Diagnostic Considerations

Other conditions to be considered in patients with suspected sudden cardiac death (SCD) include arrhythmogenic right ventricular (RV) dysplasia and Brugada syndrome.

Important considerations include the following:

Recognize and initiate early management of patients with ischemic heart disease. The importance of this cannot be overestimated, because approximately 80% of SCD cases can be attributed to ischemic heart disease.
Use appropriate medical therapy for ischemic heart disease (eg, beta-blockers).
It is very important to involve a specialist in cardiovascular disease in the care of patients who have had a cardiac arrest or have symptoms of ischemic heart disease, valvular disorders, or presentations with complex arrhythmias.
It is very important to educate patients about the consequences of noncompliance with medical therapy.

Differential Diagnoses

Workup

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Media Gallery

Sudden Cardiac Death. Interplay of various risk factors that can lead to sudden cardiac death.
Sudden Cardiac Death. Plots of mortality rates (deaths per 1000 persons) for ischemic heart disease occurring out of the hospital or in the emergency department (top) and occurring in the hospital (bottom) by age, sex, and race in 40 states during 1985.
Sudden Cardiac Death. Figure a: Neurologic outcome stratified by initial cardiac arrest score. Neurologic recovery is defined as discharged to home and able to care for self. Figure b: Overall survival stratified by initial cardiac arrest score.
Sudden Cardiac Death. Epsilon wave in a patient with arrhythmogenic right ventricular dysplasia.
Sudden Cardiac Death. Ventricular fibrillation appeared during rapid atrial fibrillation in a patient with Wolff-Parkinson-White syndrome.
Sudden Cardiac Death. Complex arrhythmias such as ventricular tachycardia/ventricular fibrillation (VT/V)F are the result of an imbalance between important components that control the rhythm. Reprinted with permission from Nova Science Publishers, Inc (Dudley SC, Kocheril AG, Sovari AA, Eds. Ventricular Arrhythmia: From Principles to Patients, Part of the Cardiology Research and Clinical Developments Series. Nova Science Publishers. New York, 2013).

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Author

Ali A Sovari, MD, FACP, FACC Attending Physician, Cardiac Electrophysiologist, Cedars Sinai Medical Center and St John's Regional Medical Center

Ali A Sovari, MD, FACP, FACC is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Physician Scientists Association, American Physiological Society, Biophysical Society, Heart Rhythm Society, Society for Cardiovascular Magnetic Resonance

Disclosure: Nothing to disclose.

Coauthor(s)

Abraham G Kocheril, MD, FACC, FACP, FHRS Professor of Medicine, University of Illinois College of Medicine

Abraham G Kocheril, MD, FACC, FACP, FHRS is a member of the following medical societies: American College of Cardiology, Central Society for Clinical and Translational Research, Heart Failure Society of America, Cardiac Electrophysiology Society, American College of Physicians, American Heart Association, American Medical Association, Illinois State Medical Society

Disclosure: Nothing to disclose.

Arnold S Baas, MD, FACC, FACP Professor of Medicine, Division of Cardiology, Fellowship Director for Advanced Heart Failure and Transplant Cardiology, Ahmanson UCLA Cardiomyopathy Center, Mechanical Circulatory Support, and Heart Transplant Program, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Ronald Reagan UCLA Medical Center

Arnold S Baas, MD, FACC, FACP is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Society of Echocardiography, International Society for Heart and Lung Transplantation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ronald J Oudiz, MD, FACP, FACC, FCCP Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Liu Center for Pulmonary Hypertension, Division of Cardiology, LA Biomedical Research Institute at Harbor-UCLA Medical Center

Ronald J Oudiz, MD, FACP, FACC, FCCP is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Heart Association, American Thoracic Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Actelion, Bayer, Gilead, United Therapeutics<br/>Received research grant from: Actelion, Arena, Gilead, GSK, Liquidia, Reata, United Therapeutics<br/>Received income in an amount equal to or greater than $250 from: Actelion, Complexa, Gilead, Medtronic, Reata, United Therapeutics.

Chief Editor

Mikhael F El-Chami, MD Associate Professor, Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine

Mikhael F El-Chami, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, Heart Rhythm Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Medtronic; Boston Scientific, Biotronik<br/>Received research grants (as part of Multicenter studies) from Medtronic and Boston Scientific.

Additional Contributors

Russell F Kelly, MD Assistant Professor, Department of Internal Medicine, Rush Medical College; Chairman of Adult Cardiology and Director of the Fellowship Program, Cook County Hospital

Russell F Kelly, MD is a member of the following medical societies: American College of Cardiology

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the contributions of previous authors Krishna Malineni, MD, and Peter A McCullough, MD, MPH, FACC, FACP, FCCP, to the development and writing of this article.

Sudden Cardiac Death Differential Diagnoses

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Differential Diagnoses

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