what móreshould we do to prevent sudden cardiac · pdf filecardiology –rhythm...
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Prof. Dr. Johan SaenenCardiology – Rhythm management – CardiogeneticsAntwerp University HospitalUniversity of Antwerp
What móre should we do to preventSudden Cardiac Death ?
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Sudden cardiac death
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Sudden cardiac death• A leading cause of mortality in the Western world• Estimated incidence of 1-2/1000/year.
Sudden cardiac death 36%Lung Cancer 16%Stroke 16%Breast Cancer 9%Traffic accidents 9%
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Sudden cardiac death
• All ages
• Asymptomatic patients
• Often no detectable disease
• SCD 1st symptom in 30%
• Up to 93% lethal arrhythmias
• Normal autopsy
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• “Heart Attack – Heart Failure – Heart rupture – Cardiac Arrest”• Underlying diseases:
Sudden cardiac death
10-15% Cardiomyopathies
60-80% Coronary Artery Disease
10-20% Primary Electrical Diseases 1-2% Aortic disease
1-5% Idiopathic Ventricular Fibrillation
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Sudden cardiac death
• Primary prevention: AHT, DM, CH, Obesity, Sedentarism, Smoking
• Revascularisation
• Secondary prevention: Controlling Risk factorsHeart failure treatmentICD implantationResynchronisation therapyVT ablation
Prevention of SCD in CAD
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VERY LIKELY other high-risk patients out there !
Sudden cardiac deathSCD <45y of age = up to 70% hereditary cause
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SCD• Confirm diagnosis
• Identify high-risk relatives
• Pre symptomatic screening
• Prevent transmission to offspring through PGD
SUDS• Molecular autopsy
Sudden cardiac deathGenes have become the key to unlock
SCD prevention
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CARDIOGENETICS
PATHOLOGY
ER ICUSCD
Hemodynamic stabilization
CPRBLS
ALS
HD Stabilization - Diagnostic work-up - Therapy - ICDPre-diagnostic triage Prevention
General PracticeAlarmsymptoms Familial history
TriggersHistory
Contemporary management of SCDSudden cardiac death
CARDIOLOGY
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Prevention in inherited cardiac diseaseand/or when SCD <45y
Sudden cardiac death
Alarm symptoms:Cardiac syncope = sudden, no trigger, no prodromiSupine syncopeExercise syncopeSymptomatic palpitations
Atrial fibrillation at young ageAngina pectoris at young ageHeart failure signs at young ageUnexplained/’transient’ epilepsy
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Prevention in inherited cardiac diseaseand/or when SCD <45y
Sudden cardiac death
Family history alarm signs:“Hartaderbreuk”Heart conditionSyncopes/black-outsSIDS, Sudden death <45yPacemaker or ICDSuspicious traffic accidentsUnexplained (near)drowning
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Death in BelgiumWhat is a natural cause of death ?
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Death in BelgiumHow do you know
And does not affect family ?
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What móre should we do to prevent SCD:
1. SCD < 45y = 70% hereditary
2. Investigate family
3. Recognize alarm symptoms
4. Only declare proven natural cause of deathInsist on autopsy as it may save family members
5. Dedicated cardiogenetics clinic