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Sample records for aborted sudden cardiac

  1. Aborted sudden cardiac death: a clinical perspective

    PubMed Central

    Mazeika, P

    2001-01-01

    Sudden cardiac death in the community remains a major public health problem. The purpose of this article is to outline the epidemiology, pathophysiology, and immediate treatment of the cardiac arrest victim. The subsequent in-hospital diagnostic evaluation and management will then be discussed with an emphasis on the role of the implantable cardioverter-defibrillator. A systematic and evidence based approach should help to optimize patient care.


Keywords: cardiology; implantable cardioverter-defibrillator; resuscitation; sudden cardiac death PMID:11375448

  2. Aborted Sudden Cardiac Death and a Mother with Suspected Metabolic Myopathy

    PubMed Central

    Finsterer, Josef; Stöllberger, Claudia; Keller, Hans

    2014-01-01

    Aborted sudden cardiac death (SCD) has not been reported as initial manifestation of cardiac involvement in metabolic myopathy (MM). A 20-year-old female with a previous history of three syncopes, hyperhidrosis, and recurrent tick bites experienced aborted SCD. Her mother presented with MM, and a history of pituitary adenoma, nephroptosis, arterial hypertension, depression, migraine, goiter, pancreatitis, osteoporosis, hyperhidrosis, multiple muscle ruptures, and hyperlipidemia. After a few days of disorientation and amnesia, the young female recovered completely. Clinical neurological examination was noticeable for partial ophthalmoparesis and mild hyperprolactinemia. She received an implantable cardioverter defibrillator, which did not discharge so far. Recurrent syncopes and aborted SCD may be the initial manifestation of MM with multiple organ involvement. The family history is important in cases with aborted SCD to guide the diagnostic work-up. Phenotypic heterogeneity between the family members may be an indicator of MM. PMID:25187745

  3. Unusual cause of aborted sudden cardiac death in a teen athlete: homozygosity for the 4G allele of the plasminogen activase inhibitor type 1 gene.

    PubMed

    Phillips, Susie B; Batlivala, Sarosh; Knudson, Jarrod D

    2015-10-01

    Common aetiologies of sudden cardiac death in children include coronary anomalies, channelopathies, and cardiomyopathies. Less frequently, hypercoagulable states cause sudden arrest. We report an unusual case of aborted sudden cardiac death in a teenager, ultimately found to have homozygosity for the 4G allele of the plasminogen activase inhibitor type 1 gene. PMID:25498839

  4. Anomalous Left Circumflex Coronary Artery Arising from the Right Pulmonary Artery: A Rare Cause of Aborted Sudden Cardiac Death.

    PubMed

    Liu, Bo; Fursevich, Dzmitry; O'Dell, Matthew C; Flores, Miguel; Feranec, Nicholas

    2016-01-01

    We report a case of anomalous origin of the left circumflex coronary artery arising from the right pulmonary artery resulting in stress-induced cardiac arrest. The patient collapsed after running a 5K race and was resuscitated. Subsequent workup revealed the culprit anatomy, which was successfully treated with surgical ligation. To the authors' knowledge, this is only the second case of this variant coronary anomaly resulting in aborted sudden cardiac death, subsequent surgical ligation, and recovery in a healthy young adult and is the first case treated by ligation alone without coronary bypass. PMID:27014533

  5. Aborted sudden cardiac death associated with an anomalous right coronary artery.

    PubMed

    Diaz, Rienzi A; Valdés, Julio

    2015-01-01

    Coronary artery anomalies arising from the opposite sinus of Valsalva and having an interarterial course between the aorta (AO) and pulmonary artery (PA) are the second most common cause of sudden cardiac death among young athletes, after hypertrophic cardiomyopathy. The right coronary artery (RCA) originating from the AO above the left sinus of Valsalva (LSV) is an extremely rare anomaly. We report the first case of a RCA arising from the AO above the LSV that subsequently runs between the AO and the PA, discovered by a 64-slice multidetector coronary CT, in a patient who was successfully resuscitated from ventricular fibrillation (VF) cardiac arrest while running in a marathon race. PMID:26153291

  6. Sudden Cardiac Arrest

    MedlinePlus

    ... from American Heart Association Aneurysms and Dissections Angina Arrhythmia Bundle Branch Block Cardiomyopathy Carotid Artery Disease Chronic ... terms: SCA, sudden cardiac death (SCD), sudden death, arrhythmias, ... ventricular fibrillation, defibrillator, automatic cardiac defibrillator ( ...

  7. Sudden Cardiac Death

    PubMed Central

    Weinberg, Marc

    1978-01-01

    Over the past decade, there has been a significant decrease in the hospital mortality of patients with coronary artery disease. However, sudden cardiac death, which accounts for the majority of deaths from coronary artery disease, hasbeen little affected. This report reviews the pathology, electrophysiology, demographics and clinical presentation of sudden cardiac death. Emergency care and possible preventative measures are examined. PMID:356435

  8. Sudden Cardiac Death in Athletes.

    PubMed

    Wasfy, Meagan M; Hutter, Adolph M; Weiner, Rory B

    2016-01-01

    There are clear health benefits to exercise; even so, patients with cardiac conditions who engage in exercise and athletic competition may on rare occasion experience sudden cardiac death (SCD). This article reviews the epidemiology and common causes of SCD in specific athlete populations. There is ongoing debate about the optimal mechanism for SCD prevention, specifically regarding the inclusion of the ECG and/or cardiac imaging in routine preparticipation sports evaluation. This controversy and contemporary screening recommendations are also reviewed. PMID:27486488

  9. Sudden Cardiac Death in Athletes

    PubMed Central

    Wasfy, Meagan M.; Hutter, Adolph M.; Weiner, Rory B.

    2016-01-01

    There are clear health benefits to exercise; even so, patients with cardiac conditions who engage in exercise and athletic competition may on rare occasion experience sudden cardiac death (SCD). This article reviews the epidemiology and common causes of SCD in specific athlete populations. There is ongoing debate about the optimal mechanism for SCD prevention, specifically regarding the inclusion of the ECG and/or cardiac imaging in routine preparticipation sports evaluation. This controversy and contemporary screening recommendations are also reviewed. PMID:27486488

  10. Sudden Cardiac Arrest (SCA) Risk Assessment

    MedlinePlus

    ... Find a Specialist Share Twitter Facebook SCA Risk Assessment Sudden Cardiac Arrest (SCA) occurs abruptly and without ... of all ages and health conditions. Start Risk Assessment The Sudden Cardiac Arrest (SCA) Risk Assessment Tool ...

  11. Sudden cardiac death.

    PubMed

    Sra, J; Dhala, A; Blanck, Z; Deshpande, S; Cooley, R; Akhtar, M

    1999-08-01

    SCD continues to be an important cause of death and morbidity. Despite expanding insight into the mechanisms causing SCD, the population at high risk is not being effectively identified. Although there is still much to do in the management phase of SCD (predicting the efficacy of various therapies), recent clinical trials have helped define the relative risks and benefits of therapies in preventing SCD. Trials are underway to determine whether treating other patient populations, including asymptomatic patients after MI, will improve survival rate. The approach to reducing mortality rate will always be multifaceted; primary prevention of coronary artery disease and prompt salvage of jeopardized myocardium are 2 important aspects of this approach. In addition to interventions for MI, such as myocardial revascularization when indicated, simple and easily administered therapies that are likely to remain the most effective prophylactic interventions are aspirin, ACE inhibitors, beta-blockers, and cholesterol-lowering agents. However, the MADIT and AVID data clearly demonstrate a role for ICD therapy in a subgroup of patients who have VT/VF and are at risk of cardiac arrest. Even though the absolute magnitude of benefit associated with ICDs is still to be determined, the AVID study and other recent reports provide convincing evidence that patients who have VT/VF fare better with ICDs than with antiarrhythmic drug therapy. For the high-risk population described in this article, in addition to aggressive anti-ischemic and heart failure therapy, ICDs are now a mainstay of life-saving treatment. Still to be surmounted is the challenge of identifying patients who have nonischemic substrates and of providing them with the appropriate therapy. Guided by genetic studies and new insight into the mechanisms of such problems as congenital long QT syndrome, life-saving and life-enhancing therapies may soon be available for the management of SCD. PMID:10459474

  12. Sudden Cardiac Arrest in Pediatrics.

    PubMed

    Scheller, RoseAnn L; Johnson, Laurie; Lorts, Angela; Ryan, Thomas D

    2016-09-01

    Sudden cardiac arrest (SCA) in the pediatric population is a rare and potentially devastating occurrence. An understanding of the differential diagnosis for the etiology of the cardiac arrest allows for the most effective emergency care and provides the patient with the best possible outcome. Pediatric SCA can occur with or without prodromal symptoms and may occur during exercise or rest. The most common cause is arrhythmia secondary to an underlying channelopathy, cardiomyopathy, or myocarditis. After stabilization, evaluation should include electrocardiogram, chest radiograph, and echocardiogram. Management should focus on decreasing the potential for recurring arrhythmia, maintaining cardiac preload, and thoughtful medication use to prevent exacerbation of the underlying condition. The purpose of this review was to provide the emergency physician with a concise and current review of the incidence, differential diagnosis, and management of pediatric patients presenting with SCA. PMID:27585126

