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1.
Autops. Case Rep ; 9(4): e2019113, Oct.-Dec. 2019. ilus
Artigo em Inglês | LILACS | ID: biblio-1024144

RESUMO

Hypertrophic cardiomyopathy used to be regarded as a rare untreatable cause of sudden death in young male athletes. This report is the case of a middle-aged female patient with hereditary hypertrophic cardiomyopathy masked by superimposed pericarditis and revealed by autopsy. This case report illustrates how co-morbidity can hide a crucial diagnosis. This case report also illustrates the value of autopsy disclosing a familial disease that is increasingly recognized and dramatically more treatable than a few decades ago. Sudden death due to hypertrophic cardiomyopathy has become preventable, if the diagnosis is made soon enough. The lessons for patient care from this case include the importance of not missing the diagnosis of hypertrophic cardiomyopathy in female patients.


Assuntos
Humanos , Feminino , Adulto , Cardiomiopatia Hipertrófica Familiar/patologia , Diagnóstico Tardio/prevenção & controle , Pericardite/patologia , Autopsia , Morte Súbita Cardíaca/etiologia , Evolução Fatal
2.
West Afr J Med ; 36(3): 286-289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622494

RESUMO

Sarcoidosis is a chronic granulomatous disease with multi-systemic involvement and with varied forms of presentation. The diagnosis can often be a challenge particularly due to the non-specific nature of the disease. It is often silent and may require no active treatment except during flares. We present the case of a middle age lady with pulmonary sarcoidosis who had sudden death from cardiac affectation without prior cardiac symptoms. We concluded that active cardiac assessment is a prudent step in patients presenting with sarcoidosis regardless of the organ of affectation at presentation or diagnosis.


Assuntos
Morte Súbita Cardíaca/etiologia , Sarcoidose Pulmonar/complicações , Cardiomiopatias , Morte Súbita Cardíaca/patologia , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Sarcoidose Pulmonar/patologia
3.
Medicine (Baltimore) ; 98(39): e16982, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574797

RESUMO

To investigate factors predicting the onset of major adverse cardiovascular and cerebrovascular events (MACCEs) after primary percutaneous coronary intervention (pPCI) for patients with non-ST-segment elevation infarction (NSTEMI) and single concomitant chronic total occlusion (CTO). Neutrophil gelatinase-associated lipocalin (NGAL) and glycosylated hemoglobin (HbA1c) both play essential role in cardiovascular and cerebrovascular homoeostasis. However, current knowledge of its predictive prognostic value is limited.422 patients with NSTEMI and CTO (59.7 ±â€Š12.4 years, 74.2% men) who underwent successful pPCI were enrolled and followed for 2 years. Multivariate cox regression analysis and receiver operating characteristic (ROC) curve analysis were performed to determine the factors predicting MACCEs.140 patients (33.2%) experienced MACCEs in the follow-up period. Multivariate cox regression analysis found when we process the model with NGAL at admission, low left ventricular ejection fraction (LVEF, HR = 0.963, 95% CI 0.940 to 0.987, P = .003) and fasting blood glucose (HR = 1.078, 95% CI 1.002 to 1.159, P = .044), but not NGAL at admission, were independent predictors of 2 years MACCEs. While HbA1C (HR = 1.119, 95% CI 1.014 to 1.234, P = .025), LVEF (HR = 0.963, 95% CI 0.939 to 0.987, P = .003), estimated glomerular filtration rate (HR = 1.020, 95% CI 1.006 to 1.035, P = .006) and NGAL value 7 day (HR = 1.020, 95% CI 1.006 to 1.035, P = .006) showed their predictive value in another model. ROC analysis indicated NGAL 7 day (AUC = 0.680, P = .0054 and AUC = 0.622, P = .0005) and LVEF (AUC = 0.691, P = .0298 and AUC = 0.605, P = .0021) could predict both in-hospital and 2 years MACCEs, while higher NGAL at admission could only predict poorer in-hospital prognosis (AUC = 0.665, P = .0103). Further analysis showed the prognostic value of NGAL was particularly remarkable among those HbA1C<6.5%.Patients with NSTEMI and single concomitant CTO receiving pPCI with higher NGAL on 7 days during hospitalization are more likely to suffer 2 years MACCEs, particularly in those with lower HbA1C.


