ICL 4.1: Sudden Cardiac Death Flashcards
what is sudden cardiac death?
the abrupt cessation of heart function = cardiac arrest
usually due to ventricular arrhythmia
how many people are effected by SCD?
350,000/year
most of them are young athletes – football and basketball have the highest numbers
1:40,000 to 1:80,000 per year which is 100-150 deaths during competitive sports each year
what are the most common causes of SCD?
over 35 years old = CAD
under 35 = congenital and acquired abnormalities
what are the common cardiovascular conditions associated with SCD?
- hypertrophic or dilated cardiomyopathy
- congenital anomalies of the coronary artieries
- Kawasaki’s disease
- Wolf-Parkinson-White syndrome
- long QT syndrome
- myocarditis
- Marfan’s syndrome
what are the genetics, EKG findings, echo findings and indications for BB associated with hypertrophic cardiomyopathy?
AD inheritance
EKG: large QRS waves
echo: hypertrophy is in the septum as opposed to being symmetrical like with HTN
BB help the symptoms but it doesn’t prevent SCD
which coronary artery anomalies are associated with SCD?
the origin of the right coronary artery from the left sinus of Valsalva is the most common anomalous origin
if pt. is having exertion chest pain, syncope or palpitations, consider stress testing if they have risk factors even if they look healthy
how can marfan’s syndrome cause SCD?
AD fibrillin 1 mutation that most commonly leads to aortic dissection
there’s an enlarged aorta and as it gets bigger, the aneurysm balloons out till it gets to the point that it bursts
what are the PE clues that indicate Marfan’s?
- symmetric pectus excavatum = caved in chest
- myopic with lens subluxation = looks like a quarter moon
- wrist sign and thumb sign = can you wrap your pinky and thumb all the way around your wrist? when you put your hand in a fist, does your thumb stick out?
- SUPER long legs and arms
what are the cardiac findings associated with Marfan’s?
- aortic roo dilation
2. valve issues; especially mitral regorge or MVP
which dysarrythmias can cause SCD?
- long QT syndrome
- Brugada’s syndrome
- Wolf Parkinson White
these patients often complain of dizziness or syncope
what is commotio cortis?
ventricular fibrillation in totally healthy people that gets brought on because of a blunt force trauma to the chest
you get hit at the exact time that the heart is in ventricular repolarization and it sends the heart into Vfib which can cause SCD
ex. get hit in the chest with a baseball so it’s common in male baseball players
how do we prevent SCD?
it’s very challenging…because sometimes the first clue that they have a problem is they collapse in SCD
- pre-participation exam (sports physicals)
- treat cause or exacerbating factors when able
- be prepared for SCA (training, ACD)
- Lyndsay’s Law
what is Lyndsay’s Law?
put into effect to try and prevent SCD
it enforces a pre-participation exam sports physical that makes sure students are able to play
the participation exam form includes all the proper screening questions and parts of the PE that are necessary to see if someone is at risk for SCD
it also mandates that all coaches and trainers have to be educated on symptoms of SCD and how to address them so that more people are looking out for it and know how to handle it
how do you screen for SCD?
- abnormal EKG
- echo changes
- exercise stress testing
- MRI
- genetic testing
- ambulatory rhythm monitoring
any abnormal results you should consider referral to a cardiologist
what are the pros of using an EKG or echo to screen for HCM?
they may detect conditions that put athlete at risk and potentially allow intervention prior to an adverse event
however, they cost money and it could lead to kids not being involved in sports just because they can’t afford to get an EKG – also a normal test doesn’t always exclude the condition
