History Of Sudden Cardiac Arrest Research Articles

Sudden cardiac arrest risk in young athletes

Underlying cardiac abnormalities are the main cause of unexpected death in athletes on field. These abnormalities have been associated with a previous history of syncope, a family history of sudden cardiac arrest (SCA), cardiac murmur, a history of over-exhaustion post exercise and ventricular tachyarrhythmia during physical activity. The timely diagnosis of susceptible athletes may assist with an appropriate management plan for these individuals, and allow for the prevention of premature death in sport. A young football player was screened for SCA risk using the fundamental components of the pre-participation examination (PPE) – essentially, a medical history, a resting and stress electrocardiogram, and an echocardiogram to support clinical findings. The case is submitted with consideration of the applicable literature to accentuate the importance of using PPE to prevent SCA in young athletes.

Sudden cardiac arrest risk in young athletes

Underlying cardiac abnormalities are the main cause of unexpected death in athletes on field. These abnormalities have been associated with a previous history of syncope, a family history of sudden cardiac arrest (SCA), cardiac murmur, a history of over-exhaustion post exercise and ventricular tachyarrhythmia during physical activity. The timely diagnosis of susceptible athletes may assist with an appropriate management plan for these individuals, and allow for the prevention of premature death in sport. A young football player was screened for SCA risk using the fundamental components of the pre-participation examination (PPE) – essentially, a medical history, a resting and stress electrocardiogram, and an echocardiogram to support clinical findings. The case is submitted with consideration of the applicable literature to accentuate the importance of using PPE to prevent SCA in young athletes.

Sudden cardiac arrest risk in young athletes

Underlying cardiac abnormalities are the main cause of unexpected death in athletes on field. These abnormalities have been associated with a previous history of syncope, a family history of sudden cardiac arrest (SCA), cardiac murmur, a history of over-exhaustion post exercise and ventricular tachyarrhythmia during physical activity. The timely diagnosis of susceptible athletes may assist with an appropriate management plan for these individuals, and allow for the prevention of premature death in sport. A young football player was screened for SCA risk using the fundamental components of the pre-participation examination (PPE) – essentially, a medical history, a resting and stress electrocardiogram, and an echocardiogram to support clinical findings. The case is submitted with consideration of the applicable literature to accentuate the importance of using PPE to prevent SCA in young athletes.

Sudden Cardiac Arrests, Automated External Defibrillators, and Medical Emergency Response Plans in Tennessee High Schools

Schools are important public locations of sudden cardiac arrest (SCA), and the American Heart Association (AHA) recommends medical emergency response plans (MERPs), which may include an automated external defibrillator (AED) in schools. The objective of this study was to determine the incidence of SCA and the prevalence of AEDs and MERPs in Tennessee high schools. Tennessee Secondary School Athletic Association member schools were surveyed regarding SCA on campus within 5 years, AED presence, and MERP characteristics. Of 378 schools, 257 (68%) completed the survey. There were 21 (5 student and 16 adult) SCAs on school grounds, yielding a 5-year incidence of 1 SCA per 12 high schools. An AED was present at 11 of 21 schools with SCA, and 6 SCA victims were treated with an AED shock. A linear increase in SCA frequency was noted with increasing school size (<500 students: 3.3% incidence, 500-1000: 6.5%, 1000-1500: 12.5%, ≥1500: 18.2%; P = 0.003). Of 257 schools, 71% had an MERP, 48% had an AED, and only 4% were fully compliant with AHA recommendations. Schools with a history of SCA were more likely to be compliant (19% vs. 3%, P = 0.011). The 5-year incidence of SCA in Tennessee high schools is 1 in 12, but increases to 1 in 7 for schools with more than 1000 students. Compliance with AHA guidelines for MERPs is poor, but improved in schools with recent SCA. Future recommendations should encourage the inclusion of AED placement in schools with more than 1000 students.

