Sudden cardiac death causes

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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

Sudden cardiac arrest (SCA) may be caused by underlying cardiac abnormality including coronary artery abnormality , hypertrophy of myocardium, myocardial disease, valvular heart disease, congenital heart disease, abnormality in conducting system and electrical instability. The type of cardiac disease that is associated with sudden cardiac death (SCD) depends on the age of the individual [1] [2] [3] [4] [5] [6] [7] [8].

Causes

Diffential diagnosis of sudden cardiac death

[11][12][13][14][15][16][17][18][19][20][21][22][23]


Differentiating diagnosis of sudden cardiac death Coronary Artery Disease Ideopathic dilated cardiomyopathy Hypertrophic cardiomyopathy Arrhythmogenic right ventricular cardiomyopathy Valvular Heart Disease Congenital Heart Disease Long QT syndrome WPW syndrome Ideopathic monomorphic VT Polymorphic VT Ideopathic VF Sudden unexpected nocturnal death (Lai-Lai, sleep death, Laos Pukkuri
Incidence 80% 10% 1% 2% 1% to 5% in native valves, 0.2%–0.9% in prosthesis 0.04% 0.05% 0.1% Rare 0.15% 5% 0.001%
Mechanism Atherosclerosis in coronary arteries: 3 vessels disease in 40-86% patients with stenosis > 75%, MI < 50%, Qwave MI < 25%, recent coronary thrombosis 15-64% , healed infarct>50% in autopsy or survivors of SCD, Non atherosclerotic changes including coronary emboli, coronary arthritis, coronary dissection in few cases Myocardial stretch, neuroendocrine factors, electrolyte abnormality, proarrhythmic effect of antiarrhythmic drugs, excessive activation of sympathetic and renin angiotensin system Arrhythmia, abrupt hemodynamic deterioration, ischemia Fatty and fibrofatty myocardial infiltration, patchy myocarditis, apoptosis of left ventricle, left ventricular septum (50-67%), right ventricular inflow, outflow tract and apex( triangle of dysplasia) Arrhythmia, prosthetic valve dysfunction, Coexisting CAD SCD is late presentation after surgical repair of complex congenital heart disease such as Eisenmenger syndrome,transposition of the great arteries (atrial switch or congenitally corrected), Fontan circulations. Prolongation of repolarization, early after depolarization In 10% of WPW patients, SCD is first presentation. Development of VF in the presence of rapid conduction of AF to the ventricle through accessory pathway Normal structure of the heart, Originated from RV outflow tract (more common), or LV outflow tract. SCD is rare Initiation of arrhythmia with coupled premature complex, in the presence of acquired or congenital Long QT interval or ischemia, sporadic or familiar Normal structure of the heart with high incidence of recurrence of VF or cardiac arrest or syncope (30%) without ICD implantation Unknown
Risk factors of SCD Plaque, fissure, hemorrhage, thrombosis in coronary arteries Frequent episodes of non sustain VT, syncope Family history of SCD, recurrent syncope, sustained VT, history of SCA, massive LVH, multiple episodes of non sustained VT Asymptomatic aotric valve disease is low risk for SCD. Risk factors of SCD in MVP: myxomatous degeneration of the valve, coexisting mitral regurgitation, LV dysfunction Risk factors of SCD in TOF: QRS prolongation, dilated RV Incidence of cardiac event in LQTS1, LQTS2> LQTS3 Lethality of cardiac event in LQTS3 > LQTS1, LQTS2 Predictors of VF: AF with shortest interval between ventricle beats less than 250 msec Cathecolamine release after stressful emotional or physical event Young, male sex, southeast asian ethnicity
Arrhythmia VT, VF (75%), bradycardia, asystole(25%) Mechanism of VT: bundle branch reentry tachycardia, terminal event: asystole, electromechanical dissociation in advanced LV dysfunction Ventricular tachycardia, Ventricular fibrillation ECG in normal sinus rhythm T waves inversion in V1-V3, complete, incomplete RBBB, epsilone wave ( terminal notch on QRS complex), VT is LBBB contour Atrial arrhythmias (43%), QRS prolongation (mean 132ms) Torsadepoints, ECG findings: abnormal Twaves contour, Twaves alternance, sinus bradycardia RV outflow tract VT is LBBB contour, inferior axis, Termination with vagal maneuver such as adenosine. LVOT VT or fasciculated VT is RBBB contour with left axis deviation, originated from left posterior septum, Termination with calcium channel blocker SCD in the presence of polymorphic VT and even normal LV function without torsadepoints. Termination of cathecolaminergic polymorphic VT (CPVT) with betablocker Ealy repolarization abnormality in inferior lateral leads, No response to betablocker in the presence of ideopathic VF or short coupled of torsades de points