Assuntos
Oclusão Coronária/sangue , Oclusão Coronária/cirurgia , Hemoglobina A Glicada/metabolismo , Lipocalina-2/sangue , Infarto do Miocárdio sem Supradesnível do Segmento ST/sangue , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Intervenção Coronária Percutânea , Idoso , Biomarcadores/sangue , Glicemia/metabolismo , Oclusão Coronária/complicações , Oclusão Coronária/fisiopatologia , Morte Súbita Cardíaca/etiologia , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Prognóstico , Estudos Prospectivos , Choque Cardiogênico/etiologia , Acidente Vascular Cerebral/etiologia , Volume Sistólico
4.
Forensic Sci Int ; 302: 109906, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31419596

RESUMO

The aim of this study is to determine the molecular mechanism of sudden death in a previously healthy patient. Clinical exome sequencing revealed I536T-RBM20 variant, which alters RNA splicing of TTN and is causative for dilated cardiomyopathy. Comprehensive RNA sequencing (RNA-seq) was also performed in the patient samples and the control samples. Splicing abnormality was compared in cardiac muscle and skeletal muscle. RNA-seq analysis of the cardiac and skeletal muscle showed abnormal splicing of LDB3, not of TTN. Exon 11 of LDB3 was abnormally included in the patient samples compared with the control samples. This abnormal LDB3 splicing pattern in skeletal muscle has been reported in myotonic dystrophy type 1 (DM1) patients. We, thus, confirmed that the patient had expanded CTG repeat in DMPK and the diagnosis was genetically DM1. This finding suggest that one of the molecular mechanisms of sudden cardiac death in this asymptomatic subclinical DM1 patient might be LDB3 abnormal splicing due to the CTG repeat in DMPK, rather than RBM20 variant. RNA-seq analysis is useful to determine the exact molecular diagnosis for sudden cardiac death.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Morte Súbita Cardíaca/etiologia , Proteínas com Domínio LIM/genética , Distrofia Miotônica/diagnóstico , Processamento de RNA , Doenças Assintomáticas , Éxons , Humanos , Masculino , Miotonina Proteína Quinase/genética , Análise de Sequência de RNA , Expansão das Repetições de Trinucleotídeos , Adulto Jovem
5.
Med Clin North Am ; 103(5): 809-820, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378327

RESUMO

With recent advances in genetic diagnostics, many inherited diseases, which can cause life-threatening arrhythmias, are being better characterized. Many of these diseases are caused by genetic disorders that affect the function of the ion channels that regulate the action potential or the function of important cardiac muscle regulatory proteins. This article summarizes the diseases that we have learned about, such as the long QT syndrome, Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia. The article examines the diagnosis, genetic screening of patients and their relatives, management, and referral to a specialist for further therapy.


Assuntos
Arritmias Cardíacas/congênito , Canalopatias/diagnóstico , Morte Súbita Cardíaca/etiologia , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologia , Canalopatias/complicações , Humanos , Prognóstico , Avaliação de Sintomas
6.
Med Clin North Am ; 103(5): 913-930, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378334

RESUMO

Sudden cardiac death (SCD) is a leading cause of death in the United States. Despite improvements in therapy, the incidence of SCD as a proportion of overall cardiovascular death remains relatively unchanged. This article aims to answer the question, "Who is at risk for SCD?" In the process, it reviews the definition, pathophysiology, epidemiology, and risk factors of SCD. Patients at risk for SCD and appropriate treatment strategies are discussed.


