How to prevent sudden cardiac death? Sudden cardiac death risk factors are present silently for decades. How to screen young athletes for risk of sudden death? Sudden heart death survival rate is low.
Transcript of video
Reduce risks of sudden cardiac death. Sudden Cardiac Death happens in athletes. Dr. Anton Titov, MD. How can death due to sudden cardiac arrest be prevented? Video interview with top expert in cardiology. Sudden cardiac arrest prevention focuses on identification of risk factors: hypertrophic cardiomyopathy, Arrhythmogenic right ventricular cardiomyopathy and ischemic heart disease. Dr. Anton Titov, MD. Long QT syndrome and subclinical hypertrophic cardiomyopathy are major risk factors for sudden cardiac death. Second opinion ensures that hypertrophic cardiomyopathy diagnosis is correct and complete. Second opinion also helps to choose the best treatment strategy for cardiac arrhythmia. Seek second opinion on ischemic and non-ischemic cardiomyopathy and be confident that your treatment is the best. Healthy lifestyle reduces risk of sudden cardiac death but genetic screening is important. Prediction and prevention of sudden cardiac death involves EKG and echocardiography testing. EKG can find subclinical hypertrophic cardiomyopathy. Prevention of sudden cardiac death is a key challenge for cardiologists and patients. Medical Second Opinion. Dr. Anton Titov, MD. Let’s talk about sudden cardiac death. This is a very dreaded word combination. It does happen to patients with underlying heart disease or who probably had a myocardial infarction event the past. Sudden heart death also happens to patients who have no signs or symptoms. They have no overt symptoms of heart disease. Dr. Anton Titov, MD. What are the main causes of sudden cardiac death? What are the ways to prevent it? And what is the best way to identify people who are at particular risk for sudden cardiac death? Medical Second Opinion. Dr. Dale Adler, MD. You are just correct. Sudden cardiac death is obviously highly highly dreaded. And so in one small area you have the genetic abnormalities. You have heart rhythm disturbances. You have the long QT syndromes, where if there is a family history of cardiac arrhythmia or sudden death as its consequence. We are much better now in understanding the genes that are associated with sudden cardiac death. And we can assess other family members. We can see if they have those genes. And if they do, we can take care of them in the correct way. Medical Second Opinion. Long QT syndromes are identified on electrocardiogram [EKG, ECG]. Medical Second Opinion. Dr. Dale Adler, MD. You can identify long QT syndrome on an electrocardiogram. There are many gray areas on the electrocardiogram. But that’s where EKG is helpful. If there really is a family history of sudden death. Then you add the genetic information to it. And you make a correct diagnosis of sudden death risks. Then you find the best treatment to prevent sudden death. There are many more issues in terms a sudden death in patients with structural heart disease. So some of the structural heart disease could also be genetic. There is the hypertrophic cardiomyopathy group. There is the Arrhythmogenic Right Ventricular Dysplasia (ARVD) group. Dr. Dale Adler, MD. And those also can have a genetic component. Sometimes there is a family history of sudden cardiac death. Then patients can be screened for sudden death genetic risks. Their genes can be assessed. You know how to follow them. But there is a much larger group of patients with sudden death. They are the patients who have some problem with the overall pumping capacity of their heart. But they do not have a problem with blood flow to the heart. We would call this problem a nonischemic cardiomyopathy. Many times there may be a genetic component to such patients. And then the big share of patients with sudden cardiac death is this. We worry about them very much. It is the ischemic cardiomyopathy. These patients are not getting enough blood flow. Sometimes patients are brought into a hospital following a cardiac arrest. They are taken to the catheterization laboratory. At least half of the time we will find that they have an occlusion of a blood vessel of the heart. To prevent sudden death it is important to take care of the heart blood vessels. It is a big deal of course. Identification of families that are at risk for sudden cardiac death is a big deal. And also identification of patients who have problems with the overall pumping capacity of the heart is a big deal. Dr. Dale Adler, MD. Despite all that, we know sudden death is an enormous issue. Because once patients get to the