Cases reported "Death, Sudden, Cardiac"

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1/22. Defibrillator challenges for the new millennium: the marriage of device and patient-making and maintaining a good match.

    Although it has become clear that implantable cardioverter defibrillators (ICDs) are effective, important challenges remain for the physician. Due to the limitations of available risk stratification tools, patient selection for primary sudden death prevention remains controversial in many populations. Additionally, the proliferation of device choices has led to challenges in matching the appropriate device to the individual patient: device size is balanced against longevity; the advantages of dual chamber systems is weighed against their increased complexity; physician and patient preferences in device implant site are constrained by site-dependent effects on defibrillation effectiveness and lead failure rates; and special consideration must be given to the patient with a preexisting pacemaker. After ICD placement, determination of appropriate follow-up frequency and methodology to assess device function must be considered. This article will review patient selection, device implant site selection, device-device interactions, single versus dual chamber ICD selection, and follow-up.
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2/22. Aborted sudden death, transient Brugada pattern, and wide QRS dysrrhythmias after massive cocaine ingestion.

    Although cocaine is one of the leading causes of drug-related deaths, there is little clinical information describing the precise sequence of events leading to death in the cocaine intoxication. Usually, cocaine-related sudden deaths are unwitnessed, its electrocardiographic features are not attainable, and the majority of these patients have a rapidly fatal course and die before arriving at the hospital. We report a patient with massive cocaine ingestion who developed psychomotor agitation and generalized seizures followed by asystolic cardiac arrest. ventilation with supplemental oxygen by endotracheal intubation immediately restored spontaneous heart beat. After resuscitation, a severe metabolic acidosis (pH 6.65) and cardiac dysrrhythmias consistent with sodium channel poisoning were detected. The electrocardiogram showed accelerated junctional rhythm at 85 beats/min with right bundle branch block and left anterior hemiblock configuration, prolongation of QRS (0.16 sec) and QTc (0.52 sec) intervals, and terminal J wave associated with coved ST-segment elevation in leads V(1) and V(2) resembling the brugada syndrome. sodium bicarbonate administration was quickly followed by normalization of the cardiac conduction disturbances. This article discusses the clinical and electrophysiologic implications of these findings.
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3/22. Sudden death following rupture of a right ventricular aneurysm 9 months after ablation therapy of the right ventricular outflow tract.

    aneurysm formation has not been previously described as a complication of radiofrequency ablation. A 49-year-old woman with wolff-parkinson-white syndrome underwent ablation of abnormal conduction pathways in Koch's triangle and in the outflow tract of the right ventricle. Nine months after the procedure, she died suddenly, and was found at autopsy to have a hemopericardium due to rupture of an aneurysm in the right ventricular outflow tract. The gross and histological features of the aneurysm suggest that it developed because of radiofrequency ablation. The possibility of this potentially fatal complication should be considered during follow-up evaluation of ablation therapy patients.
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4/22. Atrial paralysis in a patient with Emery-Dreifuss muscular dystrophy.

    Emery-Dreifuss disease is a benign X-linked muscular dystrophy characterized by a distinct pattern of muscle weakness, which is of insidious onset and slow progression. It is associated with atrial paralysis that results in sudden death in early adulthood if left untreated. The authors report the documentation of electrical and mechanical silence confined to the atria in a patient with this disease. electrocardiography and electrophysiological study document the absence of electrical atrial activity, and inability to pace the atria. Hemodynamic studies demonstrate the absence of A waves, and angiography revealed immobility of the atria. This patient has done well following the institution of permanent ventricular pacing. His brother, who also had muscular dystrophy, died a sudden cardiac death at the age of 29 after refusing medical intervention. Emery-Dreifuss muscular dystrophy is particularly worthy of recognition because of the preventable occurrence of sudden death in young patients with an otherwise excellent prognosis. Permanent ventricular pacing is indicated.
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5/22. Arrhythmogenic right ventricular cardiomyopathy and sudden cardiac death in young Koreans.

    The aim of this study was to assess the frequency and clinical characteristics of arrhythmogenic right ventricular cardiomyopathy (ARVC) in young victims of sudden cardiac death (SCD). From January 1999 to December 2000, postmortem studies were conducted in 38 cases of SCD (age < or =35 (27 /-7) years old, 26 male) from the Taegu-Kyungpook region of southeastern korea. Cases of sudden infant death syndrome were excluded. The causes of SCD were ARVC in 42%, acute myocardial infarction in 11%, myocarditis in 11%, pulmonary embolism in 8%, hypertrophic cardiomyopathy in 5%, aortic rupture in 3%, aortic stenosis in 3%, and unknown in 18%. The mean age of the 16 ARVC victims was 27 /-5 years and 10 were male. None were competitive athletes, or had been suspected of having cardiovascular disease before death. SCD was not related to vigorous physical or competitive activity and occurred during sleep in 7 cases, during work in 4, during bathing in 2, while driving, praying and eating in 1 case each. ARVC is an important cause of SCD in young people in this area of korea.
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6/22. ventricular fibrillation during anesthesia in association with J waves in the left precordial leads in a child with coarctation of the aorta.

