Preventing Sudden Cardiac Death: Risk Factors and Screening

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• Identifying Risk Factors for Sudden Cardiac Death
• The Role of Genetic Screening in Prevention
• EKG and Echocardiography in Risk Detection
• Sudden Cardiac Death in Young Athletes
• Advancements in Preventive Cardiac Defibrillators
• Full Transcript

Identifying Risk Factors for Sudden Cardiac Death

Dr. Dale Adler, MD, emphasizes the importance of identifying risk factors for sudden cardiac death, which can often be silent for decades. Key risk factors include hypertrophic cardiomyopathy, long QT syndrome, and ischemic heart disease. Understanding these factors allows for targeted prevention strategies, potentially saving lives.

The Role of Genetic Screening in Prevention

Genetic screening plays a crucial role in preventing sudden cardiac death. Dr. Adler highlights how advancements in understanding genetic abnormalities, such as those associated with long QT syndrome, enable the assessment of family members for potential risks. This proactive approach allows for early intervention and management.

EKG and Echocardiography in Risk Detection

Electrocardiograms (EKG) and echocardiography are vital tools in detecting subclinical conditions that may lead to sudden cardiac death. Dr. Adler notes that these tests can identify conditions like hypertrophic cardiomyopathy, providing a pathway for early diagnosis and treatment, thus reducing the risk of sudden cardiac events.

Sudden Cardiac Death in Young Athletes

Sudden cardiac death in young athletes is a significant concern, as highlighted by Dr. Adler. He discusses the importance of screening athletes for structural heart abnormalities, such as hypertrophic cardiomyopathy, to prevent tragic events. A detailed clinical examination and EKG are recommended for those participating in sports.

Advancements in Preventive Cardiac Defibrillators

Dr. Adler discusses the advancements in preventive cardiac defibrillators, which are now smaller and potentially wireless. These devices are crucial in managing patients at risk of sudden cardiac death, offering a less invasive option with fewer complications, thus improving patient outcomes and quality of life.

Full Transcript

Dr. Anton Titov, MD: 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.

Dr. Anton Titov, MD: Reduce risks of sudden cardiac death. Sudden Cardiac Death happens in athletes. How can death due to sudden cardiac arrest be prevented? Sudden cardiac arrest prevention focuses on identification of risk factors: hypertrophic cardiomyopathy, Arrhythmogenic right ventricular cardiomyopathy, and ischemic heart disease. 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.

Dr. Dale Adler, MD: You are just correct. Sudden cardiac death is obviously highly dreaded. 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. 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.

Long QT syndromes are identified on electrocardiogram [EKG, ECG]. 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. 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 of sudden death in patients with structural heart disease. 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. 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.

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 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.

Some sudden cardiac death events happen in young athletes. And not necessarily 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 heart. All athletes are screened for hypertrophic cardiomyopathy.

Dr. Dale Adler, 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.

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.

There are some 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 of 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 an inexpensive test. EKG 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.

Cardiac echocardiography is another diagnostic step. Nevertheless, echocardiogram is probably even more precise. Somebody is very much worried about the sudden cardiac death situation. Perhaps it's worth taking an ultrasound of the heart.

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. They will never have sudden death. They will not show phenotype of hypertrophic cardiomyopathy.

That's the ultimate 4P medicine (Predictive, Preventive, Personalized, Participatory). 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.