hospital with a heart attack, we can help them well. There is a group of sudden cardiac death patients that never gets to the hospital. This group of patients troubles us very much. The other piece to the sudden death equation is this. Dr. Anton Titov, MD. When you identified risk factors, what to do about them? Sudden cardiac death risk factors could be a genetic basis, or dilatation of the heart, or problems with coronary arteries, or the scar on the heart. Then treatment of underlying cause is important. It is the use of preventive defibrillators. And that has been an area with tremendous progress. So the devices that we use nowadays are much much smaller than in the past. I think all of us are very encouraged by the development of a device that is actually going to be wireless. Preventive cardiac defibrillator will be implanted underneath the skin. You don’t actually have to have wires in the bloodstream. And that kind of device we would hope could last for a long period of time. We hope wireless cardiac defibrillator will not create the complications of the wires going across valves and into the heart. We hope there will not be risk of infection. Medical Second Opinion. Some sudden cardiac death events happen in young athletes. Dr. Dale Adler, MD. And not necessary professional athletes, but somebody who might be playing soccer in school. Young athletes that play other sports. In Italy all athletes are screened for structural abnormalities of the hear. All athletes are screened for hypertrophic cardiomyopathy. Dr. Anton Titov, MD. What are the best ways to screen for hypertrophic cardiomyopathy? Does it make sense? Because risk of sudden cardiac death makes a lot of parents very worried. Because sudden death events happen. Even though overall in population of many people sudden cardiac death events are rare. But any one sudden cardiac death is one death too many. Medical Second Opinion. You are absolutely correct. And of course sudden death events in young athletes receive a tremendous amount of media attention. And it is a tragedy like all sudden deaths. All deaths that you think might have been able to be prevented. And you are just correct. Hypertrophic cardiomyopathy ranks up high in sudden cardiac death events in young athletes. Dr. Dale Adler, MD. There are some other other genetic syndromes. They would be much more rare. Everybody in this country is very aware of the Italian experience. We would say that without question a careful clinical exam is important. All athletes, anybody going to participate in any kind of sport, should have a detailed clinical examination. It may not find risks for sudden death. An EKG [electrocardiography] is wonderful. But there’s been a tremendous amount a controversy over whether patients must have an EKG. Who you must act on if you find an EKG abnormality? Whether that should be done. I think that it [EKG] is inexpensive test. IECG is easy to perform. If there is any hint anywhere of family history of cardiac arrhythmias or sudden death, I think it’s nice to do EKG. And so for parents I don’t think it’s ever a bad idea to do the following diagnostic tests. To do a careful clinical cardiology exam. Electrocardiogram is definitely not a bad thing for someone to undergo. Medical Second Opinion.Dr. Anton Titov, MD. Cardiac echocardiography is another diagnostic step. Nevertheless echocardiogram is probably even more precise. Dr. Dale Adler, MD. Somebody is very much worried about the sudden cardiac death situation. Perhaps it’s worth taking a ultrasound of the heart. Medical Second Opinion. Yes and there could be additional diagnostic tests if there’s a pathology found on the electrocardiogram. Physicians might move forward to additional diagnostic tests. One of the issues is that none of these diagnostic tests are failsafe. Because in hypertrophic cardiomyopathy patients can carry a gene mutation. They could have a risk of having a sudden cardiac death event. But they haven’t manifested this risk yet. And that is sudden death risk identification area that we are very interested in. Because if you can identify those patients, possibly we could treat those patients early. Dr. Dale Adler, MD. They will never have sudden death. They will not show phenotype of hypertrophic cardiomyopathy. Medical Second Opinion on sudden cardiac death. That’s the ultimate 4P medicine (Predictive, Preventive, Personalized, Participatory). Medical Second Opinion. Dr. Anton Titov, MD. It is very much so, correct. Sudden cardiac death risk factors are often hidden until a cardiac arrest happens. Who is at risk? Hypertrophic cardiomyopathy, Arrhythmogenic Right Ventricular Dysplasia.