Frequency Of Sudden Death Research Articles

Forensic medical characteristics of the prevalence of sudden death from cardiovascular diseases in the constituent entities of the Russian Federation

The purpose of the study is to study the prevalence and frequency of sudden death (SD) from cardiovascular diseases (CVD) in the structure of non-violent death, taking into account the socio-economic development of the constituent entities of the Russian Federation. We analyzed the frequency of this indicator, compared it with the data of the Federal State Statistics Service, and determined the overall dynamics. We conducted a non-parametric analysis of the initial data, carried out clustering and visualization based on the following parameters of the initial sample: «CVD mortality in the structure of non-violent death», «morbidity» and «per capita income level». Correlation dependences of the level of mortality from CVD according to the form 42 on the indicated indicators of the socio-economic condition of the subject were determined. Identified subjects of the Russian Federation with an increase in mortality from CVD; established the dependence of the level of VS on CVD and a number of medical and economic indicators.

Fragmentation of narrow QRS complex of sinus origin in patients with postinfarction cardiosclerosis as prognostic criterion for course of coronary heart disease

Fragmentation of a QRS complex is an ECG-phenomenon resulting from non-uniform activation of the ventricular myocardium in the background of cicatricial, fibrous changes. This indicator is associated with adverse outcomes (including the development of life-threatening arrhythmias, sudden death) in patients with various cardiovascular pathologies, including ischemic heart disease. Objective. To study the effect of fragmentation of a narrow sinus QRS complex on the frequency of visits to outpatient hospitals, hospitalization in cardiology hospitals, the frequency of implantation of ECS, recurrent heart attacks and deaths in patients with myocardial infarction in history. Assess the prognostic significance of the prevalence and different localization of QRS fragmentation. Material and methods. The study included 137 patients with postinfarction cardiosclerosis and CHF with preserved LV EF, who were hospitalized in the years 2013-2018. The main group (with QRS fragmentation) included 39 patients, the control group (without fragmentation) had 98 ones. The groups were comparable in age and sex. We analyzed the surface ECG in 12 leads using the following fragmentation criteria: notch R (S) or RSR notch in at least two leads corresponding to the same zone of origin with a QRS duration of less than 120 ms. Results. Total mortality (12 [30.8 %] vs 14 [14.3 %]) and the frequency of sudden death (5 [12.8 %] vs 3 [3.1 %]) were significantly higher in the group with QRS fragmentation. In cases with a fatal outcome, the median number of leads with QRS fragmentation was greater (5 vs 2; p xy = 0.77; p < 0.001). The risk of recurrent heart attack in the main and control groups was not significantly different. The chances of an ECS-implantation among patients with fragmentation were 20.1 times higher than in the control group (p < 0.001; OR: 20.1; 95 % Cl: 6.2-65.7). Among patients requiring installation of an ECS, fragmentation of the ventricular complex was on average encountered in a larger number of leads (p = 0.049). Fragmentation on the lower wall of the left ventricle was a factor that increased the chances of implanting an ECS by 18.7 times (p = 0.005; OR: 18.7; 95% Cl: 2.1-167.3). Findings. The presence of fragmentation of a narrow sinus QRS complex in two or more ECG leads in patients with post-infarction cardiosclerosis is associated with a significant increase in the frequency of visits to outpatient medical facilities and the frequency of hospitalizations; the frequency of arrhythmic events requiring the implantation of an ECS; an increase in overall mortality and the risk of sudden death, but not associated with a significant risk of recurrent heart attacks. With increase in number of assignments with fragmentation of QRS the frequency of hospitalizations increases. Fragmentation on the bottom wall increases the chances of installing an ECS, and fragmentation on the side wall is a marker of an unfavorable outcome.

The sudden death among the young persons under effect of the different forms of physical loads

The present review of the literature publications concerns the problem of sudden death (SD) among the young persons under effect of the different forms of physical loads. The statistical data on the frequency of sudden death are presented together with information about risk factors of SD, the morphological substrates and structural changes that promote death coming. The cases of sudden death among the young persons associated with the amateur sports activities and the professional sport of records are presented. The role of physical exercises and psycho-emotional stresses in the development of the terminal processes is considered with special reference to the risk factors and genetic predisposition to sudden cardiac death, largely among male athletes. The questions of sudden death in connection with cardiac pathologies as its main causes are discussed.