  13. Cardiac Innervation and Sudden Cardiac Death

    PubMed Central

    Fukuda, Keiichi; Kanazawa, Hideaki; Aizawa, Yoshiyasu; Ardell, Jeffrey L.; Shivkumar, Kalyanam

    2015-01-01

    Afferent and efferent cardiac neurotransmission via the cardiac nerves intricately modulates nearly all physiological functions of the heart (chronotropy, dromotropy, lusitropy and inotropy). Afferent information from the heart is transmitted to higher levels of the nervous system for processing (intrinsic cardiac nervous system, extracardiac-intrathoracic ganglia, spinal cord, brain stem and higher centers) which ultimately results in efferent cardiomotor neural impulses (via the sympathetic and parasympathetic nerves). This system forms interacting feedback loops that provide physiological stability for maintaining normal rhythm and life-sustaining circulation. This system also ensures that there is fine-tuned regulation of sympathetic-parasympathetic balance in the heart under normal and stressed states in the short (beat to beat), intermediate (minutes-hours) and long term (days-years). This important neurovisceral /autonomic nervous system also plays a major role in the pathophysiology and progression of heart disease, including heart failure and arrhythmias leading to sudden cardiac death (SCD). Transdifferentiation of neurons in heart failure, functional denervation, cardiac and extra-cardiac neural remodeling have also been identified and characterized during the progression of disease. Recent advances in understanding the cellular and molecular processes governing innervation and the functional control of the myocardium in health and disease provides a rational mechanistic basis for development of neuraxial therapies for preventing SCD and other arrhythmias. Advances in cellular, molecular, and bioengineering realms have underscored the emergence of this area as an important avenue of scientific inquiry and therapeutic intervention. PMID:26044253

  14. Radiofrequency Ablation to Prevent Sudden Cardiac Death

    PubMed Central

    Atoui, Moustapha; Gunda, Sampath; Lakkireddy, Dhanunjaya; Mahapatra, Srijoy

    2015-01-01

    Radiofrequency ablation may prevent or treat atrial and ventricular arrhythmias. Since some of these arrhythmias are associated with sudden cardiac death, it has been hypothesized that ablation may prevent sudden death in certain cases. We performed a literature search to better understand under which circumstances ablation may prevent sudden death and found little randomized data demonstrating the long-term effects of ablation. Current literature shows that ablation clearly prevents symptoms of arrhythmia and may reduce the incidence of sudden cardiac death in select patients, although data does not indicate improved mortality. Ongoing clinical trials are needed to better define the role of ablation in preventing sudden cardiac death. PMID:26306130

  15. Sudden Cardiac Death Risk Stratification

    PubMed Central

    Deyell, Marc W.; Krahn, Andrew D.; Goldberger, Jeffrey J.

    2015-01-01

    Arrhythmic sudden cardiac death (SCD) may be due to ventricular tachycardia/fibrillation (SCD-VT/VF) or pulseless electrical activity/asystole. Effective risk stratification to identify patients at risk of arrhythmic SCD is essential for targeting our health care and research resources to tackle this important public health issue. Although our understanding of SCD due to pulseless electrical activity/asystole is growing, the overwhelming majority of research in risk stratification has focused on SCD-VT/VF. This review focuses on existing and novel risk stratification tools for SCD-VT/VF. For patients with left ventricular dysfunction and/or myocardial infarction, advances in imaging, measures of cardiac autonomic function, and measures of repolarization have shown considerable promise in refining risk. Yet the majority of SCD-VT/VF occurs in patients without known cardiac disease. Biomarkers and novel imaging techniques may provide further risk stratification in the general population beyond traditional risk stratification for coronary artery disease alone. Despite these advances, significant challenges in risk stratification remain that must be overcome before a meaningful impact on SCD can be realized. PMID:26044247

  16. Athletes at Risk for Sudden Cardiac Death

    ERIC Educational Resources Information Center

    Subasic, Kim

    2010-01-01

    High school athletes represent the largest group of individuals affected by sudden cardiac death, with an estimated incidence of once or twice per week. Structural cardiovascular abnormalities are the most frequent cause of sudden cardiac death. Athletes participating in basketball, football, track, soccer, baseball, and swimming were found to…

  17. Sudden cardiac death in athletes.

    PubMed

    Schmied, C; Borjesson, M

    2014-02-01

    A 'paradox of sport' is that in addition to the undisputed health benefits of physical activity, vigorous exertion may transiently increase the risk of acute cardiac events. In general, the risk of sudden cardiac death (SCD) approximately doubles during physical activity and is 2- to 3-fold higher in athletes compared to nonathletes. The incidence of SCD in young athletes is in fact very low, at around 1-3 per 100,000, but attracts much public attention. Variations in incidence figures may be explained by the methodology used for data collection and more importantly by differences between subpopulations of athletes. The incidence of SCD in older (≥ 35 years) athletes is higher and may be expected to rise, as more and older individuals take part in organized sports. SCD is often the first clinical manifestation of a potentially fatal underlying cardiovascular disorder and usually occurs in previously asymptomatic athletes. In the young (<35 years), SCD is mainly due to congenital/inherited cardiac abnormalities, whilst coronary artery disease (CAD) is the most common cause in older athletes. Cardiac screening including family/personal history, physical examination and resting electrocardiogram (ECG) may identify individuals at risk and has the potential to decrease the risk of SCD in young athletes. Screening including the ECG has a high sensitivity for underlying disease in young athletes, but the specificity needs to be improved, whereas the sensitivity of screening without the use of ECG is very low. The screening modality recommended for young athletes is of limited value in older athletes, who should receive individualized screening with cardiac stress testing for patients with high risk of underlying CAD. As cardiovascular screening will never be able to identify all athletes at risk, adequate preparedness is vital in case of a potentially fatal event at the sporting arena/facility. Firstly, we will review the magnitude of the problem of SCD in athletes of

  18. Genetics of sudden cardiac death.

    PubMed

    Refaat, Marwan M; Hotait, Mostafa; London, Barry

    2015-07-01

    Sudden cardiac death (SCD) is defined by the World Health Organization (WHO) as death within 1 h of symptom onset (witnessed) or within 24 h of being observed alive and symptom free (unwitnessed). It affects more than 3 million people annually worldwide and affects approximately 1/1000 people each year in the USA. Familial studies of syndromes with Mendelian inheritance, candidate genes analyses, and genome-wide association studies (GWAS) have helped our understanding of the genetics of SCD. We will review the genetics of arrhythmogenic hereditary syndromes with Mendelian inheritance from familial studies with structural heart disease (hypertrophic cardiomyopathy, dilated cardiomyopathy, and arrhythmogenic cardiomyopathy) as well as primary electrical causes (long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and short QT syndrome). In addition, we will review the genetics of intermediate phenotypes for SCD such as coronary artery disease and electrocardiographic variables (QT interval, QRS duration, and RR interval). Finally, we will review rare and common variants that are associated with SCD in the general population and were identified from candidate gene analyses and GWAS. Our understanding of the genetics of SCD will improve by the use of next-generation sequencing/whole-exome sequencing as well as whole-genome sequencing which have the potential to discover unsuspected common and rare genetic variants that might be associated with SCD. PMID:26026997

  19. Sudden cardiac death – Historical perspectives

    PubMed Central

    Abhilash, S.P.; Namboodiri, Narayanan

    2014-01-01

    Sudden cardiac death (SCD) is an unexpected death due to cardiac causes that occurs in a short time period (generally within 1 h of symptom onset) in a person with known or unknown cardiac disease. It is believed to be involved in nearly a quarter of human deaths, with ventricular fibrillation being the most common mechanism. It is estimated that more than 7 million lives per year are lost to SCD worldwide. Historical perspectives of SCD are analyzed with a brief description on how the developments in the management of sudden cardiac arrest evolved over time. PMID:24568828

  20. Sudden cardiac death in 2 young siblings.

    PubMed

    Kundu, Reetu; Punia, Rajpal Singh; Handa, Uma; Singh, Amandeep; Mohan, Harsh

    2014-12-01

    Hypertrophic cardiomyopathy is a disease known for exhibiting phenotypic and genetic heterogeneity. At times, sudden cardiac death may be the first and foremost manifestation of the disease. We report 2 cases of hypertrophic cardiomyopathy causing sudden death, which were diagnosed on autopsy with special emphasis on histopathological findings of this entity. The role of a pathologist cannot be undermined as the disease is a diagnostic challenge often overlooked by the neophytes in the field due to unawareness. PMID:25361060

  1. Sudden cardiac death in the older athlete.

    PubMed

    Chugh, Sumeet S; Weiss, Joseph B

    2015-02-10

    The overwhelming majority of sports-related sudden deaths occur among those older than 35 years of age. Because increasing numbers of older people are participating in organized endurance and competitive sporting events, the incidence of sports-related sudden death in older adults is expected to rise. Older athletes will approach clinical cardiologists for advice regarding their fitness for participation. It is important to recognize both that strenuous exercise is associated with a transient elevation in risk of sudden cardiac death and that appropriate training substantially reduces this risk. The approach to pre-participation screening for risk of sudden death in the older athlete is a complex issue and at present is largely focused on identifying inducible ischemia due to significant coronary disease. In this brief review, we summarize the current state of knowledge in this area with respect to epidemiology, mechanisms, and approaches to risk stratification, as viewed from the perspective of the consulting clinical cardiologist. PMID:25660928

