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1.
Am J Case Rep ; 22: e930380, 2021 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-34535623

RESUMO

BACKGROUND Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction, and the literature is undecided on the etiology, predisposing factors, and susceptible populations involved. SCAD is a disease that is under-recognized, underdiagnosed, and mainly affects young women of reproductive age. It has the highest incidence in the third trimester and postpartum period. CASE REPORT We present a case of a 29-year-old woman who was brought by family members to our Emergency Department (ED) in Riyadh, Saudi Arabia with sudden cardiac arrest due to SCAD in the right coronary artery 13 days after normal spontaneous vaginal delivery. The patient was brought in with no cardiopulmonary resuscitation for 20 min. She was resuscitated successfully in the ED. Her initial rhythm was ventricular fibrillation (VF). Point-of-care ultrasound (PoCUS) was performed during pulse checks, which revealed no signs of right ventricular strain nor signs of deep vein thrombosis (DVT). After that, she underwent primary percutaneous coronary intervention, which confirmed the diagnosis of right coronary artery dissection. The patient was successfully managed and discharged from the hospital after 18 days. She was independent and in good health after 4 months of follow-up. CONCLUSIONS A high index of suspicion, familiarity with predisposing factors for SCAD, and PoCUS may play a critical role in detecting and managing SCAD patients.


Assuntos
Vasos Coronários , Morte Súbita Cardíaca , Adulto , Angiografia Coronária , Morte Súbita Cardíaca/etiologia , Dissecação , Feminino , Humanos , Período Pós-Parto
2.
Pan Afr Med J ; 38: 404, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34381548

RESUMO

Right ventricular dysplasia (RVD) is a rare disease of the heart that primarily affects the right ventricle. It is a clinical and pathological entity that presents classically with palpitations, syncope, or even sudden death. It presents rarely in the elderly. Where sudden death is the first and only presentation, an autopsy is required to make the diagnosis. However, the pathomorphological features of RVD can easily be overlooked or missed at autopsy. We report the case of a 68-year-old male with the past medical history of hypertension, gout and inflammatory bowel syndrome. He was admitted on account of difficulty in breathing, abdominal swelling and reduced urination. Physical examination revealed hypertension with cardiac murmurs, widespread crepitations, distended abdomen and lower limb oedema. Provisional diagnoses of acute-on-chronic kidney disease and congestive cardiac failure secondary to hypertensive heart disease, precipitated by probable gastrointestinal infection were made. While on admission, he had an episode of syncope. Electrocardiogram revealed bigeminy and bradycardic sinus rhythm with unifocal ventricular premature contraction. He died on the 8th week of admission. Autopsy revealed an enlarged heart weighing 600gm; there was thinning of the apical aspect of the right ventricular wall with subtotal fibrofatty replacement. Microscopic examination revealed a transmural replacement of cardiac myocytes by fibroadipose tissue extending inwards, in the most parts, from the epicardium to the endocardial surface. Our aim is to increase the awareness of these pathomorphological features among anatomic/forensic pathologists.


Assuntos
Displasia Arritmogênica Ventricular Direita/diagnóstico , Cardiomegalia/diagnóstico , Morte Súbita Cardíaca/etiologia , Idoso , Displasia Arritmogênica Ventricular Direita/fisiopatologia , Autopsia , Eletrocardiografia , Humanos , Masculino
3.
Medicina (Kaunas) ; 57(7)2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34357002

RESUMO

Congenital long QT syndrome (LQTS) is a hereditary ion channelopathy associated with ventricular arrhythmia and sudden cardiac death starting from young age due to prolonged cardiac repolarization, which is represented by QT interval changes in electrocardiogram (ECG). Mutations in human ether-à-go-go related gene (KCNH2 (7q36.1), formerly named hERG) are responsible for Long QT syndrome type 2 (LQT2). LQT2 is the second most common type of LQTS. A resuscitated 31-year-old male with the diagnosis of LQT2 and his family are described. Sequencing analysis of their genomic DNA was performed. Amino acid alteration p.(Ser631Pro) in KCNH2 gene was found. This variant had not been previously described in literature, and it was found in three nuclear family members with different clinical course of the disease. Better understanding of genetic alterations and genotype-phenotype correlations aids in risk stratification and more effective management of these patients, especially when employing a trigger-specific approach to risk-assessment and individually tailored therapy.