Fast Progressing His-Purkinje Conduction Disturbances in a Myotonic Dystrophy Pacient.

Myotonic dystrophy leads to multiple systemic complications and the age of death is earlier in myotonic dystrophy patients than in the general population. These patients have a high frequency of sudden death related to respiratory failure, cardiac arrhythmias and in particular to cardiac conduction disturbances. Prophylactic pacemaker implantation should be considered in asymptomatic myotonic dystrophy patients, which in the early stages of disease present minor conduction disturbances in 12-leads ECG. Even if the rate of progression of conduction abnormalities is usually slow, fast progression has been often observed thus making the clinical course of individual patients rather unpredictable.

P-136: Do sudden death & fatal myocardial infarction have the same risk factors in primary prevention?

Objectifs Sudden death, defined as a death which happens within 1 hour from the first symptom, is classified commonly as a coronary accident. Myocardial infarction is proposed as principal cause of sudden death. The frequency of sudden death is higher than that of fatal myocardial infarction. A recent overview showed that blood pressure lowering drugs did not decrease sudden death risk, whereas they decrease the risk of fatal myocardial infarction. We analyzed here the risk factors of sudden death and fatal myocardial infarction to provide more insight of the relation between these two accidents. Methodes We used Cox model to build the risk scores for two studied accidents on R (version 3.2.2), based on 15279 individual data in placebo group from seven randomized controlled trials (six of INDANA database in hypertension & one in type 2 diabetes Diahhycab). Resultats Sudden death and fatal myocardial infarction had the same five significant risk factors: age, sex (male), smoking, systolic blood pressure and type 2 diabetes history. Cholesterolemia was a significant predictor for fatal myocardial infarction but not for sudden death. Male sex and smoking displayed stronger associations with fatal myocardial infarction than sudden death, whereas type 2 diabetes history demonstrated the opposite tendency (Table 1). Table 1 . Comparison of risk factors of sudden death and of fatal myocardial infarction, using Cox model (maximum duration of follow up was 12 years) Sudden death Fatal myocardial infarction Hazard ratio p-value Hazard ratio p-value Age (5 years) 1.16 (1.11 – 1.22) 1.63e-10*** 1.18 (1.13 – 1.23) 1.97e-14*** Sex (male) 1.73 (1.18 – 2.54) 2.12 (1.52 – 2.97) 1.05-05*** Smoking 1.76 (1.26 – 2.45) 2.20 (1.66 – 2.93) 5.93e-08*** Systolic blood pressure (cm Hg) 1.05 (1.01 – 1.09) 0.026* 1.06 (1.02 – 1.10) History of type 2 diabetes 2.01 (1.23 – 3.26) 1.79 (1.17 – 2.75) Cholesterolemia (mmol/l) 1.10 (0.96 – 1.26) 0.166 1.20 (1.08 – 1.33) Conclusion In our trial database, sudden death and fatal myocardial infarction were associated with the same common cardiovascular risk factors.

STUDING OF SUDDEN DEATHS IN MOSCOW

In this retrospective study, we report the frequency and main causes of sudden deaths in Moscow over 3year period. Frequency of sudden death is 78 134 cases. Males were 63.0% of cases. The incidence of sudden death was highest in the 2 age extremes (39% were 40–59 year old and 57.5% were elderly). The most important direct causes of sudden death were cardiovascular diseases (93%). 15% of outpatient medical records were filled in the course of pronouncement of death. A divergence in diagnosis occurred in 45.1 % of cases.

Quand implanter un stimulateur cardiaque dans la maladie de Steinert ?

Myotonic dystrophy is the most frequent adult form of hereditary muscular dystrophy caused by a mutation on the DMPK gene. Myotonic dystrophy leads to multiple systemic complications related to weakness, respiratory failure, cardiac arrhythmias and cardiac conduction disturbances. Age of death is earlier in myotonic dystrophy patients than in general population with a high frequency of sudden death. Several mechanisms are involved in sudden death: atrio-ventricular block, severe ventricular arrhythmias or non-cardiac mechanism. The high degree of atrio-ventricular block is a well-recognized indication of pacemaker implantation but the prophylactic implantation of pacemaker should be considered to prevent sudden death in asymptomatic myotonic dystrophy patients. A careful clinical evaluation needs to be done for the identification of patients at high risk of sudden death. The resting ECG and SA ECG are non-invasive tools useful to select the patients who need an electrophysiologic study. In presence of prolonged HV interval more than or equal to 70 ms one can discuss the implantation of a prophylactic pacemaker. The choice of an implantable cardiac defibrillator is preferred in presence of spontaneous ventricular tachycardia or an alteration of the left ventricular ejection fraction.

