Evaluation of the survivor of sudden cardiac arrest
- Philip J Podrid, MD, FACC
Philip J Podrid, MD, FACC
- Professor of Medicine, Professor of Pharmacology and Experimental Therapeutics
- Boston University School of Medicine
- Lecturer, Harvard Medical School
- Section Editors
- Brian Olshansky, MD
Brian Olshansky, MD
- Section Editor — Cardiac Arrhythmias
- Adjunct Professor of Medicine
- Des Moines University
- Scott Manaker, MD, PhD
Scott Manaker, MD, PhD
- Section Editor — Critical Care
- Professor of Medicine
- University of Pennsylvania School of Medicine
Sudden cardiac arrest (SCA) and sudden cardiac death (SCD) refer to the sudden cessation of cardiac activity with hemodynamic collapse, typically due to sustained ventricular tachycardia/ventricular fibrillation. These events mostly occur in patients with structural heart disease (that may not have been previously diagnosed), particularly coronary heart disease. (See "Pathophysiology and etiology of sudden cardiac arrest".)
The event is referred to as SCA (or aborted SCD) if an intervention (eg, defibrillation) or spontaneous reversion restores circulation. The event is called SCD if the patient dies. However, the use of SCD to describe both fatal and nonfatal cardiac arrest persists by convention. (See "Overview of sudden cardiac arrest and sudden cardiac death", section on 'Definitions'.)
Evaluation of the survivor of SCD includes the following:
●Identification and treatment of acute reversible causes
●Evaluation for structural heart diseaseTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Siscovick DS, Raghunathan TE, Psaty BM, et al. Diuretic therapy for hypertension and the risk of primary cardiac arrest. N Engl J Med 1994; 330:1852.
- Hoes AW, Grobbee DE, Lubsen J, et al. Diuretics, beta-blockers, and the risk for sudden cardiac death in hypertensive patients. Ann Intern Med 1995; 123:481.
- Salerno DM, Asinger RW, Elsperger J, et al. Frequency of hypokalemia after successfully resuscitated out-of-hospital cardiac arrest compared with that in transmural acute myocardial infarction. Am J Cardiol 1987; 59:84.
- Gettes LS. Electrolyte abnormalities underlying lethal and ventricular arrhythmias. Circulation 1992; 85:I70.
- Michaud GF, Sticherling C, Tada H, et al. Relationship between serum potassium concentration and risk of recurrent ventricular tachycardia or ventricular fibrillation. J Cardiovasc Electrophysiol 2001; 12:1109.
- European Heart Rhythm Association, Heart Rhythm Society, Zipes DP, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006; 48:e247.
- Centers for Disease Control and Prevention (CDC). State-specific mortality from sudden cardiac death--United States, 1999. MMWR Morb Mortal Wkly Rep 2002; 51:123.
- Zheng ZJ, Croft JB, Giles WH, Mensah GA. Sudden cardiac death in the United States, 1989 to 1998. Circulation 2001; 104:2158.
- Spaulding CM, Joly LM, Rosenberg A, et al. Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. N Engl J Med 1997; 336:1629.
- Drory Y, Turetz Y, Hiss Y, et al. Sudden unexpected death in persons less than 40 years of age. Am J Cardiol 1991; 68:1388.
- Chugh SS, Kelly KL, Titus JL. Sudden cardiac death with apparently normal heart. Circulation 2000; 102:649.
- Survivors of out-of-hospital cardiac arrest with apparently normal heart. Need for definition and standardized clinical evaluation. Consensus Statement of the Joint Steering Committees of the Unexplained Cardiac Arrest Registry of Europe and of the Idiopathic Ventricular Fibrillation Registry of the United States. Circulation 1997; 95:265.
- Kuisma M, Alaspää A. Out-of-hospital cardiac arrests of non-cardiac origin. Epidemiology and outcome. Eur Heart J 1997; 18:1122.
- Yannopoulos D, Bartos JA, Raveendran G, et al. Coronary Artery Disease in Patients With Out-of-Hospital Refractory Ventricular Fibrillation Cardiac Arrest. J Am Coll Cardiol 2017; 70:1109.
- Maron BJ, Carney KP, Lever HM, et al. Relationship of race to sudden cardiac death in competitive athletes with hypertrophic cardiomyopathy. J Am Coll Cardiol 2003; 41:974.