Assuntos
Parada Cardíaca , Síndrome do QT Longo , Adulto , Morte Súbita Cardíaca/etiologia , Canal de Potássio ERG1/genética , Canais de Potássio Éter-A-Go-Go/genética , Parada Cardíaca/genética , Humanos , Síndrome do QT Longo/complicações , Síndrome do QT Longo/genética , Masculino , Mutação
4.
Nutrients ; 13(7)2021 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-34371962

RESUMO

Low heart rate variability (HRV) is independently associated with increased risk of sudden cardiac death (SCD) and all cardiac death in haemodialysis patients. Long chain n-3 polyunsaturated fatty acids (LC n-3 PUFA) may exert anti-arrhythmic effects. This study aimed to investigate relationships between dialysis, sleep and 24 h HRV and LC n-3 PUFA status in patients who have recently commenced haemodialysis. A cross-sectional study was conducted in adults aged 40-80 with chronic kidney disease (CKD) stage 5 (n = 45, mean age 58, SD 9, 20 females and 25 males, 39% with type 2 diabetes). Pre-dialysis blood samples were taken to measure erythrocyte and plasma fatty acid composition (wt % fatty acids). Mean erythrocyte omega-3 index was not associated with HRV following adjustment for age, BMI and use of ß-blocker medication. Higher ratios of erythrocyte eicosapentaenoic acid (EPA) to docosahexaenoic acid (DHA) were associated with lower 24 h vagally-mediated beat-to-beat HRV parameters. Higher plasma EPA and docosapentaenoic acid (DPAn-3) were also associated with lower sleep-time and 24 h beat-to-beat variability. In contrast, higher plasma EPA was significantly related to higher overall and longer phase components of 24 h HRV. Further investigation is required to investigate whether patients commencing haemodialysis may have compromised conversion of EPA to DHA, which may impair vagally-mediated regulation of cardiac autonomic function, increasing risk of SCD.


Assuntos
Ácidos Graxos Ômega-3/sangue , Frequência Cardíaca , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Diálise Renal , Adulto , Idoso , Idoso de 80 Anos ou mais , Sistema Nervoso Autônomo/fisiopatologia , Estudos Transversais , Morte Súbita Cardíaca/etiologia , Diabetes Mellitus Tipo 2/complicações , Ácidos Docosa-Hexaenoicos/sangue , Ácido Eicosapentaenoico/sangue , Membrana Eritrocítica/química , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Sono
6.
J Forensic Leg Med ; 82: 102227, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34403966

RESUMO

About two-thirds of sudden deaths are sudden cardiac deaths (SCD), and ischemic heart disease (IHD) accounts for 60% of these. Although an autopsy needs to be performed to prove SCD, the forensic autopsy rate is very low in Japan. To diagnose the cause of death, postmortem computed tomography (PMCT) is often performed. Because coronary artery calcification (CAC) is a risk factor in cardiac diseases such as IHD and its severity can be evaluated with CT, we examined its ability to diagnose SCD. We collected 104 autopsy cases with CT scans. On the basis of the autopsy report, we separated the cases into two groups: SCD suspected as the cause of death and SCD not suspected. We calculated each CAC severity with the Agatston score from the CT images. Cases with Agatston scores of more than 400 were labeled as severe. The relationship between SCD and CAC severity was confirmed with Fisher's exact test (p < 0.05). The sensitivity and specificity of CAC severity for SCD were 20.3% and 97.5%, respectively, and the positive likelihood ratio was 8.1. Severe CAC can increase the probability of SCD. In cases in which only PMCT can be performed, this finding can be helpful for diagnosing SCD.