Assuntos
Doença das Coronárias/complicações , Morte Súbita Cardíaca/epidemiologia , Adulto , Idoso , Doença das Coronárias/fisiopatologia , Morte Súbita Cardíaca/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Volume Sistólico , Estados Unidos/epidemiologia
7.
Methodist Debakey Cardiovasc J ; 15(2): 111-121, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384374

RESUMO

Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden cardiac death in young athletes. The pathophysiology leading to sudden cardiac death, the specific risks associated with the different varieties of AAOCA, and the effects of different management strategies on the risk of sudden cardiac death are all unknown. This article describes the current knowledge of AAOCA, a proposed nomenclature for the different anatomic subtypes, the different modalities used to diagnose and characterize the disease, the available management strategies, and an algorithm used by the authors to diagnose and manage these patients.


Assuntos
Técnicas de Imagem Cardíaca , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/terapia , Morte Súbita Cardíaca/prevenção & controle , Algoritmos , Tomada de Decisão Clínica , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/fisiopatologia , Morte Súbita Cardíaca/etiologia , Técnicas de Apoio para a Decisão , Humanos , Seleção de Pacientes , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco
8.
Expert Rev Cardiovasc Ther ; 17(9): 645-651, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31422711

RESUMO

Introduction: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetically determined disease associated with a significant risk of ventricular arrhythmias and sudden cardiac death (SCD). Implantable cardioverter-defibrillators (ICDs) are the only effective preventive measure. Over the past 30 years, much effort has been invested in determining predictors of adverse arrhythmic events in these patients. Areas covered: This review summarizes available evidence on risk stratification for ARVC, with an emphasis on recent research findings. While efforts are ongoing to define risk predictors, several recent publications have synthetized and built on this knowledge base. A recently published meta-analysis has clarified the strongest predictors of ventricular arrhythmias in ARVC, which vary depending on the population included. Three management guidelines/expert consensus documents have integrated the previously described risk predictors into proposed ICD recommendations. Furthermore, a risk prediction model has allowed the integration of multiple risk factors to provide individualized risk prediction and to inform shared-decision making regarding ICD implantation. Expert opinion: Over the past few years, knowledge of risk prediction in ARVC has been consolidated and refined. Further improvements may be made by the considering additional predictors such as exercise and by targeting more specific surrogate outcomes for SCD.


Assuntos
Arritmias Cardíacas/etiologia , Displasia Arritmogênica Ventricular Direita/complicações , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Humanos , Medição de Risco , Fatores de Risco
10.
Int J Med Inform ; 128: 32-38, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31160009

RESUMO

BACKGROUND: The management of hypertrophic cardiomyopathy (HCM) patients requires the knowledge of risk factors associated with sudden cardiac death (SCD). SCD risk factors such as syncope and family history of SCD (FH-SCD) as well as family history of HCM (FH-HCM) are documented in electronic health records (EHRs) as clinical narratives. Automated extraction of risk factors from clinical narratives by natural language processing (NLP) may expedite management workflow of HCM patients. The aim of this study was to develop and deploy NLP algorithms for automated extraction of syncope, FH-SCD, and FH-HCM from clinical narratives. METHODS AND RESULTS: We randomly selected 200 patients from the Mayo HCM registry for development (n = 100) and testing (n = 100) of NLP algorithms for extraction of syncope, FH-SCD as well as FH-HCM from clinical narratives of EHRs. The clinical reference standard was manually abstracted by 2 independent annotators. Performance of NLP algorithms was compared to aggregation and summarization of data entries in the HCM registry for syncope, FH-SCD, and FH-HCM. We also compared the NLP algorithms with billing codes for syncope as well as responses to patient survey questions for FH-SCD and FH-HCM. These analyses demonstrated NLP had superior sensitivity (0.96 vs 0.39, p < 0.001) and comparable specificity (0.90 vs 0.92, p = 0.74) and PPV (0.90 vs 0.83, p = 0.37) compared to billing codes for syncope. For FH-SCD, NLP outperformed survey responses for all parameters (sensitivity: 0.91 vs 0.59, p = 0.002; specificity: 0.98 vs 0.50, p < 0.001; PPV: 0.97 vs 0.38, p < 0.001). NLP also achieved superior sensitivity (0.95 vs 0.24, p < 0.001) with comparable specificity (0.95 vs 1.0, p-value not calculable) and positive predictive value (PPV) (0.92 vs 1.0, p = 0.09) compared to survey responses for FH-HCM. CONCLUSIONS: Automated extraction of syncope, FH-SCD and FH-HCM using NLP is feasible and has promise to increase efficiency of workflow for providers managing HCM patients.


