scholarly journals Aborted Sudden Cardiac Death in a Female Patient Presenting with Takotsubo-Like Cardiomyopathy due to Epicardial Coronary Vasospasm

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Sorin Giusca ◽  
Tom Eisele ◽  
Peter Nunninger ◽  
Benedikt Münz ◽  
Grigorios Korosoglou
Keyword(s):  
Coronary Artery ◽  
Sudden Cardiac Death ◽  
Takotsubo Cardiomyopathy ◽  
Cardiac Death ◽  
Elderly Women ◽  
Apical Ballooning ◽  
Late Enhancement ◽  
Lv Function ◽  
Icd Implantation ◽  
Lv Dysfunction

Takotsubo cardiomyopathy is characterized by apical ballooning of the left ventricle (LV) in the absence of relevant coronary artery stenosis, which typically occurs in elderly women after emotional stress. Catecholamine cardiotoxicity, metabolic disturbance, and coronary microvascular impairment have previously been proposed as underlying pathophysiologic mechanisms of takotsubo cardiomyopathy, whereas myocardial stunning resulting from epicardial coronary artery vasospasm is not generally accepted as a cause of takotsubo cardiomyopathy. The prognosis of takotsubo cardiomyopathy is generally more favourable compared to myocardial infarction; however, severe complications such as rupture of the LV and life-threatening arrhythmias may occur. Herein, we describe a case of an 84-year-old female, who presented with aborted sudden cardiac death due to ventricular fibrillation. Echocardiography suggested LV apical ballooning with severely impaired LV-function, so that takotsubo cardiomyopathy was suspected. However, coronary angiography revealed epicardial spasm of the left anterior ascending, which resolved after intracoronary injection of 0.2 mg nitroglycerine. Cardiac magnetic resonance exhibited subendocardial late enhancement and echocardiography showed normalization of LV dysfunction during follow-up. The patient was put on conservative treatment with nitrates and calcium inhibitors and ICD implantation were deferred.

scholarly journals 1228 New predictors of sudden cardiac death in hypertrophic cardiomyopathy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D M Adamczak ◽  
A Rogala ◽  
M Antoniak ◽  
Z Oko-Sarnowska
Keyword(s):  
Risk Factors ◽  
Hypertrophic Cardiomyopathy ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Volume Index ◽  
Lv Function ◽  
Icd Implantation ◽  
Significant Difference

Abstract BACKGROUND Hypertrophic cardiomyopathy (HCM) is a heart disease characterized by hypertrophy of the left ventricular myocardium. HCM is the most common cause of sudden cardiac death (SCD) in young people and competitive athletes due to fatal ventricular arrhythmias. However, in most patients, HCM has a benign course. That is why it is of utmost importance to properly evaluate patients and identify those who would benefit from a cardioverter-defibrillator (ICD) implantation. The HCM SCD-Risk Calculator is a useful tool for estimating the risk of SCD. The parameters included in the model at evaluation are: age, maximum left ventricular (LV) wall thickness, left atrial (LA) dimension, maximum gradient in left ventricular outflow tract, family history of SCD, non-sustained ventricular tachycardia (nsVT) and unexplained syncope. Nevertheless, there is potential to improve and optimize the effectiveness of this tool in clinical practice. Therefore, the following new risk factors are proposed: LV global longitudinal strain (GLS), LV average strain (ASI) and LA volume index (LAVI). GLS and ASI are sensitive and noninvasive methods of assessing LV function. LAVI more accurately characterizes the size of the left atrium in comparison to the LA dimension. METHODS 252 HCM patients (aged 20-88 years, of which 49,6% were men) treated in our Department from 2005 to 2018, were examined. The follow-up period was 0-13 years (average: 3.8 years). SCD was defined as sudden cardiac arrest (SCA) or an appropriate ICD intervention. All patients underwent an echocardiographic examination. The medical and family histories were collected and ICD examinations were performed. RESULTS 76 patients underwent an ICD implantation during the follow-up period. 20 patients have reached an SCD end-point. 1 patient died due to SCA and 19 had an appropriate ICD intervention. There were statistically significant differences of GLS and ASI values between SCD and non-SCD groups; p = 0.026389 and p = 0.006208, respectively. The average GLS in the SCD group was -12.4% ± 3.4%, and -15.1% ± 3.5% in the non-SCD group. The average ASI values were -9.9% ± 3.8% and -12.4% ± 3.5%, respectively. There was a statistically significant difference between LAVI values in SCD and non-SCD groups; p = 0.005343. The median LAVI value in the SCD group was 45.7 ml/m2 and 37.6 ml/m2 in the non-SCD group. The ROC curves showed the following cut-off points for GLS, ASI and LAVI: -13.8%, -13.7% and 41 ml/m2, respectively. Cox’s proportional hazards model for the parameters used in the Calculator was at the borderline of significance; p = 0.04385. The model with new variables (GLS and LAVI instead of LA dimension) was significant; p = 0.00094. The important factors were LAVI; p = 0.000075 and nsVT; p = 0.012267. CONCLUSIONS The proposed new SCD risk factors were statistically significant in the study population and should be taken into account when considering ICD implantation.