  2. Sudden cardiac death & the Reverse Dodo Verdict.

    PubMed

    Healy, David; Howe, Gareth; Mangin, Derelie; Le Noury, Joanna

    2014-01-01

    Adverse effects of treatment on cardiac QT intervals were first reported 50 years ago. A clear link to sudden death was established, but the problem remained relatively unknown. The issue of treatment related effects on the heart, and the contribution this might make to sudden cardiac deaths in general, came more clearly into focus 20 years ago, linked to regulatory actions. In an era of polypharmacy, and mixing of prescribed and non-prescribed pharmacologically active agents it is now becoming increasingly clear that unanticipated cardiac effects may be common and a significant cause of mortality. There is likely underreporting and also underdiagnosis, as recognition requires a timely ECG. This paper proposes two methods to handle the problem. PMID:24902504

  3. Pathophysiology and prevention of sudden cardiac death.

    PubMed

    Goyal, Vineet; Jassal, Davinder S; Dhalla, Naranjan S

    2016-03-01

    Sudden cardiac death (SCD) is known to occur in individuals with diverse diseases. Each disease state has a specific etiology and pathophysiology, and is diagnosed and treated differently. Etiologies for SCD include cardiac arrhythmias, coronary artery disease, congenital coronary artery anomalies, hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, dilated cardiomyopathy, and aortic valve stenosis. A potential unifying mechanism of SCD in these diseases involves a massive stimulation of the sympathetic nervous system's stress response and the subsequent elevation of circulating catecholamines. The diagnosis of cardiac diseases that contribute to an increased risk for SCD is accomplished by a combination of different techniques including electrocardiography, echocardiography, magnetic resonance imaging, and invasive cardiac catheterization. Several therapies including anti-arrhythmic drugs, β-blockers, and antiplatelet agents may be used as medical treatment in patients for the prevention of SCD. Invasive therapies including percutaneous angioplasty, coronary artery bypass surgery, and implantable cardioverter-defibrillators are also used in the clinical management of SCD. PMID:26651385

  4. Sudden cardiac death associated with methylone use.

    PubMed

    Carbone, Peter N; Carbone, David L; Carstairs, Shaun D; Luzi, Scott A

    2013-03-01

    The rise in popularity of "bath salts" as safe alternatives to MDMA (3,4-methylenedioxymethamphetamine), methamphetamine, and other illicit substances has resulted in increased scrutiny of the contents and toxicology associated with these products. We report a case of sudden death related to the synthetic cathinone methylone (3,4-methylenedioxy-N-methylcathinonmethylone) in a previously healthy 19-year-old man. Although several fatal case reports have been published involving methylone and other synthetic cathinones, this is the first reported case of sudden cardiac death associated with methylone use. Although lack of published data prevented a comparison of blood methylone concentrations between our case and existing reports, the amount of methylone we detected postmortem (0.07 mg/dL) is below those reported in MDMA-related fatalities. Our report suggests that methylone toxicity has been greatly underestimated by users of this synthetic cathinone. PMID:23403480

  5. [Relevancy of sudden death of cardiac origin].

    PubMed

    Báyes de Luna, Antoni; Kotzeva, Anna; Goldwasser, Diego; Subirana, Maite; Puig, Maria Teresa; Bayés-Genis, Toni; Cinca, Juan; Vázquez, Rafael

    2007-01-01

    Sudden death (SD) is of cardiac origin in approximately 80-90% of the cases and represents one of the most important challenges of the modern cardiology. Evaluation and understanding of its epidemiological, clinical and histopathological characteristics can lead to better results in its management. In Spain was carried a multicenter study MUSA with two arms: 1/ EULALIA: histopathological aspects of SD and 2/ MUSIC: SD in heart failure with focus on identification of population groups at risk, pathophysiological mechanisms of development and clinical prognostic markers. The preliminary conclusions of both studies are the following: 1/ EULALIA trial: From the total 121 sudden deaths, 109 (90%) were of cardiac origin and of these 45% presented characteristics of myocardial hypertrophy. The histopathological findings reveled that in only 48% of cases acute ischemic heart disease was present. In the other cases of ischemic heart disease the sudden death was probably by arrhythmic origin related with the presence of old myocardial infarction. This is the most striking difference compared with Anglo-Saxon studies. In the 29 cases of ACS, 18 had eroded and combination of eroded and ruptured plaques. In the cases of non-ACS plaques were stable in 20, and combination of stable and vulnerable plaques in 7 cases. Statistically significant results as independent predictors of sudden death gave the following markers: history of MI, cephalization of vessels in thorax X-ray, left atrium size > 45 mm, high levels of NT-proBNP and PIP, LBBB on ECG recording and body mass index. PMID:18938710

  6. Sudden cardiac death: epidemiology and risk factors

    PubMed Central

    Adabag, A. Selcuk; Luepker, Russell V.; Roger, Véronique L.; Gersh, Bernard J.

    2016-01-01

    Sudden cardiac death (SCD) is an important public-health problem with multiple etiologies, risk factors, and changing temporal trends. Substantial progress has been made over the past few decades in identifying markers that confer increased SCD risk at the population level. However, the quest for predicting the high-risk individual who could be a candidate for an implantable cardioverter-defibrillator, or other therapy, continues. In this article, we review the incidence, temporal trends, and triggers of SCD, and its demographic, clinical, and genetic risk factors. We also discuss the available evidence supporting the use of public-access defibrillators. PMID:20142817

  7. Sudden cardiac death athletes: a systematic review

    PubMed Central

    2010-01-01

    Previous events evidence that sudden cardiac death (SCD) in athletes is still a reality and it keeps challenging cardiologists. Considering the importance of SCD in athletes and the requisite for an update of this matter, we endeavored to describe SCD in athletes. The Medline (via PubMed) and SciELO databases were searched using the subject keywords "sudden death, athletes and mortality". The incidence of SCD is expected at one case for each 200,000 young athletes per year. Overall it is resulted of complex dealings of factors such as arrhythmogenic substrate, regulator and triggers factors. In great part of deaths caused by heart disease in athletes younger than 35 years old investigations evidence cardiac congenital abnormalities. Athletes above 35 years old possibly die due to impairments of coronary heart disease, frequently caused by atherosclerosis. Myocardial ischemia and myocardial infarction are responsible for the most cases of SCD above this age (80%). Pre-participatory athletes' evaluation helps to recognize situations that may put the athlete's life in risk including cardiovascular diseases. In summary, cardiologic examinations of athletes' pre-competition routine is an important way to minimize the risk of SCD. PMID:20682064

  8. [Sudden cardiac death in diabetes mellitus].

    PubMed

    Israel, C W; Lee-Barkey, Y H

    2016-05-01

    Sudden cardiac death (SCD) represents one of the most frequent causes of death in patients with diabetes. In contrast to patients without diabetes it has not been significantly reduced despite improvements in the treatment of acute myocardial infarction and long-term treatment of cardiovascular diseases as well as diabetes mellitus. Several mechanisms can be responsible for the high incidence of SCD in diabetics: 1. arrhythmogenic effects mediated via cardiac autonomic neuropathy, repolarization disturbances or sympathetic tone activation (hypoglycemia), 2. myocardial ischemia due to atherosclerosis, endothelial dysfunction, platelet aggregation or thrombophilic effects, 3. myocardial disease due to inflammation, fibrosis, associated hypertension or uremia and 4. potassium imbalance due to diabetic nephropathy or hypoglycemia. This review introduces concepts of mechanisms that are responsible for SCD in patients with diabetes. Treatment of patients with diabetes should primarily consider a systematic assessment of any deterioration of this chronic disease and of complications at an early stage. Cardiovascular drug treatment corresponds to that of non-diabetics. In antidiabetic treatment drugs with a low risk of hypoglycemia should be preferred. Treatment with implantable cardioverter defibrillators (ICD) also combined with cardiac resynchronization therapy () demonstrated a high life-saving potential particularly in patients with diabetes. PMID:27071967

  9. Risk stratification for sudden cardiac death

    PubMed Central

    Cutler, Michael J; Rosenbaum, David S.

