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Sudden Cardiac Death How common is it ?

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Sudden Cardiac Death How common is it ? Of the 728,743 heart disease deaths in 1999, 462,340 (63.4%) were defined as sudden cardiac deaths (SCD). – PowerPoint PPT presentation

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Title: Sudden Cardiac Death How common is it ?


1
Sudden Cardiac DeathHow common is it ?
  • Of the 728,743 heart disease deaths in 1999,
    462,340 (63.4) were defined as sudden cardiac
    deaths (SCD).
  • These high numbers of sudden deaths from heart
    disease, and the fact that they occur outside of
    the hospital, are alarming,"
  • Jeffrey P. Koplan, MD, MPH
  • Director, Centre for Disease Control, Feb
    2002

In Ireland, this corresponds to some 6,000
sudden cardiac deaths annually
2
What is sudden Cardiac Death ?
  • Cardiac arrest
  • A massive heart attack
  • He just dropped dead
  • He died in his sleep
  • A massive stroke
  • A huge clot to his heart
  • Cot death
  • Sudden Infant Death Syndrome (SIDS)
  • Sudden Heart Failure
  • Sudden Adult Death Syndrome (SADS)
  • Death occurring within one hour of onset of
    symptoms due to cardiac causes

3
Ventricular Tachycardia
Normal Rhythm
Ventricular Fibrillation
2 8 year old man who died suddenly while wearing
a cardiac monitor
4
Hypertrophic Cardiomyopathy
Viral Myocarditis
Valvular Heart Disease
Dilated Cardiomyopathy
Drugs
Ventricular Fibrillation
Commotio Cordis
Channelopathy
Electrocution
Coronary Artery Disease
Sudden Infant Death Syndrome
Wolf-Parkinson White Syndrome
5
Likelihood of success with defibrillation
Ventricular Tachycardia
Time from Collapse
Normal Rhythm
0 mins
gt90
2 mins
80
10 mins
lt10
2 8 year old man who died suddenly while wearing
a cardiac monitor
Ventricular Fibrillation
6
Causes of SCD by age
Deaths per million/yr
Age (yrs)
7
Causes of SCD under 50 years
Deaths per million/yr
Age (yrs)
8
What can you do about it ?
  1. Prevention through screening
  2. Prompt defibrillation

9
Screening
  • Principles
  • Practical
  • Reliable
  • High sensitivity and specificity
  • Cost effective

10
Screening
  • 2. Questionnaire
  • Do you have a first degree relative who dropped
    dead suddenly under 50 y.o. or who has been
    diagnosed with a heart condition ?
  • Have you had a blackout for no obvious reason ?
  • Have you had sudden onset rapid heart beating ?
  • (Do you get chest tightness or shortness of
    breath out of the ordinary while exercising ?)
  • If yes to any of above, refer to GP.
  • If significant family history or symptoms, refer
    to local cardiologist for further testing

11
Screening
  • 3. Cardiac Tests
  • Electrocardiogram
  • Exercise Test (Steps or treadmill)
  • Echocardiogram (Ultrasound)
  • 24 hour Holter Monitor

12
Problems with Screening
  • Indeterminates / False positives
  • False negatives
  • Myocarditis / Commotio Cordis
  • How often should they be repeated
  • What to do with true positives

13
Sir Rannulph Fiennes after completing 7 marathons
in 7 days on 7 continents
6 months after cardiac arrest and bypass surgery
14
The Automatic External Defibrillator (AED)
The Solution to out of hospital Cardiac Arrest
is shocking
15
Commotio Cordis 13 y.o boy hit with a baseball
in the chest and successfully resuscitated with
an AED by passing police officers
16
Cardiac Arrest Survival Rates
  • Chicago 1988 1
  • Seattle 1998 24 (First responder programme)
  • Las Vegas 1999 30 (overall)
  • 72 (3 mins)
  • Ireland 2003 1

80 of cardiac arrests occur at home
70 of cardiac arrests are witnessed
17
The Problem
  • How do we get AEDs to cardiac arrest
  • victims within 5 minutes of collapse ?
  • Possible strategies
  • 1. Increase density of ambulance dispatch
    centres
  • 2. Police cars
  • 3. Public Access Defibrillation
  • Sports venues / clubs All airplanes
  • Shopping Centres Gyms
  • Golf Clubs Jails
  • 4. First Responder programmes

18
Ambulance Dispatch Centres
77
10
19
The Problem
  • How do we get AEDs to cardiac arrest
  • victims within 5 minutes of collapse ?
  • Possible strategies
  • 1. Increase density of ambulance dispatch
    centres
  • 2. Police cars
  • 3. Public Access Defibrillation
  • Sports venues / clubs All airplanes
  • Shopping Centres Gyms
  • Golf Clubs Jails
  • 4. First Responder programmes

20
Progetto Vita in Piacenza, Italy, 1999
39 semiautomatic external defibrillators
12 high-risk locations, 12 lay-staffed
ambulances 15 police-cars.
Survival
12 10 8 6 4 2 0
1285 lay volunteers trained to intervene
11.1 (43.7)
The first experience of out-of-hospital early
defibrillation by non-medical volunteers in
a medium-size European city.
Total

(Shockable Rhythms)
2.9 (16.6)
Plt0.05
Conventional EMS
Progetto Vita
197 Cardiac arrests
266,531 inhabitants
21
The Problem
  • How do we get AEDs to cardiac arrest
  • victims within 5 minutes of collapse ?
  • Possible strategies
  • 1. Increase density of ambulance dispatch
    centres
  • 2. Police cars
  • 3. Public Access Defibrillation
  • Sports venues / clubs All airplanes
  • Shopping Centres Gyms
  • Golf Clubs Jails
  • 4. First Responder programmes

22
Community First Responder Scheme
Incoming Call
Control Centre Regional Operator
999
Nurse
Emergency Medical Technician
2 members of local community response team on
call carrying pager/mobile and AED
Ambulance
Physician
Fire Brigade
Police Station / Patrol Car
Trained Community Member
Victim
23
What can the GAA do ?
  • Adopt a policy supporting the widespread
    deployment of AEDs in clubs
  • Encourage clubs to raise money locally to
    purchase an AED and train all / most coaches in
    their use (4 hr training course)
  • AEDs cost 2,500.
  • Could clubs become the location for a communitys
    AED ?

24
What can coaches do ?
  • Get trained and encourage colleagues to get
    trained in basic life support (BLS) AED
  • Nearest training centre details available from
    The Irish Heart Foundation
  • Know how to recognise cardiac arrest and teach
    others
  • Have a response strategy for your club (AED / 999
    / CPR)
  • Find secure but accessible location for AED in
    the club
  • Task Force on Sudden Cardiac Death guidelines to
    be discussed with sporting groups and published
    in 2005

25
Cormac Mac Anallen
The solution is shocking
Marc-Vivien Foe
Miklos Fehrer
John McCall
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