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Sudden Cardiac Death (SCD)

Sudden cardiac death is an untreated fatal complication of either congenital or acquired heart disease. Very often is is caused by terminal ventricular fibrillation, usually in the final stages of a heart disease. In severe coronary heart disease (CHD) it may occur within the framework of an acute myocardial infarction (a heart attack), or ventricular fibrillaiton appears as a complication of severe chronic CHD.  This means the "flickering" of the heart muscle is so fast that the heart is unable to provide pumping power. A quick initiation of resuscitative measures, particularly defibrillation, may be life-saving. In order to avoid such a situation, it is important to identify early on patients at risk of SCD.In order to do so, using echocardiography to determine the pumping capacity of the heart is of particular significance. If the  left ventricular function(LV-function) is significantly limited, current guidelines for care of affected patients call for an implanted defibrillator (ICD).

In addition to CHD, the main causes of life-threatening ventricular fibrillation are congestive heart failure (cardiac insufficiency), heart muscle inflammation and congenital heart disease (e.g. Arrhythmogenic Right Ventricular Dysplasia, ARVCM). If a particular family has a history of frequent unclear sudden deaths, or a series of such occurrences, it is possible a congenital structural heart disease may exist and should be examined among close relatives. In addition to genetic tests, some of the tools available are imaging technology such as echocardiography, the cardio-MRI and, if needed, also cardiac catheterization. These examination procedures can precisely but gently determine whether there is a particular risk for the patient.  Warning signs w´hich may signal the possibility of sudden cardiac death very often include severe dizziness or fainting which is knwn as syncope. It is important to distinguish harmless causes from dangerous arrhythmias. 

The 24 hour-ECG (the long term Holter-ECG) often gives an indication as to which path to follow. In many patients, unfortunately, the result, "It never works when someone's watching!" is not uncommon, meaning, when a long-term ECG is applied, the arrhythmia or vertigo attacks do not occur.  This can be remedied by the use of a portable ECG event-recorder. If the portable ECG is unable to help reach a definitive diagnosis, the implantation of an implantable event recorder may be indicated. Also known as a loop recorder, this small, implantable device is placed under the skin, where in the event of a syncope it then can be read by a doctor. This data is then read either in the physician’s practice, at a clinic, or the information can be transmitted via telemetric technology per telephone. State-of-the-art systems (e.g. biomonitor) can automatically forward dangerous arrhythmic occurences.  

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