    2009-01-01

    The proportion of cardiovascular deaths attributable to sudden cardiac death (SCD) is on the rise. Herein lies the rationale for developing risk stratification strategies to predict who will benefit from prophylactic ICD implantation. Current guidelines recommend prophylactic ICD therapy in patients with reduced left ventricular ejection fraction (LVEF). However, there are clear limitations in using LVEF alone to decide who should receive an ICD. There is mounting evidence that microvolt-level T wave alternans (TWA) is an important marker of arrhythmic risk. TWA is appealing because it non-invasively probes underlying electrophysiological substrate and has been linked to cellular mechanisms for arrhythmias. This review considers the clinical role of TWA for risk stratification of SCD. PMID:19631909

  10. Predicting the risk of sudden cardiac death.

    PubMed

    Lerma, Claudia; Glass, Leon

    2016-05-01

    Sudden cardiac death (SCD) is the result of a change of cardiac activity from normal (typically sinus) rhythm to a rhythm that does not pump adequate blood to the brain. The most common rhythms leading to SCD are ventricular tachycardia (VT) or ventricular fibrillation (VF). These result from an accelerated ventricular pacemaker or ventricular reentrant waves. Despite significant efforts to develop accurate predictors for the risk of SCD, current methods for risk stratification still need to be improved. In this article we briefly review current approaches to risk stratification. Then we discuss the mathematical basis for dynamical transitions (called bifurcations) that may lead to VT and VF. One mechanism for transition to VT or VF involves a perturbation by a premature ventricular complex (PVC) during sinus rhythm. We describe the main mechanisms of PVCs (reentry, independent pacemakers and abnormal depolarizations). An emerging approach to risk stratification for SCD involves the development of individualized dynamical models of a patient based on measured anatomy and physiology. Careful analysis and modelling of dynamics of ventricular arrhythmia on an individual basis will be essential in order to improve risk stratification for SCD and to lay a foundation for personalized (precision) medicine in cardiology. PMID:26660287

  11. Sudden cardiac death in young athletes

    PubMed Central

    Östman-Smith, Ingegerd

    2011-01-01

    Athletic activity is associated with an increased risk of sudden death for individuals with some congenital or acquired heart disorders. This review considers in particular the causes of death affecting athletes below 35 years of age. In this age group the largest proportion of deaths are caused by diseases with autosomal dominant inheritance such as hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, long QT-syndrome, and Marfan’s syndrome. A policy of early cascade-screening of all first-degree relatives of patients with these disorders will therefore detect a substantial number of individuals at risk. A strictly regulated system with preparticipation screening of all athletes following a protocol pioneered in Italy, including school-age children, can also detect cases caused by sporadic new mutations and has been shown to reduce excess mortality among athletes substantially. Recommendations for screening procedure are reviewed. It is concluded that ECG screening ought to be part of preparticipation screening, but using criteria that do not cause too many false positives among athletes. One such suggested protocol will show positive in approximately 5% of screened individuals, among whom many will be screened for these diseases. On this point further research is needed to define what kind of false-positive and false-negative rate these new criteria result in. A less formal system based on cascade-screening of relatives, education of coaches about suspicious symptoms, and preparticipation questionnaires used by athletic clubs, has been associated over time with a sizeable reduction in sudden cardiac deaths among Swedish athletes, and thus appears to be worth implementing even for junior athletes not recommended for formal preparticipation screening. It is strongly argued that in families with autosomal dominant disorders the first screening of children should be carried out no later than 6 to 7 years of age. PMID:24198575

  12. Postmortem imaging of sudden cardiac death.

    PubMed

    Michaud, Katarzyna; Grabherr, Silke; Jackowski, Christian; Bollmann, Marc Daniel; Doenz, Franceso; Mangin, Patrice

    2014-01-01

    Postmortem imaging is increasingly used in forensic practice in cases of natural deaths related to cardiovascular diseases, which represent the most common causes of death in developed countries. While radiological examination is generally considered to be a good complement for conventional autopsy, it was thought to have limited application in cardiovascular pathology. At present, multidetector computed tomography (MDCT), CT angiography, and cardiac magnetic resonance imaging (MRI) are used in postmortem radiological investigation of cardiovascular pathologies. This review presents the actual state of postmortem imaging for cardiovascular pathologies in cases of sudden cardiac death (SCD), taking into consideration both the advantages and limitations. The radiological evaluation of ischemic heart disease (IHD), the most frequent cause of SCD in the general population of industrialized countries, includes the examination of the coronary arteries and myocardium. Postmortem CT angiography (PMCTA) is very useful for the detection of stenoses and occlusions of coronary arteries but less so for the identification of ischemic myocardium. MRI is the method of choice for the radiological investigation of the myocardium in clinical practice, but its accessibility and application are still limited in postmortem practice. There are very few reports implicating postmortem radiology in the investigation of other causes of SCD, such as cardiomyopathies, coronary artery abnormalities, and valvular pathologies. Cardiomyopathies representing the most frequent cause of SCD in young athletes cannot be diagnosed by echocardiography, the most widely available technique in clinical practice for the functional evaluation of the heart and the detection of cardiomyopathies. PMCTA and MRI have the potential to detect advanced stages of diseases when morphological substrate is present, but these methods have yet to be sufficiently validated for postmortem cases. Genetically determined

  13. Heart failure therapy and sudden cardiac death prevention.

    PubMed

    Morgan, J M

    2004-12-01

    Primary prophylaxis of sudden cardiac death by implantable defibrillators is an accepted therapeutic strategy because sudden cardiac death is reduced by their use. However, many patients at risk of sudden cardiac death due to left ventricular systolic dysfunction also suffer heart failure symptoms. There is increasing evidence that the morbidity of heart failure can be alleviated by device therapy in which ventricular dysynchrony is improved by biventricular pacing. Both therapies in the same device can reduce both morbidity and mortality. Device therapy is an important new aspect in the field of heart failure management. PMID:15729212

  14. Strategies for the prevention of sudden cardiac death during sports.

    PubMed

    Corrado, Domenico; Drezner, Jonathan; Basso, Cristina; Pelliccia, Antonio; Thiene, Gaetano

    2011-04-01

    Sudden cardiac death of a young athlete is the most tragic event in sports and devastates the family, the sports medicine team, and the local community. Such a fatality represents the first manifestation of cardiac disease in up to 80% of young athletes who remain asymptomatic before sudden cardiac arrest occurs; this explains the limited power of screening modalities based solely on history and physical examination. The long-running Italian experience showed that electrocardiogram (ECG) screening definitively improves the sensitivity of pre-participation evaluation for heart diseases and substantially reduces the risk of death in the athletic field (primary prevention). However, some cardiac conditions, such as coronary artery diseases, present no abnormalities on 12-lead ECG. Moreover, cardiac arrest due to non-penetrating chest injury (commotio cordis) cannot be prevented by screening. This justifies the efforts for implementing programmes of early external defibrillation of unpredictable arrhythmic cardiac arrest. This article reviews the epidemiology of sudden cardiac arrest in the athlete in terms of incidence, sport-related risk, underlying causes, and the currently available prevention programmes such as pre-participation screening and early external defibrillation by using automated external defibrillators. The best strategy is to combine synergistically primary prevention of sudden cardiac death by pre-participation identification of athletes affected by at-risk cardiomyopathies and secondary prevention with back-up defibrillation of unpredictable sudden cardiac arrest on the athletic field. PMID:21567995

  15. Sudden unexpected death, epilepsy and familial cardiac pathology.

    PubMed

    Eastaugh, A J; Thompson, T; Vohra, J K; O'Brien, T J; Winship, I

    2015-10-01

    We evaluated the prevalence of epilepsy in a cohort of patients who suffered a sudden unexpected death (SUDEP), and determined the proportion of the deaths that were related to an identifiable underlying familial cardiac pathology. Epilepsy is common in people who experience a sudden unexpected death, with approximately a quarter having identifiable familial electrophysiological abnormalities. Familial cardiac pathology may be an important cause of SUDEP. A retrospective evaluation was performed of 74 families that were referred to the Royal Melbourne Hospital Cardiac Genetic Clinic over a 5 year period for investigation following a family member's sudden, presumed cardiac, death. This state-wide referral clinic includes all patients who have died from a sudden unexpected death in whom the cause of death is unascertained. An epilepsy diagnosis was categorised as either definite, probable, possible or unlikely. The family members underwent comprehensive clinical evaluations and investigations in an attempt to identify a familial cardiac cause for the sudden unexpected death. Our findings suggest that systematic referral to a cardiac genetics service is warranted for the first degree relatives of people with epilepsy who experience a sudden unexplained death, for further evaluation and to identify those who are at higher risk for sudden death. Interventions may then be instituted to potentially reduce this risk. PMID:26195332

  16. Sudden cardiac death from the perspective of coronary artery disease.

    PubMed

    Sara, Jaskanwal D; Eleid, Mackram F; Gulati, Rajiv; Holmes, David R

    2014-12-01

    Sudden cardiac death accounts for approximately 50% of all deaths attributed to cardiovascular disease in the United States. It is most commonly associated with coronary artery disease and can be its initial manifestation or may occur in the period after an acute myocardial infarction. Decreasing the rate of sudden cardiac death requires the identification and treatment of at-risk patients through evidence-based pharmacotherapy and interventional strategies aimed at primary and secondary prevention. For this review, we searched PubMed for potentially relevant articles published from January 1, 1970, through March 1, 2014, using the following key search terms: sudden cardiac death, ischemic heart disease, coronary artery disease, myocardial infarction, and cardiac arrest. Searches were enhanced by scanning bibliographies of identified articles, and those deemed relevant were selected for full-text review. This review outlines various mechanisms for sudden cardiac death in the setting of coronary artery disease, describes risk factors for sudden cardiac death, explores the management of cardiac arrest, and outlines optimal practice for the monitoring and treatment of patients after an acute ST-segment elevation myocardial infarction to decrease the risk of sudden death. PMID:25440727

  17. Late Gadolinium Enhancement Among Survivors of Sudden Cardiac Arrest

    PubMed Central

    Neilan, Tomas G.; Farhad, Hoshang; Mayrhofer, Thomas; Shah, Ravi V.; Dodson, John A.; Abbasi, Siddique A.; Danik, Stephan B.; Verdini, Daniel J.; Tokuda, Michifumi; Tedrow, Usha B.; Jerosch-Herold, Michael; Hoffmann, Udo; Ghoshhajra, Brian B.; Stevenson, William G.; Kwong, Raymond Y.

