Sunday, March 12, 2017

Sudden Arrhythmic Death

Resultado de imagen de emergency medicine news
Roberts, James R. Emergency Medicine News 2017; 39(3): 8-9
doi: 10.1097/01.EEM.0000513577.37092.89
"Some patients suffer sudden arrhythmic death without any prior symptoms, but a relatively large number of young individuals who die suddenly and unexpectedly experience warning symptoms prior to their arrest. Unfortunately, these symptoms are seemingly benign and often not worrisome to the patient or inscrutable to the evaluating clinician, but they nonetheless prognosticate future cardiac arrest. Substernal chest pain with radiation to the arms associated with nausea and vomiting, diaphoresis, and shortness of breath would not be deemed benign by any emergency clinician and at least initially attributed to a cardiac etiology. Likewise, abnormalities on the ECG or cardiac enzymes are also likely to substantiate a cardiac event. Presyncope in a healthy, young individual with normal exam, however, is likely not very concerning.
It would be best to be able to identify patients prior to their sudden arrhythmic death, but so far no study of an unselected population has been able to characterize variables. A nationwide study among young adults in Denmark attempted to clarify symptoms that young individuals experienced prior to a sudden arrhythmic death. Many causes of cardiac death are secondary to coronary artery disease, as discussed in last month's column, but now more causes have been identified with sophisticated DNA analysis."