Defibrillator Implantation for the Primary Prevention of Sudden Death in Patients Awaiting Cardiac Transplantation: One Center's Experience

Patients who are on a waiting list for cardiac transplantation often have a clinical profile that satisfies current recommendations for the implantation of an implantable cardioverter defibrillator (ICD) for the primary prevention of sudden death. The prospect that transplantation may take place within the short-to-medium term puts the effectiveness of this therapy in doubt. We investigated the incidence of therapy delivered by ICDs implanted for primary prevention in patients awaiting cardiac transplantation. Recent changes in the incidence of sudden death at our center were also investigated. Data on 308 patients listed for heart transplantation between 1998 and 2008 were reviewed. An ICD was indicated for primary prevention at initial evaluation in 17 patients. Of these, 53% received appropriate ICD therapy while carrying an ICD for a mean period of 7.8 ± 4.8 months. Only one patient received inappropriate therapy and none had any complications associated with device use. The frequency of sudden death has decreased over the course of recent years.

Implante de desfibrilador como prevención primaria de muerte súbita en pacientes en lista de espera de trasplante cardiaco: experiencia de un centro

Patients who are on a waiting list for cardiac transplantation often have a clinical profile that satisfies current recommendations for the implantation of an implantable cardioverter–defibrillator for the primary prevention of sudden death. The prospect that transplantation may take place within the short-to-medium term puts the effectiveness of this therapy in doubt. We investigated the incidence of therapy delivered by implantable cardioverter–defibrillators implanted for primary prevention in patients awaiting cardiac transplantation. Recent changes in the incidence of sudden death at our center were also investigated. Data on 308 patients listed for heart transplantation between 1998 and 2008 were reviewed. An implantable cardioverter–defibrillator was indicated for primary prevention at initial evaluation in 17 patients. Of these, 53% received appropriate implantable cardioverter–defibrillator therapy while carrying an implantable cardioverter–defibrillator for a mean period of 7.8 months (±4.8). Only one patient received inappropriate therapy and none had any complications associated with device use. The frequency of sudden death has decreased over the course of recent years. Full English text available from: www.revespcardiol.org

Survey of Sudden Death From Aneurysmal Subarachnoid Hemorrhage in Cadavers Referred to Legal Medicine Organization of Tehran, 2001–2005

Some cases with aneurysmal subarachnoid hemorrhage (SAH) never reach the medical centre alive and they are not included in most studies of SAH. To explain the clinical profile of sudden death from aneurysmal SAH, we examined the epidemiology and clinicopathologic characteristics of patients with aneurysmal SAH who never reached medical attention or died within first 24 hours of the onset of first symptoms. Using the autopsy records in Legal Medicine Organization of Tehran, we identified all cadavers who were diagnosed with aneurysmal SAH between 2001 and 2005. There were 85 women and 60 men with a mean age of 50 years. Twenty patients (14%) died without reaching medical care and 58 (40%) died within first 24 hours of the onset of first symptoms. The remnant had died after 24 hours to 28 days of hospitalization. In comparing patients with sudden death versus remnant, the main variables were the frequency of posterior circulation aneurysms that was found in 59% compared with 19.4% in those who had died after 24 hours, intraventricular hemorrhage 53.8% versus 19.4%, and pulmonary edema 92.3% versus 34.3% (P = 0.01). In our population, the frequency of sudden death from aneurysmal SAH has not changed during the last 5 years. The typical clinical profile of sudden death in SAH includes intraventricular hemorrhage, pulmonary edema, and a ruptured posterior circulation aneurysm. Intracerebral hemorrhage is rarely connected to sudden death from aneurysmal SAH.

La mort subite du sportif est-elle si fréquente ?