    2016-01-01

    OBJECTIVES The aim of this study was to describe the role of contrast-enhanced cardiac magnetic resonance (CMR) in the workup of patients with aborted sudden cardiac arrest (SCA) and in the prediction of long-term outcomes. BACKGROUND Myocardial fibrosis is a key substrate for SCA, and late gadolinium enhancement (LGE) on a CMR study is a robust technique for imaging of myocardial fibrosis. METHODS We performed a retrospective review of all survivors of SCA who were referred for CMR studies and performed follow-up for the subsequent occurrence of an adverse event (death and appropriate defibrillator therapy). RESULTS After a workup that included a clinical history, electrocardiogram, echocardiography, and coronary angiogram, 137 patients underwent CMR for workup of aborted SCA (66% male; mean age 56 ± 11 years; left ventricular ejection fraction 43 ± 12%). The presenting arrhythmias were ventricular fibrillation (n = 105 [77%]) and ventricular tachycardia (n = 32 [23%]). Overall, LGE was found in 98 patients (71%), with an average extent of 9.9 ± 5% of the left ventricular myocardium. CMR imaging provided a diagnosis or an arrhythmic substrate in 104 patients (76%), including the presence of an infarct-pattern LGE in 60 patients (44%), noninfarct LGE in 21 (15%), active myocarditis in 14 (10%), hypertrophic cardiomyopathy in 3 (2%), sarcoidosis in 3, and arrhythmogenic cardiomyopathy in 3. In a median follow-up of 29 months (range 18 to 43 months), there were 63 events. In a multivariable analysis, the strongest predictors of recurrent events were the presence of LGE (adjusted hazard ratio: 6.7; 95% CI: 2.38 to 18.85; p < 0.001) and the extent of LGE (hazard ratio: 1.15; 95% CI: 1.11 to 1.19; p < 0.001). CONCLUSIONS Among patients with SCA, CMR with contrast identified LGE in 71% and provided a potential arrhythmic substrate in 76%. In follow-up, both the presence and extent of LGE identified a group at markedly increased risk of future adverse events. PMID

  18. Bilateral sudden hearing loss following habitual abortion: a case report and review of literature.

    PubMed

    Yin, Tuanfang; Huang, Fengying; Ren, Jihao; Liu, Wei; Chen, Xing; Li, Lihua; Xie, Dinghua; Lu, Yongde

    2013-01-01

    Sudden sensorineural hearing loss (SSNHL) is usually unilateral and can be associated with tinnitus and vertigo. The most common causes of this disease are known to be the vascular and viral agents, but immune disorders are involved in the development of sudden deafness. The antiphospholipid syndrome (APS) is an acquired autoimmune system disorder, which is defined as the presence of antiphospholipid antibodies (APA) in the patient's blood, then cause venous and/or arterial thrombosis in various organs of the body, for example, thrombosis can occur in the placenta and/or the inner ear. As a result, it can cause abortion and/or sudden deafness. Bilateral SSNHL following habitual abortion is a rare clinical event. Here, we report a case of 32-year-old woman who presented with bilateral sudden hearing loss following recurrent pregnancy loss (RPL) as the first manifestation of primary antiphospholipid syndrome. Combine the literature, the diagnosis, clinical implication and treatment are discussed. PMID:24040484

  19. Extreme sacrifice: sudden cardiac death in the US Fire Service

    PubMed Central

    2013-01-01

    Firefighting is a hazardous profession which has claimed on average the lives of 105 US firefighters per year for the past decade. The leading cause of line-of-duty mortality is sudden cardiac death, which accounts for approximately 45% of all firefighter duty-related fatalities. Strenuous physical activity, emotional stress, and environmental pollutants all strain the cardiovascular system, and each can increase the risk of sudden cardiac events in susceptible individuals. Sudden cardiac death is more likely to occur during or shortly after emergency duties such as fire suppression, despite the fact that these duties comprise a relatively small proportion of firefighters' annual duties. Additionally, cardiac events are more likely to occur in firefighters who possess an excess of traditional risk factors for cardiovascular disease along with underlying atherosclerosis and/or structural heart disease. In this review, we propose a theoretical model for the interaction between underlying cardiovascular disease in firefighters and the multifactorial physiological strain of firefighting. PMID:23849605

  20. [Sudden cardiac death in individuals with normal hearts: an update].

    PubMed

    González-Melchor, Laila; Villarreal-Molina, Teresa; Iturralde-Torres, Pedro; Medeiros-Domingo, Argelia

    2014-01-01

    Sudden death (SD) is a tragic event and a world-wide health problem. Every year, near 4-5 million people experience SD. SD is defined as the death occurred in 1h after the onset of symptoms in a person without previous signs of fatality. It can be named "recovered SD" when the case received medical attention, cardiac reanimation effective defibrillation or both, surviving the fatal arrhythmia. Cardiac channelopathies are a group of diseases characterized by abnormal ion channel function due to genetic mutations in ion channel genes, providing increased susceptibility to develop cardiac arrhythmias and SD. Usually the death occurs before 40 years of age and in the autopsy the heart is normal. In this review we discuss the main cardiac channelopathies involved in sudden cardiac death along with current management of cases and family members that have experienced such tragic event. PMID:25128006

  1. Sudden cardiac death in 13 captive chimpanzees (Pan troglodytes).

    PubMed

    Lammey, Michael L; Lee, D Rick; Ely, John J; Sleeper, Meg M

    2008-02-01

    Sudden cardiac death (SCD), presumed secondary to fatal arrhythmias, is a common cause of mortality in captive chimpanzees at the Alamogordo Primate Facility. Over the 6-year period at the Alamogordo Primate Facility between 2001 and 2006, 13 animals were defined as sudden cardiac death (11 male and 2 female) on the basis of clinical presentation which was 38% of all deaths. All animals had annual physical exams, including electrocardiograms and serial blood pressures. Six of the 13 animals underwent a complete cardiac evaluation by a veterinary cardiologist and all six of these animals were diagnosed with various degrees of cardiomyopathy. Systemic hypertension was noted in two of the 13 cases and antemortem cardiac arrhythmias were seen in all 13 animals. Histological examination of the hearts revealed myocardial fibrosis in 12 chimpanzees. Most of the animals (10/13) that died of sudden cardiac death had cardiomegaly (increased heart weight/body weight ratio) and some degree of myocardial fibrosis noted. Additional data as well as serial diagnostic evaluations will be needed to identify the possible causes of sudden cardiac death in captive chimpanzees. PMID:18269527

  2. Mechanisms of Sudden Cardiac Death: Oxidants and Metabolism

    PubMed Central

    Yang, Kai-Chien; Kyle, John W.; Makielski, Jonathan C.; Dudley, Samuel C.

    2015-01-01

    Ventricular arrhythmia is the leading cause of sudden cardiac death (SCD). Deranged cardiac metabolism and abnormal redox state during cardiac diseases foment arrhythmogenic substrates through direct or indirect modulation of cardiac ion channel/transporter function. This review presents current evidence on the mechanisms linking metabolic derangement and excessive oxidative stress to ion channel/transporter dysfunction that predisposes to ventricular arrhythmias and SCD. As conventional anti-arrhythmic agents aiming at ion channels have proven challenging to use, targeting arrhythmogenic metabolic changes and redox imbalance may provide novel therapeutics to treat or prevent life-threatening arrhythmias and SCD. PMID:26044249

  3. Global burden of Sudden Cardiac Death and insights from India

    PubMed Central

    Rao, B. Hygriv

    2014-01-01

    Sudden Cardiac death (SCD) is a major clinical event causing adverse impact on global economy. This review summarizes the available epidemiological data on SCD from different parts of the world. It contrasts the Indian and global perception on the issues influencing data collection, burden of SCD and sudden deaths occurring following Myocardial Infarction. The differences in data from India and rest of the world are highlighted. PMID:24568824

  4. [Sudden cardiac death in athletes and its prevention].

    PubMed

    Tönnis, T; Tack, C; Kuck, K-H

    2015-05-01

    Athletes and especially elite athletes are predominantly young people and are not associated with high health risks, apart from traumatic injuries. Nevertheless, there is a significantly high incidence of sudden cardiac death (SCD), which ranges from 0.6 to 3.0/100,000 athletes per year. Often the SCD is the first manifestation of an underlying cardiac disease. Distinct structural cardiac disorders, such as hypertrophic cardiomyopathy, coronary artery anomalies (17 %), inflammatory disorders (6 %) and arrhythmogenic right ventricular cardiomyopathy as well as conditions without structural cardiac abnormalities, such as primary electrical diseases (channelopathies) are important causes of sudden death. A simple screening can help to identify athletes with these diseases and allow specific therapies or precautionary measures to be initiated. PMID:25963171

  5. Genetics of channelopathies associated with sudden cardiac death

    PubMed Central

    Campuzano, Oscar; Sarquella-Brugada, Georgia; Brugada, Ramon; Brugada, Josep

    2015-01-01

    Recent technological advances in cardiology have resulted in new guidelines for the diagnosis, treatment and prevention of diseases. Despite these improvements, sudden death remains one of the main challenges to clinicians because the majority of diseases associated with sudden cardiac death are characterized by incomplete penetrance and variable expressivity. Hence, patients may be unaware of their illness, and physical activity can be the trigger for syncope as first symptom of the disease. Most common causes of sudden cardiac death are congenital alterations and structural heart diseases, although a significant number remain unexplained after comprehensive autopsy. In these unresolved cases, channelopathies are considered the first potential cause of death. Since all these diseases are of genetic origin, family members could be at risk, despite being asymptomatic. Genetics has also benefited from technological advances, and genetic testing has been incorporated into the sudden death field, identifying the cause in clinically affected patients, asymptomatic family members and post-mortem cases without conclusive diagnosis. This review focuses on recent advances in the genetics of channelopathies associated with sudden cardiac death. PMID:26566530

  6. Heart Attack or Sudden Cardiac Arrest: How Are They Different?

    MedlinePlus

    ... a person loses consciousness and has no pulse. Death occurs within minutes if the victim does not receive treatment. What is the link? These two distinct heart conditions are linked. Sudden cardiac arrest can occur after a heart attack, or during recovery. Heart attacks increase the risk ...