Assuntos
Algoritmos , Cardiomiopatia Hipertrófica/complicações , Morte Súbita Cardíaca/etiologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Processamento de Linguagem Natural , Morte Súbita Cardíaca/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco
11.
Forensic Sci Int ; 301: 382-387, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31220685

RESUMO

Sudden cardiac death (SCD) is referred to as sudden and unexpected death caused by cardiovascular diseases, in which a person preexisted heart disease or not. Compelling evidence indicates that SCD etiology have been predominantly affected by host genetic factors. However, how genetic variants play roles in the inherited risk component of SCD are still largely unknown. It has been reported that Desmoglein-2 (DSG2) mutations might be related to sudden death. In the present study, we used a candidate gene approach to investigate the associations between rs397729601 (a 2-base pair indel polymorphism) mapping to the 3'UTR of DSG2 with the risk of SCD. It is shown by logistic regression analysis that the risk of SCD has been significantly increased by the deletion allele of rs397729601 [odds ratio (OR)=1.51; 95% confidence interval (CI)=1.12-2.05; P=0.00559]. Additional genotype-phenotype analysis was performed to evaluate the mRNA level, revealing that human myocardium tissues with the deletion allele showed higher expression of DSG2. Dual luciferase activity analysis was conducted in an in vitro reporter gene system, suggesting that DSG2 expression could be regulated by rs397729601 which interrupted the binding of miR-933-3p with DSG2. We concluded that rs397729601 may affect the expression of DSG2 through miR-933-3p regulation, contributing to SCD susceptibility. Thus, rs397729601 may be used as a potential marker for molecular diagnosis and genetic counseling of SCD. Our findings need to be validated through replication and further functional studies.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Morte Súbita Cardíaca/etiologia , Desmogleína 2/genética , Mutação INDEL , Polimorfismo Genético , Estudos de Casos e Controles , China , Desmogleína 2/metabolismo , Feminino , Genética Forense , Predisposição Genética para Doença , Genótipo , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Miocárdio/metabolismo , Reação em Cadeia da Polimerase , RNA Mensageiro/genética , RNA Mensageiro/metabolismo
12.
Int Heart J ; 60(3): 624-630, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31105141

RESUMO

The aim of this study was to evaluate the association of the body mass index (BMI) categories with the risk of sudden cardiac death (SCD) in a systematic review and meta-analysis.We systematically searched the PubMed, Embase, and Cochrane Library databases up to February 2018 for all studies reporting an association between BMI and risk of SCD. Relative risks (RRs) and 95% confidence intervals (CIs) were extracted and pooled using a random effects model.A total of 10 studies involving 1,381,445 participants were included in the meta-analysis. Overall, compared with the risk level in normal-weight controls, being underweight was not associated with increased risk of SCD (RR = 1.20, 95% CI, 0.95-1.51; P = 0.13). In contrast, both being overweight (RR = 1.21, 95% CI, 1.08-1.35; P = 0.0008) and obesity (RR = 1.52, 95% CI, 1.31-1.77; P < 0.00001) were associated with increased risk of SCD. The association between the BMI categories and risk of SCD was stable in the sensitivity analysis in which individual studies were serially excluded.The findings from this meta-analysis indicate that excess weight is associated with an increased risk of SCD. Further research is required to explore the underlying mechanisms.