Summary Generality: Cardiac disease is frequently responsible for sudden death in sport Age is the most useful variable to predict the cause of sudden death in athletes Hypertrophic cardiomyopathy, congenital anomalies of coronary arteries, myocarditis and arrythmogenic right ventncular dysplasia are often implicated in the under 35 year olds. After this age. sudden deaths in sport are often due to ischemic heart disease Design: A retrospective study took the census of exercise-related sudden death cases during 1994 in France. All French emergency units were contacted Results: We obtained a response rate of 58%. Only 36 deaths were reported. The rate of sudden cardiac death during sporting activity was 78%: 81% of victims were over 35 years old. Ventricular fibrillation represented the final pathway for death in 46% of cases and 13% of deaths were observed during recovery. Fifty seven percent of victims had either underlying cardiac diseases, a history of sudden death in relatives, or chest pain. This inquiry allowed us to expect 300 sudden deaths in sport each year in France Conclusion: Most of these deaths were foreseeable. Continued education of athletes and adapted training appear to be the best way to help reduce the frequency of sudden death in sport. This retrospective study has not confirmed postulated predictions of sudden death in sport incidence. Unfortunately, statistical points prevent this study from doubting the usual advanced averages concerning sudden death in sport.

Sudden unexpected deaths from ruptured abdominal aortic aneurysms

The first successful resection of an abdominal aortic aneurysm was carried out in 1951.' Interest in these aneurysms has increased since then; ~ several studies have reported an increase in the incidence of ruptured abdominal aortic aneurysms (RAAAs) over the last few years. 1,34 For patients with RAAAs, surgery is the only hope of survival, 7 however 55-86% of all RAAA deaths occur before any attempts at treatment can be madeY ,8-1° The mortality rate for patients undergoing surgical repair of a ruptured aneurysm ranges from 55-68%, 3,~,8-1° compared with 3-8% for elective repair of a non-ruptured aneurysm? ,8,H The frequency of sudden death from these aneurysms, defined as death in which the RAAA is first diagnosed at a postmortem examination, is not accurately known? The postmortem records at the University of Edinburgh's Forensic Medicine Unit (FMU) provide a useful source of information for these deaths as they cover all uncertified sudden and unexplained deaths occurring in Lothian Region in the South East of Scotland and in the Borders. The aims of this study were: (1) to establish the number of deaths from RAAAs as recorded by the Edinburgh University FMU, (2) to describe the characteristics of this cohort of patients and (3) to compare these features with other published series of patients dying from RAAAs.

Sudden death from aneurysmal subarachnoid hemorrhage

Some patients with aneurysmal subarachnoid hemorrhage (SAH) never reach the hospital alive ("sudden death") and, although their numbers are significant, they are not included in most studies of SAH. To clarify the clinical profile of sudden death from aneurysmal SAH, we reviewed the epidemiology and clinicopathologic features of patients with aneurysmal SAH who never reached medical attention. Using the medical record linkage system employed for epidemiologic studies for the population of Rochester, Minnesota, we identified all patients who were diagnosed with aneurysmal SAH between 1960 and 1989. There were 80 women and 33 men with a mean age of 55 years. Of these 113 patients, 13 (12%) died without reaching medical attention. The proportion of those with sudden death remained stable during the study period. In comparing patients with sudden death with those who reached medical attention, the only significant variable was the frequency of posterior circulation aneurysms that was found in 38%, compared with 14% in those who received medical attention (p = 0.042). At autopsy, intraventricular hemorrhage was present in 12 patients (92%) with sudden death, and intracerebral hemorrhage was present in two (15%). Twelve patients (92%) had acute pulmonary edema. In our community, the frequency of sudden death from aneurysmal SAH has not changed during the last three decades in spite of the advances in medical care. The typical clinical profile of sudden death in SAH includes intraventricular hemorrhage, pulmonary edema, and a ruptured posterior circulation aneurysm. Intracerebral hemorrhage is uncommonly associated with sudden death from aneurysmal SAH.

