Sudden Cardiac Death

■ Essentials of Diagnosis:- • Death in a well patient within 1 hour of symptom onset • Can be due to cardiac or noncardiac disease • Most common cause (> 80% of cases) is ventricular fibrillation or tachycardia in the setting of coronary artery disease • Ventricular fibrillation is almost always the terminal rhythm ■ Differential Diagnosis:- Noncardiac causes of sudden death: • Pulmonary embolism • Asthma • Aortic dissection • Ruptured aortic aneurysm • Intracranial hemorrhage • Tension pneumothorax • Anaphylaxis ■ Treatment:- • Aggressive approach obligatory if coronary artery disease is sus- pected; see below • Electrolyte abnormalities, digitalis toxicity, or implantable cardiac defibrillator malfunction can be the precipitant and is treated accordingly • Without obvious cause, echocardiography and cardiac catheteri- zation are indicated; if normal, electrophysiologic studies thereafter • An automatic implantable cardiac defibrillator should be used in all patients surviving an episode of sudden cardiac death second- ary to ventricular fibrillation or tachycardia without a transient or reversible cause

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