References

  1. ↑ 1.0 1.1 1.2 Winkel BG, Holst AG, Theilade J, Kristensen IB, Thomsen JL, Ottesen GL; et al. (2011). "Nationwide study of sudden cardiac death in persons aged 1-35 years". Eur Heart J. 32 (8): 983–90. doi:10.1093/eurheartj/ehq428. PMID 21131293.
  2. ↑ 2.0 2.1 2.2 2.3 Risgaard B, Winkel BG, Jabbari R, Behr ER, Ingemann-Hansen O, Thomsen JL; et al. (2014). "Burden of sudden cardiac death in persons aged 1 to 49 years: nationwide study in Denmark". Circ Arrhythm Electrophysiol. 7 (2): 205–11. doi:10.1161/CIRCEP.113.001421. PMID 24604905.
  3. ↑ 3.0 3.1 3.2 Bagnall RD, Weintraub RG, Ingles J, Duflou J, Yeates L, Lam L; et al. (2016). "A Prospective Study of Sudden Cardiac Death among Children and Young Adults". N Engl J Med. 374 (25): 2441–52. doi:10.1056/NEJMoa1510687. PMID 27332903.
  4. ↑ 4.0 4.1 4.2 Wisten A, Forsberg H, Krantz P, Messner T (2002). "Sudden cardiac death in 15-35-year olds in Sweden during 1992-99". J Intern Med. 252 (6): 529–36. doi:10.1046/j.1365-2796.2002.01038.x. PMID 12472914.
  5. ↑ 5.0 5.1 5.2 Chugh SS, Jui J, Gunson K, Stecker EC, John BT, Thompson B; et al. (2004). "Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large U.S. community". J Am Coll Cardiol. 44 (6): 1268–75. doi:10.1016/j.jacc.2004.06.029. PMID 15364331.
  6. ↑ 6.0 6.1 6.2 Winkel BG, Risgaard B, Sadjadieh G, Bundgaard H, Haunsø S, Tfelt-Hansen J (2014). "Sudden cardiac death in children (1-18 years): symptoms and causes of death in a nationwide setting". Eur Heart J. 35 (13): 868–75. doi:10.1093/eurheartj/eht509. PMID 24344190.
  7. ↑ 7.0 7.1 7.2 Byrne R, Constant O, Smyth Y, Callagy G, Nash P, Daly K; et al. (2008). "Multiple source surveillance incidence and aetiology of out-of-hospital sudden cardiac death in a rural population in the West of Ireland". Eur Heart J. 29 (11): 1418–23. doi:10.1093/eurheartj/ehn155. PMID 18424446.
  8. ↑ 8.0 8.1 8.2 Eckart RE, Shry EA, Burke AP, McNear JA, Appel DA, Castillo-Rojas LM; et al. (2011). "Sudden death in young adults: an autopsy-based series of a population undergoing active surveillance". J Am Coll Cardiol. 58 (12): 1254–61. doi:10.1016/j.jacc.2011.01.049. PMID 21903060.
  9. ↑ Waldmann V, Karam N, Bougouin W, Sharifzadehgan A, Dumas F, Narayanan K; et al. (2019). "Burden of Coronary Artery Disease as a Cause of Sudden Cardiac Arrest in the Young". J Am Coll Cardiol. 73 (16): 2118–2120. doi:10.1016/j.jacc.2019.01.064. PMID 31023437.
  10. ↑ Waldmann V, Karam N, Rischard J, Bougouin W, Sharifzadehgan A, Dumas F; et al. (2020). "Low rates of immediate coronary angiography among young adults resuscitated from sudden cardiac arrest". Resuscitation. 147: 34–42. doi:10.1016/j.resuscitation.2019.12.005. PMID 31857140.
  11. ↑ Moore, Benjamin; Yu, Christopher; Kotchetkova, Irina; Cordina, Rachael; Celermajer, David S. (2018). "Incidence and clinical characteristics of sudden cardiac death in adult congenital heart disease". International Journal of Cardiology. 254: 101–106. doi:10.1016/j.ijcard.2017.11.117. ISSN 0167-5273.