Morning Resistance to Thrombolytic Therapy

The Multi-center Investigation on the Limitation of Infarct Size (MILIS), begun just before the thrombolytic era of the treatment of acute myocardial infarction (MI), focused in part on the timing of therapies designed to limit infarct size.1 Careful recording of the time of both the onset of symptoms and of the rise of creatine kinase-MB enzyme activity permitted accurate timing of infarction, revealing a circadian pattern with a distinct morning peak. The database of the larger Thrombolysis in Myocardial Infarction (TIMI) II trial allowed prospective testing of our earlier observation in MILIS. The increased incidence of onset in the morning (6 am to noon, 34%), compared with night (midnight to 6 am, 15%), was even more prominent than in MILIS.2 Indeed, in almost one half of a subgroup of patients in TIMI, infarction began between 6 am and noon. Rather than relegating these curious findings to the files, Muller, Tofler, and a growing number of other investigators sensed correctly that research into the mechanisms responsible for the morning peak in the onset of infarction might lead to a better understanding of the pathogenesis of this condition3 and thereby aid in the development of preventive strategies. Their efforts have taken several interesting directions. First, in addition to acute MI, a morning increase in sudden death was described4 and found to be secondary to ventricular fibrillation, rather than to other arrhythmias.5 In the Cardiac Arrhythmia Suppression Trial (CAST), the higher mortality in patients receiving type 1c antiarrhythmic drugs could be explained in part by an excess of morning deaths in patients receiving these agents.6 A circadian variation in the frequency of sudden death appears to be especially prominent in patients with heart failure; Moser et al7 reported a 2.5-fold increase in the risk of …

Mortality in heart failure: clinical variables of prognostic value.

One hundred and fifty two patients with chronic heart failure caused primarily by left ventricular dysfunction were followed prospectively in an open study for a mean period of 21 months. The effects of several clinical variables on subsequent outcome were examined, including the effects of treatment, which was determined by the clinician caring for the patient and was not randomly allocated. In order of importance, frequent ventricular extrasystoles, non-treatment with amiodarone, low mean arterial pressure, and a diagnosis of coronary artery disease were associated with a poor prognosis, with each of these variables providing extra predictive information independently of the others. Initial serum potassium concentration and treadmill exercise time also carried further weak but independent prognostic information. Neither treatment with angiotensin converting enzyme inhibitors nor digoxin appeared to affect outcome. Left ventricular function (as reflected by M mode echocardiography) and the dose of diuretic also failed to predict outcome. There did, however, appear to be a reduction in the frequency of sudden death when angiotension converting enzyme inhibitors were given. Further studies are required to confirm the adverse prognostic significance of ventricular arrhythmias in patients with heart failure and the possible benefit associated with amiodarone treatment.

Cardiac atrioventricular junctional tissues in hearts from infants who died suddenly

The cause of sudden infant death syndrome is not known at present. Most agree that in the majority of cases it involves primary apnea. However, cardiac abnormalities probably account for a subset of these deaths. An investigation into the structure of the atrioventricular (AV) junctional tissues of the heart would provide insight into the frequency of sudden death in infants that might result from abnormal cardiac morphology. The hearts of seven infants who died from diagnosed sudden infant death syndrome were examined by serially sectioning and studying this critical region of the heart. The hearts of these infants could be divided into three groups on the basis of their morphologic features. In the first group, represented by two cases, there were marked variations from normal, the most striking feature being the presence of accessory pathways. In the second group, represented by four cases, the AV junctional tissues were not fully mature and clusters of AV nodal and bundle cells were dispersed throughout the anulus fibrosus. In the third group, the structure of the junctional tissues was normal. There remains a distinct subset of infants who might have died suddenly and unexpectedly from cardiac abnormalities that needs to be more completely defined.

Beta-blocking drugs for arrhythmias, hypertension, and ischemic heart disease

Beta-blocking drugs have provided significant improvement in the medical therapy of many types of heart disease. They are more effective in treating young hypertensive patients than elderly hypertensive patients. These drugs reduce the ventricular rate seen in atrial flutter and fibrillation, and they also reduce the frequency of ventricular ectopy. Beta blockers are important adjuncts for control of angina pectoris. When these drugs are given for a period of 1 to 3 years after myocardial infarction they reduce the incidence of reinfarction and the frequency of sudden death as well as reduce the overall mortality rate. Factors that may contribute to the overall decreased mortality include the reduction in the reinfarction rate and an increased threshold for ventricular fibrillation as well as those mechanisms that reduce myocardial oxygen utilization.