    A 14-year-old boy with coarctation of the aorta who showed repeat ventricular fibrillation during anesthesia, and ultimately sudden cardiac death in school, is presented. electrocardiography showed J waves in the left precordial leads, which became prominent after an episode of ventricular fibrillation. While some of the clinical features and electrophysiological findings were similar to those seen in brugada syndrome, others were inconsistent. J waves in the left precordial leads should be recognized as a possible waveform change inducing ventricular fibrillation predominantly at rest.
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ranking = 231.32570794753
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7/22. Early postoperative acute aortic dissection, the leading cause of sudden death after cardiac surgery? Critical role of the computed tomography scan.

    Iatrogenic acute aortic dissection (AOD) is known to occur during cardiac surgery or cardiac catheterization, whereas delayed AOD usually happens up to several years after an uneventful operation. Both entities usually are easily recognized, and their management is well described in the literature. Conversely, early postoperative AOD has not been described with any frequency in the literature, leading one to believe that once surgery is terminated, AOD is unlikely to occur and account for any early postoperative mortality or morbidity. We present our recent experience with 4 patients who sustained early postoperative AOD and whose diagnoses were facilitated by computed tomography (CT) scanning of the chest. Early postoperative acute AOD may not be uncommon and may account for more disasters and deaths than are acknowledged in the literature. diagnosis is made expeditiously if such AOD is suspected and a CT scan of the chest is done. Prevention may be based on avoiding the manipulation of the ascending aorta and a tighter control of hypertension in the immediate postoperative period. The treatment of this AOD entity is not very difficult and is within the reach of every trained cardiac surgeon.
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8/22. Electrocardiographical case. Asymptomatic patient with ST-segment elevation.

    A 46-year-old man complained of recurrent episodes of giddiness which was not associated with chest pain or breathlessness. There was no family history of sudden death. Clinical examination was unremarkable.12-lead electrocardiogram (ECG) showed ST segment elevation in the right precordial leads, with coved ST segment elevation at its J point followed by a negative T wave with no isoelectric separation, specifically in V2. These ECG features are characteristic of the brugada syndrome. He underwent a flecanide challenge which produced further elevation of ST segment at its J point and spontaneous ventricular ectopy. Electrophysiological studies induced ventricular fibrillation with 3 extra stimuli. An implantable cardioverter-defibrillator was implanted for prevention of sudden cardiac death. The brugada syndrome is discussed.
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ranking = 33.04652970679
keywords = wave
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9/22. Spontaneous T wave alternans in a patient with brugada syndrome--responses to intravenous administration of class I antiarrhythmic drug, glucose tolerance test, and atrial pacing.

    Spontaneous T wave alternans in brugada syndrome. A 43-year-old man with an episode of syncope showed ECG patterns of coved-type ST elevation in leads V1-V3 and right bundle branch block pattern. The patient had spontaneous T wave alternans at baseline, and T wave alternans diminished with distinct development of ST elevation after administration of Na channel blocker, and during oral glucose load and atrial pacing. Na channel mutation may contribute to the genesis of his ECG changes.
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ranking = 231.32570794753
keywords = wave
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10/22. ventricular fibrillation refractory to ICD therapy.

    A 14-year-old boy was admitted for the evaluation of recurrent syncope. His ECG on admission revealed a sinus rhythm with an undetermined QRS axis, T wave inversion at leads V3, V4 and abnormal q at leads I, aVL, V5 and V6. However, no underlying disease could be detected by any morphological examination. Programmed ventricular stimulation also induced no ventricular tachycardia or fibrillation (VF). Only signal-averaged ECG showed ventricular late potential and the cause of syncope was not clarified. As his brother with a similar ECG had died suddenly, he was prophylactically treated with an ICD. However, 14 months later he died suddenly after playing a video game. The ICD recorded VF, which was not converted despite 6 cardioversion attempts by the ICD. Progression of myocardial damages and/or elevation of defibrillation threshold may have been the cause of unsuccessful cardioversion.
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ranking = 33.04652970679
keywords = wave
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