Assuntos
Morte Súbita Cardíaca/etiologia , Obesidade/complicações , Sobrepeso/epidemiologia , Índice de Massa Corporal , Causas de Morte , Feminino , Humanos , Masculino , Obesidade/epidemiologia , Sobrepeso/complicações , Medição de Risco
13.
Int J Mol Sci ; 20(10)2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31100908

RESUMO

Cardiovascular diseases (CVDs) have been considered the most predominant cause of death and one of the most critical public health issues worldwide. In the past two decades, cardiovascular (CV) mortality has declined in high-income countries owing to preventive measures that resulted in the reduced burden of coronary artery disease (CAD) and heart failure (HF). In spite of these promising results, CVDs are responsible for ~17 million deaths per year globally with ~25% of these attributable to sudden cardiac death (SCD). Pre-clinical data demonstrated that renal denervation (RDN) decreases sympathetic activation as evaluated by decreased renal catecholamine concentrations. RDN is successful in reducing ventricular arrhythmias (VAs) triggering and its outcome was not found inferior to metoprolol in rat myocardial infarction model. Registry clinical data also suggest an advantageous effect of RDN to prevent VAs in HF patients and electrical storm. An in-depth investigation of how RDN, a minimally invasive and safe method, reduces the burden of HF is urgently needed. Myocardial systolic dysfunction is correlated to neuro-hormonal overactivity as a compensatory mechanism to keep cardiac output in the face of declining cardiac function. Sympathetic nervous system (SNS) overactivity is supported by a rise in plasma noradrenaline (NA) and adrenaline levels, raised central sympathetic outflow, and increased organ-specific spillover of NA into plasma. Cardiac NA spillover in untreated HF individuals can reach ~50-fold higher levels compared to those of healthy individuals under maximal exercise conditions. Increased sympathetic outflow to the renal vascular bed can contribute to the anomalies of renal function commonly associated with HF and feed into a vicious cycle of elevated BP, the progression of renal disease and worsening HF. Increased sympathetic activity, amongst other factors, contribute to the progress of cardiac arrhythmias, which can lead to SCD due to sustained ventricular tachycardia. Targeted therapies to avoid these detrimental consequences comprise antiarrhythmic drugs, surgical resection, endocardial catheter ablation and use of the implantable electronic cardiac devices. Analogous NA agents have been reported for single photon-emission-computed-tomography (SPECT) scans usage, specially the 123I-metaiodobenzylguanidine (123I-MIBG). Currently, HF prognosis assessment has been improved by this tool. Nevertheless, this radiotracer is costly, which makes the use of this diagnostic method limited. Comparatively, positron-emission-tomography (PET) overshadows SPECT imaging, because of its increased spatial definition and broader reckonable methodologies. Numerous ANS radiotracers have been created for cardiac PET imaging. However, so far, [11C]-meta-hydroxyephedrine (HED) has been the most significant PET radiotracer used in the clinical scenario. Growing data has shown the usefulness of [11C]-HED in important clinical situations, such as predicting lethal arrhythmias, SCD, and all-cause of mortality in reduced ejection fraction HF patients. In this article, we discussed the role and relevance of novel tools targeting the SNS, such as the [11C]-HED PET cardiac imaging and RDN to manage patients under of SCD risk.


Assuntos
Morte Súbita Cardíaca/etiologia , Insuficiência Cardíaca/complicações , Sistema Nervoso Simpático/efeitos dos fármacos , 3-Iodobenzilguanidina , Animais , Arritmias Cardíacas , Catecolaminas/urina , Modelos Animais de Doenças , Efedrina/análogos & derivados , Coração , Humanos , Infarto do Miocárdio , Miocárdio , Tomografia por Emissão de Pósitrons , Taquicardia Ventricular , Tomografia Computadorizada de Emissão de Fóton Único , Disfunção Ventricular Esquerda
14.
Prog Cardiovasc Dis ; 62(3): 235-241, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31075279

RESUMO

Sudden cardiac death (SCD) is a major cause of mortality in patients with nonischemic cardiomyopathy (NICM). Identifying patients who are at highest risk for SCD is an ongoing challenge. At present, guidelines recommend the use of an implantable cardioverter-defibrillator (ICD) in patients with NICM with a reduced left ventricular ejection fraction (LVEF) and heart failure (HF) symptoms. Some recent data, however, suggest that ICDs may not increase longevity in this population. Conversely, community-based studies have demonstrated that many at-risk individuals who may benefit from ICD therapy remain unprotected. Current recommendations for ICD implantation are continually debated, justifying comprehensive individualized risk assessment. Various promising techniques for further risk stratification are under evaluation, including cardiac magnetic resonance imaging, electrocardiographic assessment of electrical instability, and genetic testing. However, none of these strategies has been fully adapted into guidelines. Hence, clinical risk stratification practice today depends on LVEF and HF symptoms, which have poor sensitivity and specificity for predicting SCD risk.