Identifying patients at risk of sudden death after myocardial infarction: Value of the response to programmed stimulation, degree of ventricular ectopic activity and severity of left ventricular dysfunction

The ability of programmed ventricular stimulation to identify risk of sudden death after acute myocardial infarction (MI) was compared with 24-hour electrocardiographic assessment of ventricular ectopic activity and determination of left ventricular (LV) dysfunction. Forty-six patients underwent programmed stimulation 8 to 60 days (mean 22) after documented MI. Programmed stimulation consisted of single and double extrastimuli from the right ventricular apex at 2 times diastolic threshold during ventricular pacing and normal sinus rhythm. Of the 46 patients, 44 underwent electrocardiographic monitoring at least 6 days after MI. In 43 of the 46 patients, LV ejection fraction (EF) and the presence of LV aneurysm were determined. In response to programmed ventricular stimulation, 5 patients had sustained ventricular tachycardia (VT), 5 had nonsustained VT (≥4 beats), 13 had intraventricular reentrant repetitive responses, and 23 had either bundle branch reentrant repetitive responses or no extra responses to programmed ventricular stimulation (negative study). During a mean follow-up of 18 months, 10 patients died, 6 suddenly. One of the 10 patients with sustained or nonsustained VT died suddenly, compared with 3 of 13 patients with intraventricular reentrant responses and 2 of 23 patients with a negative study (difference not significant). Of 25 patients with Grade 0 to 2 ventricular ectopic activity, 3 died suddenly after MI, compared with 3 of 19 patients with Grade 3 or 4 activity (difference not significant). By comparison, the frequency of sudden death was greater in patients with an LVEF of <40% (5 of 16 versus 1 of 27 patients) or an LV aneurysm (5 of 13 versus 1 of 30 patients). Thus, using the described protocol, the response to programmed ventricular stimulation is not helpful in identifying patients at risk for sudden death after MI. The presence of an LV aneurysm or EF of <40% appears to provide the greatest prognostic information with respect to risk for sudden cardiac death.

ALCOHOL AND OTHER DISCRIMINANTS BETWEEN CASES OF SUDDEN DEATH AND MYOCARDIAL INFARCTION

A register of acute coronary events in Auckland, New Zealand collected data on both cases of definite myocardial infarction not dying suddenly, and cases of sudden cardiac death. This paper compares these two syndromes with respect to several clinical and pathologic variables. The following variables discriminated between these two syndromes significantly: season of the year, painful prodromal symptoms, use of digoxin and/or furosemide, age, race, alcohol consumption over the previous one year. Possible biases and sources of confounding are discussed. Heavy alcohol consumers have a higher proportion of coronary events as sudden deaths. This proportionate increase is probably due, in part at least, to an absolute increase in the frequency of sudden death. The data are supportive of the idea that persons with a high alcohol consumption who also suffer myocardial infarction are more likely to die suddenly with the infarction. The rather conflicting data from many other studies are discussed. A model is proposed, based on reported data that could explain the present findings and those previously reported by others.

Postmortem diagnosis of ventricular fibrillation by K and Na distribution in the myocardium and skeletal muscle in out-of-hospital sudden death from acute ischemic heart disease

Summary The reasons for the absence of the exact data on the frequency of sudden death from ventricular fibrillation in patients with acute ischemic heart disease are considered. The method for the postmoortem diagnosis of ventricular fibrillation occurring out-of-hospital by exclusion of other causes of sudden coronary death (heart rupture, thromboembolism, heart failure, and cardiogenic shock) is suggested. Heart rupture and thromboembolism are excluded at autopsy. Ventricular fibrillation (instantaneous death) is differentiated from heart failure and cardiogenic shock (non-instantaneous death) on the basis of the length of time it takes the patient to die, which is determined by K and Na distribution in the myocardium and skeletal muscle. This was studied in four groups of people who died both instantaneously and non-instantaneously, both from coronary and from non-coronary diseases. The main sign of coronary death was the local decrease in concentration of K in the left ventricle. Instantaneous coronary death was characterized by an almost normal content of K in the skeletal muscle and non-instantaneous coronary death was characterized by a decrease of K content both in the left ventricle and in the skeletal muscle. Possible reasons for these differences are discussed. The frequency of out-of-hospital sudden death was studied in Krasnoyarsk during a three year period by the above method and compared with the same frequency of deaths occurring in hospital.