Genome-Wide Association Study Identifies GPC5 as a Novel Genetic Locus Protective against Sudden Cardiac Arrest

BackgroundExisting studies indicate a significant genetic component for sudden cardiac arrest (SCA) and genome-wide association studies (GWAS) provide an unbiased approach for identification of novel genes. We performed a GWAS to identify genetic determinants of SCA.Methodology/Principal FindingsWe used a case-control design within the ongoing Oregon Sudden Unexpected Death Study (Oregon-SUDS). Cases (n = 424) were SCAs with coronary artery disease (CAD) among residents of Portland, OR (2002–07, population ∼1,000,000) and controls (n = 226) were residents with CAD, but no history of SCA. All subjects were of White-European ancestry and GWAS was performed using Affymetrix 500K/5.0 and 6.0 arrays. High signal markers were genotyped in SCA cases (n = 521) identified from the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS) (combined n = 19,611). No SNPs reached genome-wide significance (p<5×10−8). SNPs at 6 loci were prioritized for follow-up primarily based on significance of p<10−4 and proximity to a known gene (CSMD2, GPR37L1, LIN9, B4GALNT3, GPC5, and ZNF592). The minor allele of GPC5 (GLYPICAN 5, rs3864180) was associated with a lower risk of SCA in Oregon-SUDS, an effect that was also observed in ARIC/CHS whites (p<0.05) and blacks (p<0.04). In a combined Cox proportional hazards model analysis that adjusted for race, the minor allele exhibited a hazard ratio of 0.85 (95% CI 0.74 to 0.98; p<0.01).Conclusions/SignificanceA novel genetic locus for SCA, GPC5, was identified from Oregon-SUDS and successfully validated in the ARIC and CHS cohorts. Three other members of the Glypican family have been previously implicated in human disease, including cardiac conditions. The mechanism of this specific association requires further study.

Seriously Stressed

Substance abuse—or more likely, its abrupt cessation—was a likely trigger for an unusual cardiac syndrome. A 25-year-old woman was brought to the emergency department from home after a seizure episode. En route to the hospital, the patient lost consciousness, and the emergency medical team discovered that she was in torsades de pointes, which then progressed to ventricular fibrillation. The patient was defibrillated to sinus tachycardia with a monophasic waveform shock of 360 J. She was successfully resuscitated, regained consciousness, and denied any chest pain or shortness of breath. On further questioning, she denied any past history of arrhythmia or family history of sudden cardiac arrest or unexplained death.

Abstract 3091: The Clinical and Electrocardiographic Phenotype of Unrelated Patients with Genotype-Negative Long QT Syndrome

Long QT syndrome (LQTS) is a heterogeneous group of channelopathies characterized by increased risk of potentially lethal ventricular arrhythmias. LQT1, LQT2, and LQT3 comprise 95% of genetically proven cases and exhibit a number of established genotype-phenotype correlations. The study aimed at examining the phenotypes of genotype-negative LQTS, accounting for ~25% of LQTS cases. An IRB-approved retrospective analysis was conducted on 56 patients (39 female, 25 ± 17 years) who, after genetic testing either in our sudden death genomics laboratory or with the commercially available Familion test, were negative for mutations in the 3 principal LQTS-susceptibility genes ( KCNQ1, KCNH2, and SCN5A), and the minor genes underlying LQT5 and LQT6. All had been diagnosed with LQTS, with a clinical diagnostic score of ≥ 3.5 or QTc ≥ 480 ms. The mean diagnostic score was 4.4 (95% CI 4.2 – 4.7); mean QTc was 525 ms (95% CI 508 – 543 ms). Two-thirds were symptomatic (syncope, cardiac arrest, and/or seizures) with exercise-triggered events in 10 (26%). Twenty-one (38%) had a family history of sudden cardiac arrest. ECG showed a T wave pattern suggestive of LQT1 in 32%, LQT2 in 43%, and LQT3 in 18%. In those with exercise-induced symptoms, the ECG was LQT2-like in 50% and LQT1-like in 30%. One patient had post-partum syncope with an LQT2-like ECG. None had an auditory trigger, but 3 patients, all with an LQT2-like ECG, had a family history of auditory-triggered events. One-third of the patients had received an ICD, 58% as secondary prevention. Over 2/3 were on beta-blockers. Among the 45 patients so far tested for mutations in minor LQTS-susceptibility genes, 2 had LQTS-causing mutations in ANKB (LQT4), 1 in SCN4B (LQT10), 1 in AKAP9 (LQT11) and 2 in SNTA1 (LQT12). Genotype-negative patients with a firm LQTS diagnosis show marked phenotypic heterogeneity, suggesting multiple underlying pathogenic pathways. Only a few patients have LQTS-causing mutations in minor genes after complete LQT1–12 genetic testing. Classifying genotype negative patients into LQT1-, LQT2-, or LQT3-like profiles may guide the discovery of novel genes encoding channel interacting proteins corresponding to those specific signaling pathways.

