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The Coronary Arteries: Atherosclerosis and Ischaemic Heart Disease
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Most sudden cardiac death is due to coronary artery disease. At autopsy, especially in the context of sudden death, acute ischaemic events with thrombosis may be seen to explain the death, but often there is only significant coronary artery atheroma with or without fibrosis in the ventricle.5
Muscle Disorders
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Kourosh Rezania, Peter Pytel, Betty Soliven
Affected patients invariably develop cardiac disease manifestations during their adult life. Cardiac conduction defects typically progress from prolonged PR interval and sinus bradycardia to complete heart block and atrial paralysis. There is a risk of sudden cardiac death.
Arrhythmias in Hypertrophic Cardiomyopathy and Their Management
Published in Srilakshmi M. Adhyapak, V. Rao Parachuri, Hypertrophic Cardiomyopathy, 2020
Tom Kai Ming Wang, Milind Y. Desai
The diagnosis of arrhythmias is based on ECG and rhythm monitoring. The latter includes findings from Holter monitors, implantable loop recorders, and cardiac implanted electronic devices (CIEDs), such as pacemakers and defibrillators. Atrial fibrillation is a supraventricular tachyarrhythmia with irregular R-R intervals, atrial activity, and absence of distinct repeat P-waves on ECG [42]. Ventricular tachycardia is the presence of at least three consecutive broad complexes originating from the ventricle at > 100 beats per minute, NSVT being < 30 seconds and sustained VT being > 30 seconds [43]. Ventricular fibrillation shows rapid irregular electrical activity, usually > 300 bpm, with marked variability in electrocardiographic waveform. Sudden cardiac death is that thought to be a result of cardiac arrhythmia or hemodynamic catastrophe.
Physical demands and physiological strain of American football referees while officiating
Published in The Physician and Sportsmedicine, 2023
Hayley V. MacDonald, Emily C. Colster, Anne M. Mulholland, Clifton J. Holmes, Brett C. Bentley, James B. Robinson, Jonathan E. Wingo
Sudden cardiac death is a leading cause of mortality in the United States, accounting for 50% of cardiovascular deaths annually (≈300,000 cases per year) [1]. Many occupational cardiac events are exertion-related, occurring most frequently among occupations characterized by high levels of physical exertion, physiological strain, and extreme thermal environments [2–5]. A high proportion of exertion-related cardiac events can also be attributed to underlying cardiovascular disease (CVD) (≈80–90%) [6]. Despite employment standards for many physically demanding occupations (e.g., firefighters, first responders, law enforcement, and military) [7], workers often have suboptimal health and fitness, creating a mismatch between the physical demands of the job and their capacity to safely perform the work [3,4,8]. Furthermore, little is known about worker health and performance in other physically demanding occupations, such as sports officiating, where workers are often hired as independent contractors, and there is little (if any) assessment of health and work capacity. This lack of screening is problematic because sports officials are typically of middle and older age, overweight to obese, have low-to-fair cardiorespiratory fitness (CRF), engage in lower amounts of habitual physical activity, and have at least one CVD risk factor [9]. This health and fitness profile increases their chance of suffering an acute cardiac event [3,6,10,11].
Updates in the management of congenital heart disease in adult patients
Published in Expert Review of Cardiovascular Therapy, 2022
Danielle Massarella, Rafael Alonso-Gonzalez
This review summarizes evidence underpinning current approaches to the management of complex problems which constitute the greatest challenges in the field today. Despite significant advances in each domain, smoldering questions persist and are underscored. Arrhythmia and heart failure are two of the most pervasive long-term complications of congenital heart disease, and each is associated with highly burdensome morbidity [1,2]. In each case, technology plays an increasingly prominent role in the development of novel approaches to these clinical problems which stand to drastically improve outcomes over time. Sudden cardiac death, while rare, constitutes one of the most feared complications of congenital heart disease, and significant effort has been put forth to identify modifiable risk factors that may mitigate this risk [3–6]. As the adult population has grown, so has the prevalence of heart transplant among patients with ACHD [7]. Optimal timing and approach to transplantation, as well as strategies to mitigate increased 1-year mortality, are areas of ongoing investigation. While the prevalence of unrepaired intracardiac shunts in adults is decreasing over time in developed nations, the approach to management following late diagnosis continues to evolve. The newest consensus recommendations for shunt closure in adults with congenital heart disease as published by the European Society of Cardiology (ESC) reflect our most current understanding and stand in contrast to those proposed by the American Heart Association/American College of Cardiology (AHA/ACC) in 2018 [8–10].
Parameters of cardiac symptoms in young athletes using the Heartbytes database
Published in The Physician and Sportsmedicine, 2021
Jacob C Jones, Dai Sugimoto, Greggory P Kobelski, Prashant Rao, Stanton Miller, Chris Koilor, Gianmichel D Corrado, David M Shipon
Sudden cardiac death cases and conditions associated with sudden cardiac death are rare. Despite being the most prevalent condition of sudden cardiac death, hypertrophic cardiomyopathy is estimated to be only around 0.5% of the adolescent population [1]. Arrhythmias occur at an estimated rate of 55 per 100,000 pediatric patients [2] while only about one in every 100,000 pediatric patients carries a cardiomyopathy [3]. However, when sudden cardiac arrests occur, the results can be catastrophic. Thus, it has been discussed how health-care practitioners can efficiently and effectively screen for underlying cardiac disease. This has been a challenge, especially for young athletes because palpitations, chest pain, difficulty breathing during exercise, syncope associated with exercise, and near syncope can be very nonspecific in nature. However, these symptoms may be potential indicators of major cardiac events such as arrhythmias, ischemia, or cardiomyopathy.