  7. Sudden cardiac death secondary to antidepressant and antipsychotic drugs

    PubMed Central

    Sicouri, Serge; Antzelevitch, Charles

    2008-01-01

    A number of antipsychotic and antidepressant drugs are known to increase the risk of ventricular arrhythmias and sudden cardiac death. Based largely on a concern over QT prolongation and the development of life-threatening arrhythmias, a number of antipsychotic drugs have been temporarily or permanently withdrawn from the market or their use restricted. Some antidepressants and antipsychotics have been linked to QT prolongation and the development of Torsade de pointes arrhythmias, whereas others have been associated with a Brugada syndrome phenotype and the development of polymorphic ventricular arrhythmias. This review examines the mechanisms and predisposing factors underlying the development of cardiac arrhythmias, and sudden cardiac death, associated with antidepressant and antipsychotic drugs in clinical use. PMID:18324881

  8. CAP2 in cardiac conduction, sudden cardiac death and eye development.

    PubMed

    Field, Jeffrey; Ye, Diana Z; Shinde, Manasi; Liu, Fang; Schillinger, Kurt J; Lu, MinMin; Wang, Tao; Skettini, Michelle; Xiong, Yao; Brice, Angela K; Chung, Daniel C; Patel, Vickas V

    2015-01-01

    Sudden cardiac death kills 180,000 to 450,000 Americans annually, predominantly males. A locus that confers a risk for sudden cardiac death, cardiac conduction disease, and a newly described developmental disorder (6p22 syndrome) is located at 6p22. One gene at 6p22 is CAP2, which encodes a cytoskeletal protein that regulates actin dynamics. To determine the role of CAP2 in vivo, we generated knockout (KO) mice. cap2(-)/cap2(-) males were underrepresented at weaning and ~70% died by 12 weeks of age, but cap2(-)/cap2(-) females survived at close to the expected levels and lived normal life spans. CAP2 knockouts resembled patients with 6p22 syndrome in that mice were smaller and they developed microphthalmia and cardiac disease. The cardiac disease included cardiac conduction disease (CCD) and, after six months of age, dilated cardiomyopathy (DCM), most noticeably in the males. To address the mechanisms underlying these phenotypes, we used Cre-mediated recombination to knock out CAP2 in cardiomyocytes. We found that the mice developed CCD, leading to sudden cardiac death from complete heart block, but no longer developed DCM or the other phenotypes, including sex bias. These studies establish a direct role for CAP2 and actin dynamics in sudden cardiac death and cardiac conduction disease. PMID:26616005

  9. CAP2 in cardiac conduction, sudden cardiac death and eye development

    PubMed Central

    Field, Jeffrey; Ye, Diana Z.; Shinde, Manasi; Liu, Fang; Schillinger, Kurt J.; Lu, MinMin; Wang, Tao; Skettini, Michelle; Xiong, Yao; Brice, Angela K.; Chung, Daniel C.; Patel, Vickas V.

    2015-01-01

    Sudden cardiac death kills 180,000 to 450,000 Americans annually, predominantly males. A locus that confers a risk for sudden cardiac death, cardiac conduction disease, and a newly described developmental disorder (6p22 syndrome) is located at 6p22. One gene at 6p22 is CAP2, which encodes a cytoskeletal protein that regulates actin dynamics. To determine the role of CAP2 in vivo, we generated knockout (KO) mice. cap2−/cap2− males were underrepresented at weaning and ~70% died by 12 weeks of age, but cap2−/cap2− females survived at close to the expected levels and lived normal life spans. CAP2 knockouts resembled patients with 6p22 syndrome in that mice were smaller and they developed microphthalmia and cardiac disease. The cardiac disease included cardiac conduction disease (CCD) and, after six months of age, dilated cardiomyopathy (DCM), most noticeably in the males. To address the mechanisms underlying these phenotypes, we used Cre-mediated recombination to knock out CAP2 in cardiomyocytes. We found that the mice developed CCD, leading to sudden cardiac death from complete heart block, but no longer developed DCM or the other phenotypes, including sex bias. These studies establish a direct role for CAP2 and actin dynamics in sudden cardiac death and cardiac conduction disease. PMID:26616005

  10. Sudden arrhythmic death syndrome: a national survey of sudden unexplained cardiac death

    PubMed Central

    Behr, E R; Casey, A; Sheppard, M; Wright, M; Bowker, T J; Davies, M J; McKenna, W J; Wood, D A

    2007-01-01

    Objective To describe the characteristics of sudden arrhythmic death syndrome (SADS) and compare its incidence with official national mortality statistics for unascertained deaths. Design and setting Sudden unexplained deaths were prospectively surveyed through 117 coroners' jurisdictions in England. Consecutive cases meeting the following criteria were included: white Caucasian, aged 4–64 years, no history of cardiac disease, last seen alive within 12 h of death, normal coroner's autopsy, cardiac pathologist's confirmation of a normal heart and negative toxicology. Main outcome measures The estimated mortality from SADS was calculated and the official mortality statistics for unascertained causes of deaths in 4–64‐year‐olds was identified for the same time period. Results 115 coroner's cases were reported and 56 (49%) SADS victims were identified: mean age 32 years, range 7–64 years and 35 (63%) male. 7 of 39 cases (18%) had a family history of other premature sudden deaths (<45). The estimated mortality from SADS was 0.16/100 000 per annum (95% CI 0.12 to 0.21), compared with an official mortality of 0.10/100 000 per annum for International Classification of Diseases 798.1 (sudden death, cause unknown—instantaneous death) or 1.34/100 000 per annum for unascertained causes of death. Conclusions Deaths from SADS occur predominantly in young males. When compared with official mortality, the incidence of SADS may be up to eight times higher than estimated: more than 500 potential SADS cases per annum in England. Families with SADS carry genetic cardiac disease, placing them at risk of further sudden deaths. SADS should therefore be a certifiable cause of death prompting specialised cardiological evaluation of families. PMID:17237131

  11. The Spectrum of Epidemiology Underlying Sudden Cardiac Death

    PubMed Central

    Hayashi, Meiso; Shimizu, Wataru; Albert, Christine M.

    2015-01-01

    Sudden cardiac death (SCD) from cardiac arrest is a major international public health problem accounting for an estimated 15–20% of all deaths. Although resuscitation rates are generally improving throughout the world, the majority of individuals who suffer a sudden cardiac arrest will not survive. SCD most often develops in older adults with acquired structural heart disease, but it also rarely occurs in the young, where it is more commonly due to inherited disorders. Coronary heart disease (CHD) is known to be the most common pathology underlying SCD, followed by cardiomyopathies, inherited arrhythmia syndromes, and valvular heart disease. Over the past three decades, declines in SCD rates have not been as steep as for other causes of CHD deaths, and there is a growing fraction of SCDs not due to CHD and/or ventricular arrhythmias, particularly among certain subsets of the population. The growing heterogeneity of the pathologies and mechanisms underlying SCD present major challenges for SCD prevention, which are magnified further by a frequent lack of recognition of the underlying cardiac condition prior to death. Multifaceted preventative approaches, which address risk factors in seemingly low risk and known high-risk populations will be required to decrease the burden of SCD. In this Compendium, we review the wide-ranging spectrum of epidemiology underlying SCD within both the general population and in high-risk subsets with established cardiac disease placing an emphasis on recent global trends, remaining uncertainties, and potential targeted preventive strategies. PMID:26044246

  12. The spectrum of epidemiology underlying sudden cardiac death.

    PubMed

    Hayashi, Meiso; Shimizu, Wataru; Albert, Christine M

    2015-06-01

    Sudden cardiac death (SCD) from cardiac arrest is a major international public health problem accounting for an estimated 15%-20% of all deaths. Although resuscitation rates are generally improving throughout the world, the majority of individuals who experience a sudden cardiac arrest will not survive. SCD most often develops in older adults with acquired structural heart disease, but it also rarely occurs in the young, where it is more commonly because of inherited disorders. Coronary heart disease is known to be the most common pathology underlying SCD, followed by cardiomyopathies, inherited arrhythmia syndromes, and valvular heart disease. During the past 3 decades, declines in SCD rates have not been as steep as for other causes of coronary heart disease deaths, and there is a growing fraction of SCDs not due to coronary heart disease and ventricular arrhythmias, particularly among certain subsets of the population. The growing heterogeneity of the pathologies and mechanisms underlying SCD present major challenges for SCD prevention, which are magnified further by a frequent lack of recognition of the underlying cardiac condition before death. Multifaceted preventative approaches, which address risk factors in seemingly low-risk and known high-risk populations, will be required to decrease the burden of SCD. In this Compendium, we review the wide-ranging spectrum of epidemiology underlying SCD within both the general population and in high-risk subsets with established cardiac disease placing an emphasis on recent global trends, remaining uncertainties, and potential targeted preventive strategies. PMID:26044246

