住院猝死风险识别和预防PPT.ppt

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. 运动后心电图中 可见Brugada波显现 致心律失常性右室发育不良 ARVD 是以右室（偶有左室受累）纤维脂肪浸润、伴有起源于右室的致命性心律失常为特征的疾病 临床表现：心律失常由强体力活动诱发，可致猝死。室性早搏呈左束支阻滞形。 诊断依据 心脏影象技术（超声心动、血管造影和核磁共振）显示右室扩张、脂肪组织浸润和室壁运动异常。无瓣膜病、分流、急性心肌炎及冠心病。 心电图：V1到V3导联T波倒置或传导阻滞（完全性或不完全性） 心内膜活检在鉴别诊断中有意义。 SCD 心脏疾病 VA EF 基础心脏疾病 冠心病、心肌病、离子通道病…. 心电不稳定性 室性心律失常、晚电位、TWA….. 心功能下降 LVEF降低、充血性心力衰竭 部分完全无先兆……. 基质结构 自主神经