Novel Anatomical Findings of the Prostatic Gland and the Surrounding Capsular Structures in the Normal Prostate

With the increase of the patients with prostate cancer, the number of radical prostatectomy increased prominently. Meanwhile, surgeons and pathologists have difficulty regarding appropriate surgical dissection of the prostate and the pathological diagnosis. These problems are derived from uncertainty or misunderstanding about the precise anatomy. In fact, many surgeons are not confident of the structures of the prostatic gland, its surrounding capsules, and the sphincter. Here we investigated the surgical anatomy of the normal prostate to provide beneficial information regarding radical prostatectomy and subsequent pathological diagnosis. A 40 year-old cadaver with a history of sudden cardiac arrest was utilized in this study. Whole pelvic organs were extirpated en bloc and fixed in formalin. Whole mount step sections from the membranous urethra to the seminal vesicle were prepared and histologically examined. It has been reported that the prostatic parenchyma is covered with outside layer (lateral pelvic fascia) and inside layer (prostatic fascia, also known as "capsule"). Here, we show that nearly one third of the anterior surface of the apical region of the prostate (apical prostate) lacks this "capsule". The apical prostate is a mixture of striated muscles, glands, and elastic fibers. Furthermore, the glandular tissue exists within the anterior fibromuscular stroma and some region of the "capsule". Surgeons often try to preserve neurovascular bundles to maintain erectile function; however, other neural tissue was also observed over the entire surface of the prostate. Surgeons must be aware of these complicated anatomical structures when undertaking radical prostatectomy and subsequently diagnosing extra-prostatic extension.

Mood disturbance in patients with recurrent ventricular dysrhythmia before insertion of implantable cardioverter defibrillator

To examine the relationships among personal factors (demographic variables and trait optimism); situational factors (ejection fraction, functional status, history of sudden cardiac arrest); coping and appraisal processes; and mood disturbance in patients hospitalized for recurrent ventricular dysrhythmia before the insertion of an implantable cardioverter defibrillator (ICD). Descriptive and correlational. Five community and tertiary care hospitals in the southeast and midwest. Eighty-four men and 17 women (aged 24 through 79) scheduled to receive an initial implant of an ICD. VARIABLES AND MEASURES: Trait optimism measured by the Life Orientation Tool; coping measured by the Jalowiec Coping Scale; threat-and-challenge appraisal measured by the Meaning in Illness Questionnaire; functional status measured by the Heart Failure Functional Status Inventory; and total mood disturbance measured by the Profile of Mood States. Hierarchical regression analysis revealed that factors of age, sex, optimism, functional status, and history of sudden cardiac arrest accounted for 47% of the variance in the total mood disturbance score (F = 7.44, df = 11.68, p = 0.00) with female sex, and less trait optimism, higher threat appraisal, and more use of evasive coping behavior as significant predictors. These findings can be used to identify patients with recurrent ventricular dysrhythmia who are potentially at risk for mood disturbance in the acute care setting before ICD insertion. Nursing interventions to address these factors can be developed and tested. Longitudinal studies on the response to ICDs should include assessment of preinsertion affective state.

Short- and long-term experience with flecainide acetate in the management of refractory life-threatening ventricular arrhythmias

Thirty-eight patients with organic heart disease and history of sudden cardiac arrest or recurrent sustained ventricular tachycardia were treated with flecainide. Coronary artery disease was present in 33 patients. Previous antiarrhythmic therapy consisted of two to eight drugs (mean four). Fourteen patients were resuscitated from sudden cardiac death and 24 patients had chronic recurrent sustained ventricular tachycardia. Twenty-eight patients had electrophysiologic testing before and during flecainide treatment. Sustained ventricular tachycardia became noninducible in 5 patients, nonsustained in 5 patients and slowed in 13 patients (cycle length increased from 278 +/- 64 to 395 +/- 91 ms; p = 0.002). Three of the 14 patients with sudden cardiac death and 15 of the 24 patients with recurrent sustained ventricular tachycardia remained on long-term flecainide treatment. The mean left ventricular ejection fraction in 16 of these 18 patients was 37%. Nonlimiting side effects occurred in seven patients (18%). Proarrhythmic effects were seen in four patients (10%). At a mean follow-up time of 11 +/- 3 months, 15 patients (39%) had had no recurrence, including 5 who had inducible sustained ventricular tachycardia and 5 who did not on retesting during treatment. In the 18 patients who received long-term therapy, 3 late deaths occurred, 1 of which was of arrhythmic origin. These data suggest that flecainide is effective in about 40% of patients with severe refractory ventricular arrhythmias. Its value as a single drug in the treatment of sudden cardiac death remains to be defined.