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MEDICINE II
1.1E CARDIAC ARREST AND SUDDEN CARDIAC DEATH
Term
Death
Cardiac Arrest
Cardiovascular
Collapse
DEFINITION OF TERMS
Definition
Qualifiers or
Exceptions
Irreversible cessation
None
of all biologic
functions
Abrupt cessation of
Rare spontaneous
cardiac pump
reversions; likelihood
function, which may
of successful
be reversible but will
intervention relates to
lead to death in the
mechanism of arrest,
absence of prompt
clinical setting and
intervention
time of intervention
A (sudden) loss of
Nonspecific term that
effective blood flow
includes cardiac
caused by cardiac
arrest and its
and/or peripheral
consequences and
vascular factors that
also events that revert
may revert
spontaneously
spontaneously (such
as syncope) or only
with intervention
CARDIAC ARREST
Cardiac arrest is expected:
- Life threatening illness
- Severe injuries
Cardiac arrest is not expected
- Sudden cardiac death
SUDDENT CARDIAC DEATH (SCD)
Natural death from cardiac causes, heralded by an abrupt loss
of consciousness within 1 hour after the onset of an acute
change in CV status
Pre-existing heart disease may or may not have been known to
be present but the time and mode of death are unexpected
Usual causes:
Coronary atherosclerosis
Dilated cardiomyopathy
Infiltrative heart disease
Valvular heart disease
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Medicine II
HYPERTROPHIC CARDIOMYOPATHY
The heart muscle
(myocardium) becomes
abnormally thick
(hypertrophied). The
thickened heart muscle
can make it harder for the
heart to pump blood.
DILATED CARDIOMYOPATHY
Usually starting in your
heart's main pumping
chamber (left ventricle). The
ventricle stretches and thins
(dilates) and can't pump
blood as well as a healthy
heart can.
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Medicine II
VENTICULAR FIBRILLATION
VENTRICULAR TACHYCARDIA
TORSADES DE POINTES
Hemodynamically stable VT
Hemodynamically unstable VT
Cardiac arrest
- Asystole (sinus arrest, high grade AV block)
- Ventricular tachycardia (VT)
- Ventricular fibrillation (VF)
- Pulseless electrical activity (PEA)
EMERGENCY MANAGEMENT OF SCD: CARDIOPULMONARY
RESUSCITATION
Medicine II
PREVENTION OF SCD
Secondary prevention (postcardiac arrest survivors)
Primary prevention
- Advanced structural heart disease with LVEF < 35%
- Less advanced structural heart disease with LVEF > 35%
- Structurally normal heart with molecular disorders associated
with increased risk of ventricular arrhythmias
- General population
Implantable cardioverter defibrillator (ICD); treatment of choice
Pharmacologic therapy
- Beta-blockers
- Amiodarone
- Sotalol
SUCCESSFUL DEFIBRILLATION BY ICD
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END OF TRANX
"What you do today can improve all your tomorrows." - Ralph Marston
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