  13. Ebstein's Anomaly, Left Ventricular Noncompaction, and Sudden Cardiac Death.

    PubMed

    McGee, Michael; Warner, Luke; Collins, Nicholas

    2015-01-01

    Ebstein's anomaly is a congenital disorder characterized by apical displacement of the septal leaflet of the tricuspid valve. Ebstein's anomaly may be seen in association with other cardiac conditions, including patent foramen ovale, atrial septal defect, and left ventricular noncompaction (LVNC). LVNC is characterized by increased trabeculation within the left ventricular apex. Echocardiography is often used to diagnose LVNC; however, magnetic resonance (MR) imaging offers superior characterization of the myocardium. We report a case of sudden cardiac death in a patient with Ebstein's anomaly with unrecognized LVNC noted on post mortem examination with screening documenting the presence of LVNC in one of the patient's twin sons. PMID:26240764

  14. Sudden cardiac death markers in non-ischemic cardiomyopathy.

    PubMed

    Pimentel, Mauricio; Rohde, Luis Eduardo; Zimerman, André; Zimerman, Leandro Ioschpe

    2016-01-01

    Heart failure is an increasingly prevalent disease associated with high morbidity and mortality. In 30-40% of patients, the etiology is non-ischemic. In this group of patients, the implantable cardioverter-defibrillator (ICD) prevents sudden death and decreases total mortality. However, due to burden of cost, the fact that many ICD patients will never need any therapy, and possible complications involved in implant and follow-up, the device should not be implanted in every patient with non-ischemic heart failure. There is an urgent need to adequately identify patients with highest sudden death risk, in whom the implant is most cost-effective. In the present paper, the authors discuss current available tests for risk stratification of sudden cardiac death in patients with non-ischemic heart failure. PMID:27016256

  15. Clinical management and prevention of sudden cardiac death.

    PubMed

    Yousuf, Omair; Chrispin, Jonathan; Tomaselli, Gordon F; Berger, Ronald D

    2015-06-01

    Despite the revolutionary advancements in the past 3 decades in the treatment of ventricular tachyarrhythmias with device-based therapy, sudden cardiac death (SCD) remains an enormous public health burden. Survivors of SCD are generally at high risk for recurrent events. The clinical management of such patients requires a multidisciplinary approach from postresuscitative care to a thorough cardiovascular investigation in an attempt to identify the underlying substrate, with potential to eliminate or modify the triggers through catheter ablation and ultimately an implantable cardioverter-defibrillator (ICD) for prompt treatment of recurrences in those at risk. Early recognition of low left ventricular ejection fraction as a strong predictor of death and association of ventricular arrhythmias with sudden death led to significant investigation with antiarrhythmic drugs. The lack of efficacy and the proarrhythmic effects of drugs catalyzed the development and investigation of the ICD through several major clinical trials that proved the efficacy of ICD as a bedrock tool to detect and promptly treat life-threatening arrhythmias. The ICD therapy is routinely used for primary prevention of SCD in patients with cardiomyopathy and high risk inherited arrhythmic conditions and secondary prevention in survivors of sudden cardiac arrest. This compendium will review the clinical management of those surviving SCD and discuss landmark studies of antiarrhythmic drugs, ICD, and cardiac resynchronization therapy in the primary and secondary prevention of SCD. PMID:26044254

  16. Aetiology of sudden cardiac death in sport: a histopathologist's perspective

    PubMed Central

    Sheppard, Mary N

    2012-01-01

    In the UK, when a young person dies suddenly, the coroner is responsible for establishing the cause of death. They will ask a consultant pathologist to carry out an autopsy in order to ascertain when, where and how that person died. Once the cause of death is established and is due to natural causes, the coroner can issue a death certificate. Importantly, the coroner is not particularly interested in the cause of death as long as it is due to natural causes, which avoids the need for an inquest (a public hearing about the death). However, if no identifiable cause is established at the initial autopsy, the coroner can refer the heart to a cardiac pathologist, since the cause of death is usually due to heart disease in most cases. Consultant histopathologists are responsible for the analysis of human tissue from both living individuals and the dead in order to make a diagnosis of disease. With recent advancements in the management protocols for routine autopsy practice and assessment following the sudden death of a young individual, this review describes the role of the consultant histopathologist in the event of a sudden death of a young athletic individual, together with the older middle-aged ‘weekend warrior’ athlete. It provides concise mechanisms for the main causes of sudden cardiac death (including coronary artery disease, cardiomyopathies, valve abnormalities, major vessel ruptures and electrical conduction abnormalities) based on detailed autopsy data from our specialised cardiac pathology laboratory. Finally, the review will discuss the role of the histopathologist in the event of a ‘negative’ autopsy. PMID:23097474

  17. Wolff-Parkinson-White syndrome and sudden cardiac death.

    PubMed

    Prystowsky, E N; Fananapazir, L; Packer, D L; Thompson, K A; German, L D

    1987-01-01

    Every year, individuals with no history of heart disease succumb to sudden cardiac death (SCD). Pathologic examination of the hearts usually reveals various forms of heart disease as hypertrophic cardiomyopathy or coronary artery disease. In other cases, however, there is no obvious structural heart disease, and it is possible that some of these individuals died because of a cardiac arrhythmia involving an accessory pathway. If this were the case, the most likely scenario would be onset of atrioventricular reciprocating tachycardia (AVRT), degeneration of the AVRT into atrial fibrillation with a rapid ventricular response over the accessory pathway, and subsequent death caused by the development of ventricular fibrillation. Although these events have been documented, albeit rarely, during intracardiac electrophysiologic studies, in reality very little is known about the natural history of asymptomatic and untreated patients with Wolff-Parkinson-White (WPW) syndrome. In fact, SCD in a previously asymptomatic patient with WPW syndrome is probably relatively rare. Whether asymptomatic WPW patients should undergo electrophysiologic or pharmacologic testing to determine their 'potential' to develop serious cardiac arrhythmias is controversial. The present paucity of data concerning the natural history of WPW syndrome in asymptomatic patients militates against successful identification of those patients who are at risk for sudden death. Long-term prospective studies are necessary to clarify which asymptomatic patients with WPW syndrome require treatment. PMID:3621280

  18. [The athletes' ECG and the exercise related sudden cardiac death].

    PubMed

    Trachsel, Lukas-Daniel; Wilhelm, Matthias

    2015-05-01

    Regular physical activity induces structural, electrical and functional cardiac adaptations. The main challenge for the athletes' physician is to distinguish abnormal structural changes of the heart from training-induced adaptations (so-called “athlete's heart”). In athletes with underlying cardiac disease, physical activity may be a trigger, not the cause of exercise-induced tachyarrhythmia's and sudden cardiac death (SCD). To identify athletes with cardiac diseases and increased risk for an SCD, the European society of cardiology (ESC) recommends a pre-participation screening in elite athletes which was adopted by the Swiss society of sports medicine. The screening includes a specific medical history, cardiac auscultation and a resting ECG. Due to the high number of false-positive cases of athletes' ECGs based on traditional criteria, the ESC assessment criteria were adjusted to account for training-related changes of the ECG. The sensitivity and especially the specificity could be improved in the “revised Seattle criteria” in 2014. During the last years main attention has been shifted to the early repolarization pattern: additionally to (endurance-) training there is a clear association with male gender, ethnicity, changes in autonomic nervous system activity and high QRS-voltage criteria PMID:26098068

  19. A young mountaineer surviving sudden cardiac arrest at high altitude

    PubMed Central

    Indermuehle, Andreas; Cook, Stéphan; Marty, Hans

    2010-01-01

    A young mountaineer suffered from sudden cardiac arrest at high altitude. Cardiopulmonary resuscitation was initiated immediately. After 30 min a rescue team arrived and successfully defibrillated ventricular fibrillation upon which spontaneous circulation returned. The subsequent ECG was suggestive of extensive anterior myocardial infarction. Therefore, the patient was thrombolysed and transferred for primary percutaneous coronary intervention. Echocardiography revealed severely reduced left ventricular function with antero-septo-apical akinesia. However, angiography showed unobstructed coronary arteries. The patient fully recovered and left ventricular function normalised within 2 weeks. It may be speculated that exposure to high altitude resulted in acute coronary thrombosis which dissolved by rapid thrombolysis. PMID:22778291

  20. Nonlinear dynamics, fractals, cardiac physiology and sudden death

    NASA Technical Reports Server (NTRS)

    Goldberger, Ary L.

    1987-01-01

    The authors propose a diametrically opposite viewpoint to the generally accepted tendency of equating healthy function with order and disease with chaos. With regard to the question of sudden cardiac death and chaos, it is suggested that certain features of dynamical chaos related to fractal structure and fractal dynamics may be important organizing principles in normal physiology and that certain pathologies, including ventricular fibrillation, represent a class of 'pathological periodicities'. Some laboratory work bearing on the relation of nonlinear analysis to physiological and pathophysiological data is briefly reviewed, with tentative theories and models described in reference to the mechanism of ventricular fibrillation.

