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Sudden Cardiac Death

What is sudden cardiac death?

Sudden cardiac death (SCD) is an unexpected death that occurs within one hour of the onset of symptoms and that results from heart disease whose presence is known or unknown. Most often, SCD is the result of ventricular arrhythmias – irregularities in the beating of the lower chambers of the heart – that cause cardiac arrest. The most common cause of cardiac arrest in adults is ventricular fibrillation – an arrhythmia in which the ventricles of the heart fall in to a rapid chaotic pattern of contraction that causes the heart to stop beating.

If a patient collapses because of ventricular fibrillation, it is extremely important to restore normal circulation within minutes, a process called "defibrillation". Because patients might not always have immediate access to emergency care and defibrillation, the best treatment option for patients at risk is preventative therapy.

Sudden cardiac death should be distinguished from a "heart attack". Sudden cardiac death is due to the collapse of the normal circulation, most often due to ventricular fibrillation. A heart attack refers to a sudden blockage in a coronary artery (an artery that supplies blood to the heart), which causes the death of heart muscle. A heart attack can cause dangerous rhythm abnormalities, which can lead to sudden death. This can happen within minutes or hours of a heart attack. Sudden death can also occur in patients who have previously had heart attacks, even if the patient is not actively having a heart attack

How are those at risk for SCD identified?

Clinical features and new diagnostic technology can predict those at risk for life-threatening ventricular arrhythmias than can cause SCD.  Patients with prior heart attacks resulting in reduced function of the left ventricle and those with congestive heart failure may be at risk of SCD. Diagnostic tests that predict SCD include invasive electrophysiologic studies, and non-invasive tests like T-wave alternans testing.

How are those at risk for sudden cardiac death treated?

A first principle in preventing SCD is to determine whether or not a patient has coronary artery disease. If severe coronary artery disease is present, it is usualy necessary to restore normal blood flow and stabilize the heart with medications or procedures such as angioplasty or coronary artery bypass surgery.

For those at risk for life-threatening arrhythmias, treatments are now available that can prevent catastrophic SCD. The most effective treatment is the implantable cardioverter defibrillator, which is a device implanted in the chest that can deliver an electrical shock to restart a heart in ventricular fibrillation.

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