Sudden cardiac arrest in the absence of apparent structural heart disease
- Mark S Link, MD
Mark S Link, MD
- Section Editor — Cardiac Arrhythmias
- Professor of Medicine
- Tufts Medical School
- Section Editors
- Peter J Zimetbaum, MD
Peter J Zimetbaum, MD
- Section Editor — Cardiac Arrhythmias
- Professor of Medicine
- Harvard Medical School
- 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 due to sustained pulseless ventricular tachycardia/fibrillation, pulseless electrical activity (PEA), or asystole. The event is referred to as SCA (or aborted SCD) if an intervention (eg, defibrillation) 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'.)
SCA and SCD occur most commonly in patients with structural heart disease (including previously undiagnosed heart disease), particularly coronary artery disease. SCD in the apparently normal heart (at autopsy) is less common and is responsible for 10 to 15 percent of cases of SCD [1,2]. SCA with an apparently normal heart is more common in younger arrest victims. The majority of SCD patients without apparent structural heart disease likely do not actually have "normal" hearts, but our diagnostic tools limit identification of structural or functional abnormalities. In the past, the etiology of many of these deaths was unknown and deemed "idiopathic." However, more complete evaluation has identified the cause of death as a primary electrical disorder (ie, long QT, Wolff-Parkinson-White [WPW], catecholaminergic polymorphic ventricular tachycardia [CPVT], and Brugada syndrome) in many of these patients [1-3]. (See "Pathophysiology and etiology of sudden cardiac arrest".)
SCD in the apparently normal heart will be reviewed here. SCD in patients with heart disease, and the evaluation and options for the management of survivors of SCD, are discussed separately. (See "Overview of sudden cardiac arrest and sudden cardiac death", section on 'Etiology' and "Pathophysiology and etiology of sudden cardiac arrest", section on 'Etiology of SCD' and "Incidence of and risk stratification for sudden cardiac death after acute myocardial infarction" and "Hypertrophic cardiomyopathy: Assessment and management of ventricular arrhythmias and sudden cardiac death risk".)
In addition, sudden death may occur from noncardiac causes (eg, trauma, pulmonary embolism seizure), and these topics are discussed separately. (See "Overview of acute pulmonary embolism in adults" and "Sudden unexpected death in epilepsy".)
Based upon a review of death certificates in the United States during 1998 and 1999, sudden cardiac death (SCD) accounted for over 450,000 deaths, which represented 63 percent of cardiac deaths among adults ≥35 years of age . The incidence of SCD is increased six- to ten-fold in the presence of clinically recognized heart disease (figure 1); it also increases with age and is two to three times more common in men than women (figure 2) .
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- POTENTIAL CAUSES
- Prolonged QT interval
- Polymorphic VT with normal QT interval
- Brugada syndrome
- Commotio cordis
- WPW and other forms of SVT
- Short QT syndrome
- Early repolarization syndrome
- VF secondary to PVCs
- Idiopathic VF
- Familial SCD
- AUTOPSY AND MOLECULAR GENETIC TESTING
- EVALUATION OF SURVIVORS OF SCD
- EVALUATION OF FAMILY MEMBERS
- SUMMARY AND RECOMMENDATIONS