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Ventricular Arrhythmias in Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Antonis S. Manolis, Antonis A. Manolis, Theodora A. Manolis
Patients with heart failure with preserved ejection fraction (HFpEF) are a heterogeneous group associated with a plethora of comorbidities that leads to variable, but substantial, sudden death risk.32,33 The mortality burden of HFpEF (10–30% annually), mainly ascribed to cardiovascular (CV) causes (50–70%), is lower than with HFrEF, but clearly increased compared with age- and comorbidity-matched controls without HF. Among CV deaths, sudden death and HF death are the leading cardiac modes of death in HFpEF clinical trials, although non-CV deaths constitute a higher proportion of deaths in patients with HFpEF than in those with HFrEF. Importantly, and in contrast to HFrEF, the contribution of ventricular tachyarrhythmias to sudden death has not been clearly demonstrated in patients with HFpEF, and thus the underlying mechanism of sudden death may be different in these patients. Thus, sudden death could be sudden cardiac death (SCD), either arrhythmic SCD (most commonly attributable to VT/VF and less commonly to bradyarrhythmias or pulseless electrical activity), or non-arrhythmic SCD, whereas sudden death could also be due to non-cardiac causes, such as pulmonary disease, acute hemorrhage, etc.
Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Patients with symptomatic severe AS have a poor prognosis with a significant risk of sudden death. Patients with LV failure caused by AS have a 50% mortality rate within 2 years without surgery.
Investigation of Sudden Cardiac Death
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Sudden death has been defined as a natural, unexpected death occurring within one hour of the onset of symptoms in an apparently healthy subject or a subject whose disease was not so severe as to predict an abrupt outcome. While this may be an accurate description of many witnessed deaths in the community or in emergency departments, it is less satisfactory in pathological practice, where autopsies may be requested on patients whose deaths were not witnessed. In the case of unwitnessed deaths, which may occur during sleep or at an unknown time before a body is discovered, it is pragmatic to assume that the death was sudden if the deceased was known to be in good health 24 hours before death occurred. Similarly, a death can be classified as sudden if a patient is resuscitated after cardiac arrest, survives on life support for a period of time and then dies due to irreversible brain damage.
Decision making in anomalous aortic origin of a coronary artery
Published in Expert Review of Cardiovascular Therapy, 2023
Hitesh Agrawal, Alexandra Lamari-Fisher, Keren Hasbani, Stephanie Philip, Charles D. Fraser, Carlos M. Mery
Once both the clinical and psychosocial evaluations are complete, the findings are discussed at the Coronary Anomalies Program multidisciplinary meeting and specific recommendations for the particular patient are outlined (Figure 6). High-risk factors for sudden death include presence of ischemic symptoms, anatomic features (e.g. anomalous left coronary artery, long intramural course, ostial stenosis), or positive functional stress tests. In general, we recommend surgical intervention in patients with these high-risk features (Figure 6). In symptomatic patients with intraseptal anomalous left coronary artery, surgical intervention can be challenging and a trial of beta-blockers is considered prior to pursuing surgery. In asymptomatic AAOCA patients with negative stress tests, high athletic identity is considered an important factor in the decision-making process as the end-goal is to allow unrestrictive exercise activities for these individuals. The findings and our recommendations are presented to the family for their engagement in the decision-making process. Patients with high-risk features are typically restricted from competitive sports at diagnosis until after a complete evaluation 3 months postoperatively. This evaluation includes similar studies that were performed preoperatively. Patients with low-risk features are allowed to return back to competitive sports, but continue to be followed annually.
Psychopharmacology of Williams syndrome: safety, tolerability, and effectiveness
Published in Expert Opinion on Drug Safety, 2021
Robyn P. Thom, Barbara R. Pober, Christopher J. McDougle
Cardiovascular disease is a major source of morbidity and mortality in WS. More than 80% of individuals with WS have cardiovascular involvement [15,16] with the majority of anomalies being due to arterial stenoses from deficient circumferential artery growth [17]. A longitudinal study of 80 patients with WS demonstrated that 87.5%, 53.8%, and 22.5% had supravalvular aortic stenosis, branch pulmonary stenosis, and mitral valve prolapse, respectively [18]. The risk of cardiac sudden death, which while overall remains very rare, is elevated by about 25 to 100 times of that of the general population [17]. Risk factors for sudden death include the use of anesthesia, biventricular outflow obstruction, biventricular hypertrophy, and coronary artery obstruction [3]. Additionally, patients with WS are at increased risk of cardiac repolarization abnormalities. A retrospective study of 499 electrocardiograms from 188 patients with WS demonstrated that QTc interval prolongation was found in 13.6% of WS patients, compared to 2.0% of non-WS controls [19]. However, it remains unknown whether the medical risks of prolonged QTc in WS are similar to the consequences of genetic ‘long QTc’ syndromes in the general population.
Decline in the Volume of Structural Heart Procedures in the United States Due to the COVID-19 Pandemic
Published in Structural Heart, 2021
Houman Khalili, Hamza A. Lodhi, Michael Luna, Rani K. Hasan, Subhash Banerjee, James E. Harvey, Timothy Byrne, George S. Hanzel, Amr E. Abbas, Nirmanmoh Bhatia, Satya S. Shreenivas, Adithya Mathews, Priya Bansal, Ramez Morcos, Brijeshwar Maini
These results should be examined against the backdrop of an exponential and consistent yearly rise in transcatheter structural procedures over the last several years. Although CDC guidelines on elective procedures could largely explain these findings, concerns for healthcare-associated COVID-19 may have also led to the avoidance of medical care by patients. Complications arising from delayed care in cardiac patients, especially those with heart failure, have been speculated.4 Heart failure is one of the most common manifestations of structural heart disease (e.g. AS and mitral regurgitation).5 Moreover, patients with untreated symptomatic AS are at an increased risk of sudden death. The true impact of this decline on patient outcomes will require future investigation. An ongoing multicenter registry of patients is examining the impact of such delays on clinical outcomes of patients with structural heart disease during this period.