Assuntos
Calcinose/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Morte Súbita Cardíaca/etiologia , Artropatias/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagem , Adulto , Idoso , Autopsia , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
7.
BMJ Case Rep ; 14(8)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34413034

RESUMO

A previously healthy 12-year-old boy presented to the emergency department on the seventh day of illness with classical symptoms of postinflammatory multisystemic syndrome in children temporally associated with SARS-CoV-2 (fever, vomiting, loose stools and rashes all over the body) with COVID-19 seropositivity, high inflammatory markers and elevated cardiac enzymes with cardiogenic shock with multiple organ dysfunction syndrome. After having improved over the first 48 hours following intravenous immunoglobulin and pulsed steroids, this young boy developed sudden cardiac arrest and died. No reversible cause could be identified at the time of resuscitation. Despite an apparent clinical recovery in the myocardial function, it is likely that the myocardium remains arrhythmogenic due to cytokine-induced myocardial inflammation. There are several reports in the literature of fatality in multisystemic inflammatory syndrome in children (MISC) due to cardiovascular complication during the acute phase of the illness. To the best of our knowledge, this is the first report of sudden cardiac death in a child with MISC days after recovery from critical illness, suggesting that fatal outcome remains a potential risk during follow-up, even when there is no evidence of coronary aneurysm. Further studies are needed to identify clinical characteristics of such high-risk children presenting with MISC. We will need to follow these children closely to understand what implications they may have in the long term, and this helps in raising awareness among families of such children.


Assuntos
COVID-19 , Morte Súbita Cardíaca , Síndrome de Resposta Inflamatória Sistêmica , Arritmias Cardíacas , Criança , Morte Súbita Cardíaca/etiologia , Humanos , Masculino , SARS-CoV-2
8.
Nutrients ; 13(8)2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34444641

RESUMO

A healthy regime is fundamental for the prevention of cardiovascular diseases (CVD). In inherited channelopathies, such as Brugada syndrome (BrS) and Long QT syndrome (LQTS), unfortunately, sudden cardiac death could be the first sign for patients affected by these syndromes. Several known factors are used to stratify the risk of developing cardiac arrhythmias, although none are determinative. The risk factors can be affected by adjusting lifestyle habits, such as a particular diet, impacting the risk of arrhythmogenic events and mortality. To date, the importance of understanding the relationship between diet and inherited channelopathies has been underrated. Therefore, we describe herein the effects of dietary factors on the development of arrhythmia in patients affected by BrS and LQTS. Modifying the diet might not be enough to fully prevent arrhythmias, but it can help lower the risk.


Assuntos
Síndrome de Brugada/fisiopatologia , Morte Súbita Cardíaca/etiologia , Dieta , Alimentos , Síndrome do QT Longo/fisiopatologia , Consumo de Bebidas Alcoólicas , Animais , Síndrome de Brugada/complicações , Morte Súbita Cardíaca/prevenção & controle , Dieta Cetogênica/efeitos adversos , Ingestão de Alimentos , Eletrocardiografia , Ácidos Graxos Ômega-3/administração & dosagem , Humanos , Cetose/complicações , Síndrome do QT Longo/complicações , Estresse Oxidativo , Nervo Vago/fisiopatologia , Deficiência de Vitamina D/complicações , Desequilíbrio Hidroeletrolítico/complicações , Desequilíbrio Hidroeletrolítico/fisiopatologia
9.
Fa Yi Xue Za Zhi ; 37(3): 388-395, 2021 Jun.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34379910

RESUMO

Abstract: In cases of sudden death, the prevention of sudden cardiac death and the analysis of the cause of death after sudden cardiac death have always been a difficult problem. Therefore, clinical research and forensic pathological identification of sudden cardiac death are of great significance. In recent years, metabolomics has gradually developed into a popular field of life science research. The detection of "metabolic fingerprints" of biological fluids can provide an important basis for early diagnosis of diseases and the discovery of potential biomarkers. This article reviews the current research status of sudden cardiac death and the research on metabolomics of cardiovascular diseases that is closely related to sudden cardiac death and analyzes the application prospects of metabolomics in the identification of the cause of sudden cardiac death.


