Mode of death in sudden cardiac syndrome

Vast majority is due to cardiac arrhythmia. Patients initially presenting with Ventricular Tachycardia (VT), deteriorating to Ventricular Fibrillation (VF) and then asytole & death.

The management of sudden cardiac death

This can be divided into 3 sections :

1. The management of sudden cardiac arrest itself.
2. Secondary prevention of how to prevent the patient from recurrent cardiac arrest.
3. Primary prevention in the high risk group and in the general population.

The management of sudden cardiac arrest is:

1. To call for help immediately preferably before the patient arrive.
2. Immediate Cardio Pulmonary Resuscitation (CPR) if possible.
3. Early Defibrillation is absolutely essential for ventricular fibrillation.
4. Early admission to the hospital.
5. Advance cardiac support live.

As VT / VF is the initial rhythm in the majority of the cases without automatic external Defibrillation, the chances of successful resuscitation is very low - less than 2%. CPR itself keeps the patient alive for a short time but the longer the Defibrillation is delayed, the worse the survival. So, in essence, the Defibrillation is the most important single factor in determining the survival of sudden cardiac death. Hence if we want to increase success rate at CPR, we will have to equip every ambulance with AED.

In the presence of sudden cardiac death, the ventricular fibrillation should be defibrillated as quickly as possible (200-300 Joules). Certain drugs sometime help in the management - Lignocaine, Cordarone, Magnesium Adrenaline. Patient may have to be defibrillated repeatedly before they can be reverted back to normal rhythm.

Management of Sudden Cardiac Death Sunfival (Secondary Prevention)

Look for reversible transient factors e.g.

• acute heart attack
• underlying structure heart disease
• dilated hypertrophic cardiomyopathy
• impaired left ventricular function

High risk sub-groups such as:

• prolonged QT interval
• Brugada syndrome
• set a need for revascularisation if associated with coronary artery disease