Assuntos
Cardiomiopatias/complicações , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Cardiomiopatias/terapia , Morte Súbita Cardíaca/etiologia , Ecocardiografia , Insuficiência Cardíaca/complicações , Humanos , Imagem por Ressonância Magnética , Medição de Risco , Sensibilidade e Especificidade , Função Ventricular Esquerda
15.
Prog Cardiovasc Dis ; 62(3): 227-234, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31078562

RESUMO

Sudden cardiac death (SCD) accounts for 230,000 to 350,000 deaths per year in the United States. While many who suffer SCD possess underlying structural heart disease, inherited arrhythmia syndromes are also important contributors to SCD. In patients without structural heart disease, inherited arrhythmia syndromes are identified in >50% of the remaining patients. In this review, we will focus on the presentation and management of three major inherited syndromes that lead to SCD in patients without structural heart disease: long QT syndrome (LQTS), Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia (CPVT). All these syndromes can present in patients who are asymptomatic or, at the other extreme, with syncope and even SCD. LQTS syndrome and Brugada are the most common inherited arrhythmogenic syndromes, while CPVT is much rarer. Determining which patients need pharmacologic treatment and those who would benefit from more aggressive treatment such as sympathectomies and implantable defibrillators is not always clear.


Assuntos
Síndrome de Brugada , Morte Súbita Cardíaca/etiologia , Síndrome do QT Longo , Taquicardia Ventricular , Síndrome de Brugada/complicações , Síndrome de Brugada/diagnóstico , Síndrome de Brugada/terapia , Desfibriladores Implantáveis , Eletrocardiografia , Humanos , Síndrome do QT Longo/complicações , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/terapia , Medição de Risco , Taquicardia Ventricular/complicações , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/terapia
16.
Prog Cardiovasc Dis ; 62(3): 288-293, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31102597

RESUMO

Sudden cardiac death (SCD) is a global public health burden accounting for 15-20% of all deaths. Though established atherosclerotic risk factors explain a large proportion of the risk of SCD, these factors are often absent in a large proportion of SCD victims and the pathogenesis of SCD is still not fully established. It therefore appears that additional factors may be involved. Sauna bathing is a traditional Finnish activity that is mainly used for the purposes of relaxation and pleasure. Beyond its use for these purposes, sauna bathing has been linked with several health benefits. Emerging evidence suggests that sauna bathing is associated with reduced risk of adverse cardiovascular (CV) disease (CVD) and non-CVD outcomes as well as mortality. A number of reports have linked sauna bathing with reduced or increased risk of SCD, but the evidence is uncertain. This review summarizes available studies linking sauna bathing with SCD, the postulated mechanistic pathways underlying these associations, outlines areas of outstanding uncertainty, and the implications for prevention. We employed a comprehensive search for observational studies, randomized controlled trials (RCTs), and non-RCTs from MEDLINE and Embase since their inception until March 2019. Observational data suggest that regular sauna bathing is associated with a substantial risk reduction in SCD. Furthermore, the data suggest that a combination of regular physical activity and sauna baths confers substantial risk reduction for SCD compared with either modality alone. Few reports have linked sauna baths with SCDs, but these single case incidents have been attributed to the effects of dehydration, hypotension, and cardiac arrhythmias due to a combination of sauna exposure and alcohol consumption. Sauna bathing is generally safe for most healthy people and even among patients with stable CVD, if used sensibly and with caution. Plausible pathways underlying the protective effect of sauna bathing on SCD may be linked to the impact on CV function via reduced arterial stiffness, decreases in inflammation and oxidative stress, stabilization of the autonomic nervous system, beneficial changes in circulating lipid profiles and other CVD risk markers, and lowering of systemic blood pressure. Sauna is a potential novel tool to promote SCD prevention in addition to other known means, being an enjoyable way to take care of general health and well-being.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Banho a Vapor , Arritmias Cardíacas/etiologia , Fenômenos Fisiológicos Cardiovasculares , Morte Súbita Cardíaca/etiologia , Humanos , Fatores de Risco , Comportamento de Redução do Risco , Banho a Vapor/efeitos adversos
17.
Prog Cardiovasc Dis ; 62(3): 205-211, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31054859

