Predicting and preventing sudden cardiac death.

Case presentation : A 61-year-old moderately obese (body mass index 28.1 kg/m2) hypertensive diabetic man without any prior cardiac history collapsed suddenly at a town meeting. Bystander cardiopulmonary resuscitation was initiated, an automated external defibrillator available at the town hall was deployed, and a single shock was delivered. He regained a pulse and spontaneous respirations. He was transported to the local hospital, where he was stabilized, but remained comatose. The patient was immediately transferred to a tertiary hospital, where a therapeutic hypothermia protocol was initiated. No ECG or laboratory evidence of a transmural myocardial infarction (MI) was present. He regained consciousness 2 days after resuscitation. Coronary angiography demonstrated significant obstruction of 3 major coronary arteries, with mild global impairment of left ventricular function with an ejection fraction of 45%. Coronary bypass surgery was performed, and after implantable cardioverter-defibrillator (ICD) placement, he was discharged on a statin, a β-blocker, aspirin, and an angiotensin-converting enzyme inhibitor. The patient has no residual neurological or cognitive deficits. He has done well clinically in a cardiac rehabilitation program stressing exercise, diet, and lifestyle changes to achieve an ideal body weight. Sudden cardiac death (SCD) from cardiac arrest is the most common cause of death worldwide, accounting for >50% of all deaths from cardiovascular disease.1–4 SCD results in ≈250 000 to 300 000 deaths annually in the United States,1–4 and is characterized by unexpected cardiovascular collapse due to an underlying cardiovascular cause.1,2 SCD represents a major challenge for the clinician because most episodes occur in individuals without previously known cardiac disease.1–4 Because most individuals experiencing SCD currently are not identifiable as being at high risk, community-based public access to defibrillation programs is essential to save lives and improve neurological and functional outcomes for …

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