Cardiac arrest and sudden cardiac death. Causes and prevention in the general population

Definitions:
Cardiac arrest is the condition in which the heart suddenly loses its ability to function, leading to hemodynamic collapse of the individual. If not reversed it leads to sudden cardiac death. Sudden death is defined as a fatal event that occurs suddenly and without the presence of injury within one hour of the onset of symptoms, in a person who until that time appeared healthy (1) When sudden death is attributed to heart disease or in cases where autopsy proves existing heart disease or does not prove a non-cardiac cause of death then the sudden death is called sudden cardiac death(2).

A subcategory of sudden cardiac death is the sudden arrhythmic death syndrome where the autopsy does not prove the existence of heart disease or another cause, in which case the death is attributed to an arrhythmic cause(2).
These definitions refer to persons aged > 1 year.

All the above conditions are not diseases but are the result of underlying diseases

Causes of sudden cardiac death
The majority of cases of sudden death are due to underlying cardiac disease, i.e. they are sudden cardiac death.
Coronary artery disease is recorded as the most common cause of sudden cardiac death, accounting for approximately 75-80% of cases. Other causes of sudden cardiac death are congenital anomalies of the coronary vessels, arrhythmological syndromes (e.g. Brugada syndrome, long QT syndrome, etc.), cardiomyopathies (e.g. dilated cardiomyopathy, hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia abdomen), myocarditis, valvular diseases (most importantly aortic valve stenosis) as well as heart failure of any cause.

Treatment of cardiac arrest:
Out-of-hospital cardiac arrest has a very low survival rate.
In case of cardiac arrest, the only treatment is cardiopulmonary resuscitation and the use of a defibrillator. Early initiation of CPR and defibrillation when indicated play an important role in survival from arrest. For this reason the education of the general population as well as the placement of automatic defibrillators in public places is of major importance.

Prevention:
The only way to reduce the chance of sudden cardiac death is to diagnose the underlying causes and prevent them from occurring. Cardiac arrest and sudden cardiac death are often the first manifestation of an underlying disease of which the person is unaware, without any previous symptoms. A key role is the examination and guidance by a cardiologist.

-For coronary heart disease, the modification of risk factors (avoidance of smoking, healthy diet, regulation of arterial hypertension, hyperlipidemia and sugar) is of utmost importance. Coronary angiography and reperfusion (angioplasty or heart surgery) play a key role in the diagnosis and treatment of the disease.
– In arrhythmic syndromes, the diagnosis is based on an electrocardiographic test and/or an electrophysiological study in order to identify people at increased risk for sudden cardiac death.
– In structural diseases and valvular diseases, the basis of diagnosis is imaging (examination with heart triplex or new techniques such as magnetic or axial heart).

In all cases the indication for an implantable defibrillator that could prevent sudden cardiac death is considered.

Kontopodis Eleftherios – Interventional Cardiologist

Kahrimani Maria – Cardiologist

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