Assuntos
Morte Súbita Cardíaca , Metabolômica , Biomarcadores , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Patologia Legal , Humanos
10.
Am J Cardiol ; 152: 146-149, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34237610

RESUMO

The optimal screening strategy to prevent sudden cardiac death (SCD) in athletes remains unknown. Pre-participation screening with electrocardiogram (ECG) remains controversial. The utility and accuracy of limb-lead (LL) ECG alone in identifying cardiac abnormalities associated with SCD has not been studied. This study was a comparative secondary data analysis, comparing the interpretation accuracy of 4 physicians evaluating publicly available ECGs of the most common cardiac conditions associated with SCD in athletes. Each physician interpreted a total of 100 ECGs: 50 normal ECGs (25 LL and 25 standard 12L) and 50 abnormal ECGs (25 LL and 25 standard 12L). The agreement between LL ECGs and 12L ECGs was assessed by Cohen's kappa coefficient and the accuracy of identifying an abnormal ECG was compared across LL and 12L ECGs using a chi-squared test. Inter-rater reliability was assessed by estimating the Fleiss's kappa coefficient. The sensitivity of LL ECG and 12L ECG was identical at 86%. The specificity of LL ECG was 75% (95% CI = 65% to 83%) and 12L ECG was 82% (95% CI = 73% to 89%). Substantial agreement was seen between LL ECG and 12L ECG interpretation across all readers (k = 0.63; 95% CI = 0.49 to 0.77). Interpretation accuracy was 81% (95% CI = 74% to 86%) and 84% (95% CI 78% to 89%) using LL ECG and 12L ECG, respectively (p = 0.43). In conclusion, the accuracy, sensitivity, and specificity were high and comparable for both LL ECG and 12L ECG in identifying cardiovascular conditions associated with SCD. Agreement between LL ECG and 12L ECG was substantial.


Assuntos
Atletas , Doenças Cardiovasculares/diagnóstico , Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia/métodos , Displasia Arritmogênica Ventricular Direita/complicações , Displasia Arritmogênica Ventricular Direita/diagnóstico , Displasia Arritmogênica Ventricular Direita/fisiopatologia , Síndrome de Brugada/complicações , Síndrome de Brugada/diagnóstico , Síndrome de Brugada/fisiopatologia , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/fisiopatologia , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/fisiopatologia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/fisiopatologia , Morte Súbita Cardíaca/etiologia , Humanos , Síndrome do QT Longo/complicações , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/fisiopatologia , Programas de Rastreamento , Miocardite/complicações , Miocardite/diagnóstico , Miocardite/fisiopatologia , Síndrome de Wolff-Parkinson-White/complicações , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/fisiopatologia
11.
Am J Cardiol ; 156: 134-135, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34304863

RESUMO

Non-penetrating chest blows can occasionally trigger fatal ventricular tachyarrhythmias and sudden death (commotio cordis). Such events were initially reported in association with sporting activities and projectiles such as baseball/lacrosse balls. However, similar potentially fatal chest blows, seemingly incapable of causing death, can occur during a variety of other circumstances such as when delivered during a fight (by a fist) such as in the accompanying paper. Notably, commotio cordis events can be reversed by resuscitation and defibrillation.


Assuntos
Beisebol , Commotio Cordis , Taquicardia Ventricular , Commotio Cordis/diagnóstico , Commotio Cordis/etiologia , Commotio Cordis/terapia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Humanos , Taquicardia Ventricular/terapia , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/terapia
12.
J Forensic Leg Med ; 82: 102208, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34218057

RESUMO

Sudden cardiac death (SCD) in young athletes represents a challenging issue in forensic practice. The pathologist is frequently asked to establish the cause of death basing upon anatomical findings and to evaluate the role of the physician in preparticipation evaluation (PPE) and eligibility decision. Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a leading cause of SCD during sport activity. However, in the last few years, forms with predominant or even isolated involvement of the left ventricle (LV) have progressively been correlated with a high risk of SCD. We present a case of SCD in an apparently healthy 19-year-old semi-professional football player. Annual PPEs performed in accordance with international and Italian recommendations, were unremarkable. At autopsy, a 1-cm area of subepicardial fibro-fatty replacement was observed at the postero-lateral wall of the LV. The finding was diagnostic of arrhythmogenic left ventricular cardiomyopathy (ALVC). A review of this rare pathology has been performed under a forensic perspective, focusing on the evaluation of the medico-legal responsibility of the physician in the PPE and on the morphological aspects of the disease. Current diagnostic criteria and recommendations result to be focused on the right ventricular pattern, with a risk of misdiagnosis for isolated LV forms. Furthermore, few detailed autopsies cases concerning ALVC have been published. There is a need, therefore, to study this rare disease with a careful and revised approach.


