Sudden death

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Sudden death in young people

Cause	FH sudden death	Prodromal syncope	Prodromal chest pain	ECG abnormal
Myocardial abnormality
HOCM	+	+	-	+
Myocarditis	-	+	+	+
Dilated CM	+	+	-	+
RV CM	+	+	-	+
Congenital coronary artery disease
CAD	+	-	+	+
Kawasaki’s	-	-	+	+
Origin of RCA or LCA in right or left sinus of Valsalva	-	+	+	-
Anomalous origin of LCA in PA	-	+	+	+
Congenital heart disease
Pul vascular obstruction	-	+	-	+
Fallot’s	-	+	-	+
Transposition with atrial switch operation	-	+	-	+
Aortic stenosis	-	+	+	+
Mitral prolapse	+	+	+	+
Marfan’s	+	-	+
Arrhythmia
Long QT	+	+	-	+
Pre-excitation	-	+	-	+
VT	-	+	-	+
SAN dysfn	-	+	-	+
Heart block	-	+	-	+
High risk behaviour
Cocaine or tricyclics	-	+	+	-
Bulimia or anorexia	-	+	-	+

Cardiac causes

Dilated cardiomyopathy.

EPS guided therapy, implantable defibrillators or beta-blockers may have a role in the treatment of selected high-risk patients. More information.

RV cardiomyopathy.

Involves replacement of myocardial cells with fibrous or fatty tissue. Results in RV tachyarrhythmia and sudden death. Particularly common northern Italy. Death often occurs with exertion and may be initial manifestation of disease. ECG: RBBB in SR and LBBB pattern in VT. Echo/MRI may be diagnostic. EPS guided antiarrhythmics or ablation indicated

Ectopic origin of coronary artery in left/right sinus of Valsalva.

Aberrant artery arises at an acute angle, often from a slit-like hypoplastic ostium and transverses the aortic wall obliquely. With exertion proximal angulation or compression may occur resulting in ischaemia,VT,VF. Anomaly can be diagnosed on echo.

Fallot’s.

Patients who have undergone reparative surgery have a 6% chance of sudden death between 3 months and 20 yrs of age. Occurs most commonly in patients with residual defects, RV hypertension, and ventricular arrhythmias

Transposition and atrial switch operation.

2-8% risk of sudden death. Usually due to sinus node dysfunction but may be due to VT.

Further reading

Lithbertson RR. Sudden death from cardiac causes in children and young adults NEJM, 1996; 334:1039-1044

©Charles Gomersall, August, 2008 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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