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Year : 2015  |  Volume : 1  |  Issue : 2  |  Page : 103

Sudden cardiac death

CRY Cardiovascular Pathology, Cardiovascular Sciences Research Centre, St. George's University of London, United Kingdom

Date of Web Publication30-Sep-2015

Correspondence Address:
Prof. Mary N Sheppard
CRY Cardiovascular Pathology, Cardiovascular Sciences Research Centre, St. George's University of London
United Kingdom
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2395-5414.166319

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How to cite this article:
Sheppard MN. Sudden cardiac death. J Pract Cardiovasc Sci 2015;1:103

How to cite this URL:
Sheppard MN. Sudden cardiac death. J Pract Cardiovasc Sci [serial online] 2015 [cited 2023 Jan 31];1:103. Available from: https://www.j-pcs.org/text.asp?2015/1/2/103/166319

For the families of affected individuals, sudden cardiac death (SCD) comes as a devastating and shocking experience as it often claims the lives of young previously fit adults. Detailed case history, meticulous autopsy examination, and complete toxicological screening are essential to arrive at the underlying cause of death. Most of the cases of sudden death have a cardiac genetic cause, so a detailed autopsy and examination of the heart is essential in all cases.[1] As expected, a UK prospective study in the 1990s showed ischemic heart disease in the majority. This study also highlighted nonischemic heart disease in 7% of cases, particularly hypertrophic cardiomyopathy, dilated cardiomyopathy, and arrhythmogenic cardiomyopathy. In the final 7% of cases, after detailed pathological examination of the whole heart, no cause of death could be established.[2] This study was first greeted with skepticism by the medical profession, particularly cardiologists. Gradually, it became apparent that it was electrical abnormalities that were responsible for these sudden deaths and could be found in their relatives on screening. The term SCD or sudden arrhythmic death (SAD) was introduced, indicating the mode of death as a lethal cardiac arrhythmia. It has also been called as sudden adult death to distinguish it from sudden infant death, but it can occur at any age, not just in adulthood. The incidence of this entity has been unknown and generally underestimated. A further, prospective study showed that SAD occurred predominantly in the young males. The estimated incidence rate of these unexplained cardiac deaths is 1.34/100,000/annum, a potential of over 500 SADs in England per annum. SAD syndrome (SADS) should, therefore, be a certifiable cause of death prompting specialized cardiological evaluation of families.[3] A further study indicated even higher figures with 1.8/100,000/year.[4] Our pathological study of over 400 sudden deaths in England indicated that electrical faults in the hearts are becoming a frequent cause of sudden death.[5] In a further study of families of SADS victims, 53% screened were diagnosed with inheritable heart disease.[6] Other causes of sudden death include mitral valve prolapse, conduction system abnormalities, congenital coronary artery anomalies, myocarditis, aortic rupture, nonatherosclerotic-acquired coronary artery disease, postoperative congenital heart disease, and aortic stenosis. Thus, a large spectrum of cardiovascular disorders, both congenital and acquired, is responsible for SCD in the young males. Therefore, an accurate cardiac pathological examination is essential.[7]

Follow-up in families with clinical examination is vital for appropriate prophylaxis among relatives, guided and confirmed by genetic analysis.[8]

  References Top

Sheppard MN. Approach to the cardiac autopsy. J Clin Pathol 2012;65:484-95.  Back to cited text no. 1
Bowker TJ, Wood DA, Davies MJ, Sheppard MN, Cary NR, Burton JD, et al. Sudden, unexpected cardiac or unexplained death in England: A national survey. QJM 2003;96:269-79.  Back to cited text no. 2
Behr ER, Casey A, Sheppard M, Wright M, Bowker TJ, Davies MJ, et al. Sudden arrhythmic death syndrome: A national survey of sudden unexplained cardiac death. Heart 2007;93:601-5.  Back to cited text no. 3
Papadakis M, Sharma S, Cox S, Sheppard MN, Panoulas VF, Behr ER. The magnitude of sudden cardiac death in the young: A death certificate-based review in England and Wales. Europace 2009;11:1353-8.  Back to cited text no. 4
Fabre A, Sheppard MN. Sudden adult death syndrome and other non-ischaemic causes of sudden cardiac death. Heart 2006;92:316-20.  Back to cited text no. 5
Behr ER, Dalageorgou C, Christiansen M, Syrris P, Hughes S, Tome Esteban MT, et al. Sudden arrhythmic death syndrome: Familial evaluation identifies inheritable heart disease in the majority of families. Eur Heart J 2008;29:1670-80.  Back to cited text no. 6
de Noronha SV, Behr ER, Papadakis M, Ohta-Ogo K, Banya W, Wells J, et al. The importance of specialist cardiac histopathological examination in the investigation of young sudden cardiac deaths. Europace 2014;16:899-907.  Back to cited text no. 7
Wilde AA, Behr ER. Genetic testing for inherited cardiac disease. Nat Rev Cardiol 2013;10:571-83.  Back to cited text no. 8


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