Sudden Cardiac Death by liaoqinmei


									Cardiac Pathology in
             Sudden Death
 About 25 young patients die each year
  nationally in sudden-initially unexplained
  deaths on the field in all sports ~ usually
  heart related.
 Usually hypertropic cardiomyopathy or
  congenital abnormalities
 10:1 ratio male to female
 Football & Basketball see the highest
   Sudden Death:

 90% collapse during or after activity
 62% High School Age
Heart Anatomy Review
        Causes of Sudden Death
   Hypertrophic Cardiomyopathy (HCM)

   Aortic Stenosis

   Congenital Coronary Artery Anomalies

   Marfan Syndrome

   Mitral Valve Prolapse
    Hypertrophic Cardiomyopathy
   Definition

   Can occur c or s obstruction

   What happens then?
Hypertrophic Cardiomyopathy cont.
   Clinical Presentation:
    – History

    – Physical Exam

    – The first clinical presentation of this condition
      may be sudden cardiac death!
      Hypertrophic Cardiomyopathy
   Diagnostic tests:

   Bethesda Guidelines – HCM
    – Patients with unequivocal diagnosis of HCM
      should not participate in most competitive
      sports with possible exception of low intensity
      sports (i.e. BOWLING)
    Coronary Artery Abnormalities
   Presentation:

   The 1st clinical presentation of this
    condition may sudden cardiac death!

   Diagnostic Tests:
             Marfan Syndrome
   5% of death due to rupture of aortic valve

 Abe Lincoln
 Clinical physical signs:

   Bethesda Guidelines – Marfan’s
    – Patients s a family hx of sudden death & s
      aortic root dilitation ca participate in low &
      moderate intensity sports
    Rare causes of Sudden Death
   Long QT Syndrome: electrical abnormality

   Bethesda Guideline: QT
    – Restrict from ALL competitive sports
          Mitral Valve Prolapse
   Two flapped valve between LA and LV
    balloons back into the LA with each HB.
  When do you need to refer a
 Referrals/Common Cardiac S/S
 Syncope
 Chest pain
 Decreased exercise tolerance
 Tachycardia or palpitations c exercise
 New or loud murmur
 Hypertension
 Finding of Marfan syndrome
 Family Hx
    Referrals/Common Cardiac S/S
   Dyspnea

   Fatigue

   Claudication

   Skin Color, Temp and Aprearance

   Generalized Edema
          Cardiac Examination
   Inspection:

   Palpation:

   Blood Pressure:

 Pulse:
 Auscultations:
   A: (UR)

   P: (UL)

   T: (LL)

   M: (Apex)
        Diagnostic Testing
 Stress ECHO
 Transesophageal ECHO
 Thallium Scan
 Cardiac Catheter
You need a cardiac Work-Up if:
 Pathological Murmur during Diastole
 If S1 or S2 not heard clearly
 Murmur in UL or UR (pulmonary/aortic)
 Any murmur > II
    – Scale: I= only cardiologist will hear
             II= Softest of Softest
             III= Soft
             IV= Stethoscope flat
             V= Stethoscope tilted
             VI= Stethoscope nearly touching
             Commotio Cordis
   Blunt chest trauma resulting in severe
    cardiac contusion

   Immediate LOC, hypotension, rhythm

   Tx: Precordial chest thump
        AED & Early CPR
   Sudden Death is a rare event

   Work-up depends on (+) Hx, as PE is
    subtle or often normal

   The first presentation of sudden death
    may be the event itself

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