Hypertrophe Kardiomyopathie: Definition, klinische Präsentation, Risikostratifizierung für den plötzlichen Herztod und Therapieoptionen

2016 ◽  
Vol 73 (12) ◽  
pp. 759-765
Author(s):  
Bettina Muggli ◽  
Christiane Gruner
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Hypertrophe Kardiomyopathie ◽  
Linksventrikuläre Hypertrophie ◽  
Orale Antikoagulation ◽  
Diastolische Dysfunktion ◽  
Icd Implantation ◽  
Elektrische Kardioversion ◽  
Systemische Erkrankungen

Zusammenfassung. Die hypertrophe Kardiomyopathie (HCM) ist die häufigste hereditäre Kardiomyopathie und wird definiert durch eine unerklärte linksventrikuläre Hypertrophie mit normal grossen Ventrikeln ohne andere kardiale Ursachen oder systemische Erkrankungen. Die klinische Präsentation ist vielfältig und reicht vom asymptomatischen Familienmitglied bis hin zu Patienten mit Symptomen einer schweren Herzinsuffizienz. Häufige Probleme sind der plötzliche Herztod (’sudden cardiac death’ SCD) und die Risikostratifizierung der Patienten im Hinblick auf eine primärprophylaktische ICD-Implantation. Des Weiteren spielen natürlich die Obstruktion des linksventrikulären Ausflusstrakts und deren Behandlung (medikamentös, kathetertechnisch mittels Septalalkoholablation, chirugische Myektomie), diastolische Dysfunktion, Vorhofflimmern und die Entwicklung einer Herzinsuffizienz mit systolischer linksventrikulärer Dysfunktion eine wichtige Rolle bei der Betreuung von Patienten mit HCM. Beim Vorhofflimmern muss unabhängig vom CHA2DS2Vasc Score eine orale Antikoagulation begonnen werden und aufgrund der diastolischen Dysfunktion sollte wenn möglich wieder ein Sinusrhythmus erreicht werden durch medikamentöse Massnahmen, elektrische Kardioversion und / oder Pulmonalvenenisolation. Kommt es zur Entwicklung einer Herzinsuffizienz ist eine übliche Herzinsuffizienztherapie indiziert. Bei terminaler Herzinsuffizienz sollte frühzeitig eine Herztransplantation evaluiert werden.

Effect of Hypertension and Cardiac Hypertrophy on Coronary Artery Morphology in Sudden Cardiac Death

Circulation ◽  
1996 ◽  
Vol 94 (12) ◽  
pp. 3138-3145 ◽  
Author(s):  
Allen P. Burke ◽  
Andrew Farb ◽  
You-hui Liang ◽  
John Smialek ◽  
Renu Virmani
Keyword(s):  
Coronary Artery ◽  
Sudden Cardiac Death ◽  
Cardiac Hypertrophy ◽  
Cardiac Death

scholarly journals Anomalous Coronary Artery Origin and Sudden Cardiac Death

2019 ◽  
Vol 5 (4) ◽  
pp. 516-522 ◽  
Author(s):  
Gherardo Finocchiaro ◽  
Elijah R. Behr ◽  
Gaia Tanzarella ◽  
Michael Papadakis ◽  
Aneil Malhotra ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Anomalous Coronary Artery ◽  
Anomalous Coronary

Abstract 2415: Long-Term Baroreflex Activation Therapy Increases the Threshold for the Induction of Lethal Ventricular Arrhythmias in Dogs with Chronic Advanced Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Mengjun Wang ◽  
Valerio Zaca ◽  
Alice Jiang ◽  
Itamar Ilsar ◽  
Matthew Ebinger ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Ventricular Arrhythmias ◽  
Lv Function ◽  
Baroreflex Activation Therapy ◽  
Increased Risk ◽  
Lv Remodeling ◽  
Activation Therapy

Heart failure (HF) is associated with a high incidence of ventricular tachycardia (VT) and fibrillation (VF). Patients with HF in whom these lethal arrhythmias can be induced by electrophysiological (EP) testing carry a high risk of sudden cardiac death. We showed that chronic electrical carotid baroreflex activation therapy (BAT) with the Rheos® System (CVRx, Inc.) improves LV function, attenuates LV remodeling and restores autonomic sympathetic-parasympathetic balance in dogs with HF. This study examined the effects of long-term therapy with BAT on the induction of VT or VF in dogs with coronary microembolization-induced HF (LV ejection fraction ~20%). Eleven dogs with HF underwent EP testing at baseline prior to therapy and after 3 and 6 months of therapy with BAT and again 6 weeks after withdrawal of BAT therapy (n = 7) or no therapy at all (Control, n = 4). Programmed ventricular stimulation was performed from the right ventricular apex and included delivery of up to 4 extrastimuli at progressively shorter coupling intervals (in steps of 10 msec). The extrastimuli were delivered following 8 ventricular paced beats with a drive cycle length between 600 and 200 msec. If a sustained monomorphic VT or VF could not be induced, isoproterenol infusion was initiated to increase the sinus rate by ~30% and the EP stimulation protocol was repeated. At baseline, a sustained VT or VF was induced in all 11 dogs (100%). After 3 and 6 months of follow-up, all Control dogs (100%) were induced into sustained VT or VF. After 3 months of BAT, only 3 of 7 dogs (43%) were induced into sustained VT or VF. After 6 months of BAT, only 2 of 7 dogs (29%) were induced into sustained VT or VF. Finally after withdrawal of BAT therapy, all dogs (100%) were again induced into systained VT or VF. In addition to improving LV function and attenuating LV remodeling, long-term monotherapy with BAT markedly increases the threshold for lethal ventricular arrhythmias in dogs with chronic HF. This is a marked improvement over inducibility of lethal arrhythmias seen in historical untreated controls. This benefit of BAT supports the continued exploration of this device as a therapeutic modality for treating patients with chronic HF and increased risk of sudden cardiac death.

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