- Natale A, Sra J, Axtell K, et al. Ventricular fibrillation and polymorphic ventricular tachycardia with critical coronary artery stenosis: does bypass surgery suffice? J Cardiovasc Electrophysiol 1994; 5:988.
- Daoud EG, Niebauer M, Kou WH, et al. Incidence of implantable defibrillator discharges after coronary revascularization in survivors of ischemic sudden cardiac death. Am Heart J 1995; 130:277.
- Every NR, Fahrenbruch CE, Hallstrom AP, et al. Influence of coronary bypass surgery on subsequent outcome of patients resuscitated from out of hospital cardiac arrest. J Am Coll Cardiol 1992; 19:1435.
- Kelly P, Ruskin JN, Vlahakes GJ, et al. Surgical coronary revascularization in survivors of prehospital cardiac arrest: its effect on inducible ventricular arrhythmias and long-term survival. J Am Coll Cardiol 1990; 15:267.
- Kern KB, Hilwig RW, Rhee KH, Berg RA. Myocardial dysfunction after resuscitation from cardiac arrest: an example of global myocardial stunning. J Am Coll Cardiol 1996; 28:232.
- Myerburg RJ. Sudden cardiac death in persons with normal (or near normal) hearts. Am J Cardiol 1997; 79:3.
- Wever EF, Robles de Medina EO. Sudden death in patients without structural heart disease. J Am Coll Cardiol 2004; 43:1137.
- Viskin S, Belhassen B. Idiopathic ventricular fibrillation. Am Heart J 1990; 120:661.
- DiCarlo LA Jr, Morady F, Schwartz AB, et al. Clinical significance of ventricular fibrillation-flutter induced by ventricular programmed stimulation. Am Heart J 1985; 109:959.
- Josephson ME, Horowitz LN, Spielman SR, et al. Comparison of endocardial catheter mapping with intraoperative mapping of ventricular tachycardia. Circulation 1980; 61:395.
- Peeters HA, Sippensgroenewegen A, Wever EF, et al. Electrocardiographic identification of abnormal ventricular depolarization and repolarization in patients with idiopathic ventricular fibrillation. J Am Coll Cardiol 1998; 31:1406.
- Becker R, Melkumov M, Senges-Becker JC, et al. Are electrophysiological studies needed prior to defibrillator implantation? Pacing Clin Electrophysiol 2003; 26:1715.
- Krahn AD, Gollob M, Yee R, et al. Diagnosis of unexplained cardiac arrest: role of adrenaline and procainamide infusion. Circulation 2005; 112:2228.
- Kannel WB, Thomas HE Jr. Sudden coronary death: the Framingham Study. Ann N Y Acad Sci 1982; 382:3.
- Ranthe MF, Winkel BG, Andersen EW, et al. Risk of cardiovascular disease in family members of young sudden cardiac death victims. Eur Heart J 2013; 34:503.
- Behr E, Wood DA, Wright M, et al. Cardiological assessment of first-degree relatives in sudden arrhythmic death syndrome. Lancet 2003; 362:1457.
- Tan HL, Hofman N, van Langen IM, et al. Sudden unexplained death: heritability and diagnostic yield of cardiological and genetic examination in surviving relatives. Circulation 2005; 112:207.
- Giudici V, Spanaki A, Hendry J, et al. Sudden arrhythmic death syndrome: diagnostic yield of comprehensive clinical evaluation of pediatric first-degree relatives. Pacing Clin Electrophysiol 2014; 37:1681.
- Booth CM, Boone RH, Tomlinson G, Detsky AS. Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA 2004; 291:870.
- Gamper G, Willeit M, Sterz F, et al. Life after death: posttraumatic stress disorder in survivors of cardiac arrest--prevalence, associated factors, and the influence of sedation and analgesia. Crit Care Med 2004; 32:378.
- ETIOLOGY OF SCD
- INITIAL EVALUATION
- History and physical examination
- Laboratory testing
- EVALUATION FOR STRUCTURAL HEART DISEASE
- Coronary angiography
- - Acute coronary syndrome
- - Diagnostic angiography
- Cardiac MR
- EVALUATION FOR PRIMARY ELECTRICAL DISEASES
- General issues
- EP study
- Exercise testing
- Ambulatory monitoring
- Pharmacologic challenge
- MINOR CARDIAC ABNORMALITIES NOT ASSOCIATED WITH SCD
- EVALUATION OF FAMILY MEMBERS
- NEUROLOGIC AND PSYCHOLOGIC ASSESSMENT
- SUMMARY AND RECOMMENDATIONS