RESUMO

Sudden cardiac death (SCD) accounts for one fifth of global deaths, and occurs when a trigger (e.g. myocardial ischemia, premature ventricular contraction) interacts with an arrhythmic substrate (e.g. myocardial scar, dilated cardiomyopathy). Multimodality imaging (echocardiographic, cardiac magnetic resonance and nuclear techniques) can potentially visualize many predisposing substrates and triggers. Implantable cardioverter-defibrillator (ICD) is the most effective approach to primary prevention of SCD, and current guidelines regarding ICD implantation are based on a left ventricular ejection fraction (LVEF) ≤35%. This practice is limited by a low sensitivity and specificity, and has limited value when applied to different etiologies. In this review, the role of multimodality imaging in SCD risk-stratification and the limitations of an LVEF-based approach, are discussed. Additional randomized, prospective data are eagerly awaited to inform on the role of imaging in SCD risk-stratification, and ongoing/ planned trials are subsequently discussed.


Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Morte Súbita Cardíaca , Arritmias Cardíacas/complicações , Arritmias Cardíacas/patologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Ecocardiografia , Humanos , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e Especificidade , Função Ventricular Esquerda
18.
Prog Cardiovasc Dis ; 62(3): 265-271, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31075277

RESUMO

Sudden cardiac death (SCD) is a major public health issue in the United States and worldwide. It is estimated to affect between 1 and 1.5 million patients worldwide annually, with the global burden expected to rise due to the concomitant rise in coronary artery disease in the developing world. Although arrhythmic causes of SCD such as ventricular tachycardia and ventricular fibrillation are common and well-studied, non-arrhythmic causes are also important, with diverse etiologies from ischemia-related structural heart disease to non-ischemic heart diseases, non-atherosclerotic coronary pathologies, and inflammatory states. Recent research has also found that risk factors and/or demographics predispose certain individuals to a higher risk of non-arrhythmia-related SCD. This review discusses the epidemiology, mechanisms, etiologies, and management of non-arrhythmic SCD.


Assuntos
Doença das Coronárias/complicações , Morte Súbita Cardíaca/etiologia , Infarto do Miocárdio/complicações , Adulto , Aneurisma Coronário/complicações , Aneurisma Coronário/diagnóstico por imagem , Morte Súbita Cardíaca/epidemiologia , Humanos , Lactente , Fatores de Risco , Tomografia Computadorizada por Raios X
20.
Leg Med (Tokyo) ; 38: 73-76, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31030120

RESUMO

Commotio Cordis (CC) diagnosis is based on the occurrence of a blunt, non-penetrating blow to the chest preceding cardiovascular collapse and the absence of structural damage that would explain any observed effects. In CC lethal cases, the execution of the autopsy represents a possible diagnostic tool. Nevertheless, to date in the literature no author expresses an opinion about the use of the autopsy. In the light of the above, the authors propose a review of the literature about this topic. The review consents to state that the occurrence of a blunt blow to the chest is a necessary element for a lethal CC diagnosis, but it cannot be considered enough. Indeed, because CC is a recognized cause of sudden cardiac death, the autopsy should be always performed to exclude the presence of structural damage that would explain any observed effects. This approach is fundamental in order to achieve an accurate diagnosis and to distinguish CC from other causes of sudden cardiac death. In addition, the authors sustain that in case of autopsy data's lack the authors should not identify CC diagnosis as definitive but as possible.


Assuntos
Autopsia , Commotio Cordis/diagnóstico , Commotio Cordis/patologia , Patologia Legal , Commotio Cordis/etiologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/patologia , Diagnóstico Diferencial , Humanos , Contusões Miocárdicas/complicações , Contusões Miocárdicas/patologia
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