel D.; Myerburg, Robert J.; Page, Richard L. (2018). "2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death". Circulation. 138 (13). doi:10.1161/CIR.0000000000000549. ISSN 0009-7322.