住院猝死风险识别和预防.pptVIP

Although the highest risk factor for SCA is a previous cardiac arrest, survival rates are extremely low. It is critical to identify other risk factors so that high-risk patients can be referred for treatment. 225,000 to 300,000 of SCA patients in the U.S. have had a previous MI. Studies for heart failure patients are in progress, including the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), the goal of which is to identify therapy that will significantly reduce death rates in patients with CHF. Patients with LV dysfunction had higher rates of sudden cardiac death, than patients without LV dysfunction in the GISSI-2 Trial. Patients with more frequent PVBs had a higher rate of sudden cardiac death in patients with and without LV dysfunction. (Source: Maggioni AP. Circulation. 1993;87:312-322). A marked depression of LVEF is the most powerful predictor of SCA. A LVEF 0.30 is the most significant risk factor for SCA. This risk factor, however, has low specificity, since studies have shown more than 50% of SCA victims have a LVEF 0.30. A large registry study (n = 9,258) documented the rate of SCA among patients with varying degrees of left ventricular dysfunction.16 A strong relationship was found between LVEF and SCA, as shown above. (Source: Vreede-Swagemakers JJ. J Am Coll Cardiol. 1997;30:1500-1505) The magnitude of hypertrophy1, early onset, a strong family history, and worsening symptoms appear to indicate a higher risk for SCA. 1 Spiroto P. New Engl J Med. 2000;342;1778-1785. Another family member with LQTS may be identified in as many as 39% of patients. Specific gene markers are available for linkage analysis. 造影导致心脏破裂； The chance of a successful resuscitation declines by about 7–10% each minute. The actual relationship between defibrillation success and time is a non-linear one, with the best chance for success probably occurring in the first 3–4 minutes. The photo shows external defibrillation taking place in a hospital, possibly in an Eme