Assuntos
Cardiomiopatias/complicações , Morte Súbita Cardíaca/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Displasia Arritmogênica Ventricular Direita/diagnóstico , Atletas , Diagnóstico Diferencial , Patologia Legal , Humanos , Itália/epidemiologia , Masculino , Adulto Jovem
16.
Int Heart J ; 62(4): 919-923, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34276004

RESUMO

An early repolarization (ER) pattern or J waves are considered to be a benign finding observed in the healthy population, however, it has been pointed out that the ER pattern seen in the inferolateral leads could be an independent risk factor for fatal arrhythmias. We present a pediatric case in which early repolarization syndrome (ERS) was suspected due to the presence of ER or J waves in the inferior leads, which eventually disappeared after the administration of pilsicainide. During the follow-up period, several fatal ventricular arrhythmias were recorded after implantation of a subcutaneous implantable cardiac defibrillator (S-ICD). This report describes the efficacy of S-ICDs in a child with an ER pattern after aborted sudden cardiac death.


Assuntos
Antiarrítmicos/uso terapêutico , Morte Súbita Cardíaca/etiologia , Desfibriladores Implantáveis , Lidocaína/análogos & derivados , Criança , Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia , Humanos , Lidocaína/uso terapêutico , Masculino , Fibrilação Ventricular/terapia
17.
Sud Med Ekspert ; 64(4): 64-67, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34264584

RESUMO

OBJECTIVE: Acomprehensive forensic study of cases of sudden death of school-age children during physical exertion and sports. Investigated 9 cases of sudden death of children aged 8 to 17 years that occurred during exercise. It was studied anthropometric indicators, histological and biochemical studies to identify changes in internal organs and the cardiovascular system. The forensic medical characteristics of sudden death cases of schoolchildren are given. Along with the constitutional features, the characteristic changes in some tissues and internal organs in particular the heart and blood vessels were determined. The data obtained make it possible to develop an algorithm and propose a methodological approach for diagnosing sudden death of school-age children. The results of the study can be used as additional forensic criteria for assessing the risk of sudden death of children during physical activity.


Assuntos
Medicina Legal , Esportes , Criança , Morte Súbita/etiologia , Morte Súbita Cardíaca/etiologia , Exercício Físico , Humanos , Instituições Acadêmicas
20.
Eur Heart J ; 42(29): 2842-2850, 2021 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-34113975

RESUMO

AIMS: This study aims to improve risk stratification for primary prevention implantable cardioverter defibrillator (ICD) implantation by developing a new mutation-specific prediction model for malignant ventricular arrhythmia (VA) in phospholamban (PLN) p.Arg14del mutation carriers. The proposed model is compared to an existing PLN risk model. METHODS AND RESULTS: Data were collected from PLN p.Arg14del mutation carriers with no history of malignant VA at baseline, identified between 2009 and 2020. Malignant VA was defined as sustained VA, appropriate ICD intervention, or (aborted) sudden cardiac death. A prediction model was developed using Cox regression. The study cohort consisted of 679 PLN p.Arg14del mutation carriers, with a minority of index patients (17%) and male sex (43%), and a median age of 42 years [interquartile range (IQR) 27-55]. During a median follow-up of 4.3 years (IQR 1.7-7.4), 72 (10.6%) carriers experienced malignant VA. Significant predictors were left ventricular ejection fraction, premature ventricular contraction count/24 h, amount of negative T waves, and presence of low-voltage electrocardiogram. The multivariable model had an excellent discriminative ability {C-statistic 0.83 [95% confidence interval (CI) 0.78-0.88]}. Applying the existing PLN risk model to the complete cohort yielded a C-statistic of 0.68 (95% CI 0.61-0.75). CONCLUSION: This new mutation-specific prediction model for individual VA risk in PLN p.Arg14del mutation carriers is superior to the existing PLN risk model, suggesting that risk prediction using mutation-specific phenotypic features can improve accuracy compared to a more generic approach.


Assuntos
Arritmias Cardíacas , Proteínas de Ligação ao Cálcio/genética , Desfibriladores Implantáveis , Função Ventricular Esquerda , Adulto , Arritmias Cardíacas/genética , Morte Súbita Cardíaca/etiologia , Feminino , Humanos , Masculino , Mutação , Fatores de Risco , Volume Sistólico
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