  12. ↑ Schwartz, Peter J.; Stramba-Badiale, Marco; Crotti, Lia; Pedrazzini, Matteo; Besana, Alessandra; Bosi, Giuliano; Gabbarini, Fulvio; Goulene, Karine; Insolia, Roberto; Mannarino, Savina; Mosca, Fabio; Nespoli, Luigi; Rimini, Alessandro; Rosati, Enrico; Salice, Patrizia; Spazzolini, Carla (2009). "Prevalence of the Congenital Long-QT Syndrome". Circulation. 120 (18): 1761–1767. doi:10.1161/CIRCULATIONAHA.109.863209. ISSN 0009-7322.
  13. ↑ Visser, Marloes; van der Heijden, Jeroen F.; Doevendans, Pieter A.; Loh, Peter; Wilde, Arthur A.; Hassink, Rutger J. (2016). "Idiopathic Ventricular Fibrillation". Circulation: Arrhythmia and Electrophysiology. 9 (5). doi:10.1161/CIRCEP.115.003817. ISSN 1941-3149.
  14. ↑ Yamashina, Y.; Yagi, T.; Namekawa, A.; Ishida, A.; Sato, H.; Nakagawa, T.; Sakuramoto, M.; Sato, E.; Yambe, T. (2011). "Prevalence and characteristics of idiopathic right ventricular outflow tract arrhythmias associated with J-waves". Europace. 13 (12): 1774–1780. doi:10.1093/europace/eur256. ISSN 1099-5129.
  15. ↑ Henriques de Gouveia R, Corte Real Gonçalves F (2019). "Sudden cardiac death and valvular pathology". Forensic Sci Res. 4 (3): 280–286. doi:10.1080/20961790.2019.1595351. PMC 6713097 Check |pmc= value (help). PMID 31489394. Vancouver style error: initials (help)
  16. ↑ Israel CW (2014). "Mechanisms of sudden cardiac death". Indian Heart J. 66 Suppl 1: S10–7. doi:10.1016/j.ihj.2014.01.005. PMC 4237287. PMID 24568819.
  17. ↑ Akhtar M, Elliott PM (November 2019). "Risk Stratification for Sudden Cardiac Death in Non-Ischaemic Dilated Cardiomyopathy". Curr Cardiol Rep. 21 (12): 155. doi:10.1007/s11886-019-1236-3. PMC 6877704 Check |pmc= value (help). PMID 31768884.
  18. ↑ Goldenberg I, Horr S, Moss AJ, Lopes CM, Barsheshet A, McNitt S, Zareba W, Andrews ML, Robinson JL, Locati EH, Ackerman MJ, Benhorin J, Kaufman ES, Napolitano C, Platonov PG, Priori SG, Qi M, Schwartz PJ, Shimizu W, Towbin JA, Vincent GM, Wilde AA, Zhang L (January 2011). "Risk for life-threatening cardiac events in patients with genotype-confirmed long-QT syndrome and normal-range corrected QT intervals". J Am Coll Cardiol. 57 (1): 51–9. doi:10.1016/j.jacc.2010.07.038. PMC 3332533. PMID 21185501.
  19. ↑ Sara, Jaskanwal D.; Eleid, Mackram F.; Gulati, Rajiv; Holmes, David R. (2014). "Sudden Cardiac Death From the Perspective of Coronary Artery Disease". Mayo Clinic Proceedings. 89 (12): 1685–1698. doi:10.1016/j.mayocp.2014.08.022. ISSN 0025-6196.
  20. ↑ O'Mahony C, Elliott P, McKenna W (April 2013). "Sudden cardiac death in hypertrophic cardiomyopathy". Circ Arrhythm Electrophysiol. 6 (2): 443–51. doi:10.1161/CIRCEP.111.962043. PMID 23022709.
  21. ↑ Qiu M, Lv B, Lin W, Ma J, Dong H (December 2018). "Sudden cardiac death due to the Wolff-Parkinson-White syndrome: A case report with genetic analysis". Medicine (Baltimore). 97 (51): e13248. doi:10.1097/MD.0000000000013248. PMC 6320009. PMID 30572429.
  22. ↑ Zheng, Jingjing; Zheng, Da; Su, Terry; Cheng, Jianding (2018). "Sudden Unexplained Nocturnal Death Syndrome: The Hundred Years' Enigma". Journal of the American Heart Association. 7 (5). doi:10.1161/JAHA.117.007837. ISSN 2047-9980.
  23. ↑ Viskin S (May 2017). "Idiopathic Polymorphic Ventricular Tachycardia: a "Benign Disease" with a Touch of Bad Luck?". Korean Circ J. 47 (3): 299–306. doi:10.4070/kcj.2016.0303. PMC 5449521. PMID 28567077.
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