  1. The negative autopsy: sudden cardiac death or other?

    PubMed

    Cohle, S D; Sampson, B A

    2001-01-01

    One of the most frustrating challenges faced by the forensic pathologist is the inability to determine the cause of death in a young person previously thought healthy. The four steps in the investigation of a sudden death include obtaining the history and scene information, performing a gross and microscopic autopsy, performing appropriate laboratory tests, and making the diagnosis. When examining the heart grossly it is important to preserve the anatomic landmarks, section the coronary arteries closely, and recognize lethal abnormalities such as anomalous origin of the coronary arteries. Specimens useful for toxicologic analysis include whole blood, serum, vitreous humor, gastric contents, bile, urine a purple top tube of blood, and frozen myocardium and spleen. Lethal cardiac diseases with minimal or no anatomic findings include Brugada and Garg's syndromes, the long QT syndrome, and Wolff-Parkinson-White (WPW) syndrome. Consultation with other experts, including cardiac pathologists, cardiologists, electrophysiologists, and molecular biologists, may be helpful in determining a cause of death. PMID:11673059

  2. Genetic etiology and evaluation of sudden cardiac death.

    PubMed

    Dolmatova, Elena; Mahida, Saagar; Ellinor, Patrick T; Lubitz, Steven A

    2013-08-01

    A wide range of inherited syndromes can result in ventricular arrhythmias and sudden cardiac death (SCD). The natural histories of inherited arrhythmia syndromes are highly variable and current risk stratification techniques are limited. Thus, the management of these conditions can be difficult and often involves a combination of risk assessment, lifestyle modification, cardiac interventions, counselling, and family screening. Recent advances in high throughput sequencing have enabled routine testing in patients with a high clinical index of suspicion for an inherited arrhythmia condition, and cascade screening in relatives of mutation carriers. Given the complexity in screening and data interpretation that has been introduced by recent genomic advances, individuals with inherited arrhythmia syndromes are encouraged to seek care at specialized centers with cardiovascular genetics expertise. In this review, we discuss the etiologies of SCD syndromes and discuss strategies for the evaluation of patients at risk for SCD with a focus on the role of genetic testing and family screening. PMID:23812838

  3. Tissue and Animal Models of Sudden Cardiac Death

    PubMed Central

    Sallam, Karim; Li, Yingxin; Sager, Philip T.; Houser, Steven R.; Wu, Joseph C.

    2015-01-01

    Sudden Cardiac Death (SCD) is a common cause of death in patients with structural heart disease, genetic mutations or acquired disorders affecting cardiac ion channels. A wide range of platforms exist to model and study disorders associated with SCD. Human clinical studies are cumbersome and are thwarted by the extent of investigation that can be performed on human subjects. Animal models are limited by their degree of homology to human cardiac electrophysiology including ion channel expression. Most commonly used cellular models are cellular transfection models, which are able to mimic the expression of a single ion channel offering incomplete insight into changes of the action potential profile. Induced pluripotent stem cell derived Cardiomyocytes (iPSC-CMs) resemble, but are not identical, to adult human cardiomyocytes, and provide a new platform for studying arrhythmic disorders leading to SCD. A variety of platforms exist to phenotype cellular models including conventional and automated patch clamp, multi-electrode array, and computational modeling. iPSC-CMs have been used to study Long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy and other hereditary cardiac disorders. Although iPSC-CMs are distinct from adult cardiomyocytes, they provide a robust platform to advance the science and clinical care of SCD. PMID:26044252

  4. [Postmortem genetic testing in sudden cardiac death due to ion channelopathies].

    PubMed

    Guan, Da-wei; Zhao, Rui

    2010-04-01

    Sudden cardiac death accounts for majority of deaths in human. Evident cardiac lesions that may explain the cause of death can be detected in comprehensive postmortem investigation in most sudden cardiac death. However, no cardiac morphological abnormality is found in a considerable number of cases although the death is highly suspected from cardiac anomaly. With the advances in the modern molecular biology techniques, it has been discovered that many of these sudden deaths are caused by congenital ion channelopathies in myocardial cell, i.e., Brugada syndrome, long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, and short QT syndrome, etc. This article presents the molecular genetics, electrocardiographic abnormalities, clinical manifestations, and mechanisms leading to sudden cardiac death with emphasis on the role of postmortem genetic testing in certification of cause of death. It may provide helpful information in investigating sudden cardiac death due to ion channelopathies in medico-legal practice. PMID:20653139

  5. Student perceptions of sudden cardiac arrest: a qualitative inquiry.

    PubMed

    McDonough, Annette; Callan, Krista; Egizio, Katelyn; Kenney, Kaye; Gray, Gillian; Mundry, Gillian; Re, Gillian

    Sudden cardiac arrest (SCA) is the number one cause of death in young athletes in high school and university settings. Survival and outcomes of SCA is dependent on appropriate recognition of symptoms and immediate cardiopulmonary resuscitation (CPR), along with a shock from an automatic external defibrillator (AED). The three aims of the authors' study presented in this article were: to describe university students' perceptions and beliefs about sudden cardiac arrest, to describe university students' understanding of an AED and their level of preparedness to recognize and respond to a life threatening emergency event, and to identify university students' experiences of responding to handling life-threatening emergency events. Qualitative methodology was employed using semi-structured interviews and thematic analysis. Three major themes emerged from data analysis: confusion, uncertainty, and fear/uncomfortableness. These themes characterised participant's perceptions about SCA. The authors concluded that a lack of understanding of what SCA is and participants' inability to respond to an emergency event was evident. PMID:22585265

  6. Noninvasive imaging markers associated with sudden cardiac death.

    PubMed

    van der Bijl, Pieter; Delgado, Victoria; Bax, Jeroen J

    2016-05-01

    Sudden cardiac death (SCD) accounts for approximately 15-20% of all deaths worldwide. While the majority of SCDs occur in adults, children, and adults <35 years (<1%) may also be affected. Currently the most effective strategy for both primary and secondary prevention of SCD is the implantable cardioverter-defibrillator (ICD). However, identification of patients who will benefit from ICD implantation remains challenging. Left ventricular ejection fraction (LVEF) is the most frequent imaging parameter used to select patients for ICD implantation for primary prevention. However, LVEF has shown to be suboptimal for prediction of benefit. Non-invasive cardiac imaging permits characterization of the arrhythmogenic substrate, including dispersion of electromechanical activation, presence of myocardial scar, and cardiac innervation status. The arrhythmogenic substrate may change across the different underlying diseases. While in ischemic cardiomyopathy, differentiation and characterization of infarct core and peri-infarct zone have been shown to refine the risk stratification of patients, in non-ischemic cardiomyopathies, the substrate may be more heterogeneous and tissue characterization assessing focal and diffuse fibrosis and inflammation processes may be more relevant. Furthermore, in channelopathies, assessment of mechanical dispersion between myocardial layers may identify the patients with increased risk of ventricular arrhythmias. Finally, potential triggers of ventricular arrhythmias such as myocardial ischemia can be evaluated. The role of noninvasive imaging in the risk stratification of SCD and the selection of candidates for ICD will be discussed in this article. PMID:26632012

  7. Overexpression of KCNN3 results in sudden cardiac death

    PubMed Central

    Mahida, Saagar; Mills, Robert W.; Tucker, Nathan R.; Simonson, Bridget; Macri, Vincenzo; Lemoine, Marc D.; Das, Saumya; Milan, David J.; Ellinor, Patrick T.

    2014-01-01

    Background A recent genome-wide association study identified a susceptibility locus for atrial fibrillation at the KCNN3 gene. Since the KCNN3 gene encodes for a small conductance calcium-activated potassium channel, we hypothesized that overexpression of the SK3 channel increases susceptibility to cardiac arrhythmias. Methods and results We characterized the cardiac electrophysiological phenotype of a mouse line with overexpression of the SK3 channel. We generated homozygote (SK3T/T) and heterozygote (SK3+/T) mice with overexpression of the channel and compared them with wild-type (WT) controls. We observed a high incidence of sudden death among SK3T/T mice (7 of 19 SK3T/T mice). Ambulatory monitoring demonstrated that sudden death was due to heart block and bradyarrhythmias. SK3T/T mice displayed normal body weight, temperature, and cardiac function on echocardiography; however, histological analysis demonstrated that these mice have abnormal atrioventricular node morphology. Optical mapping demonstrated that SK3T/T mice have slower ventricular conduction compared with WT controls (SK3T/T vs. WT; 0.45 ± 0.04 vs. 0.60 ± 0.09 mm/ms, P = 0.001). Programmed stimulation in 1-month-old SK3T/T mice demonstrated inducible atrial arrhythmias (50% of SK3T/T vs. 0% of WT mice) and also a shorter atrioventricular nodal refractory period (SK3T/T vs. WT; 43 ± 6 vs. 52 ± 9 ms, P = 0.02). Three-month-old SK3T/T mice on the other hand displayed a trend towards a more prolonged atrioventricular nodal refractory period (SK3T/T vs. WT; 61 ± 1 vs. 52 ± 6 ms, P = 0.06). Conclusion Overexpression of the SK3 channel causes an increased risk of sudden death associated with bradyarrhythmias and heart block, possibly due to atrioventricular nodal dysfunction. PMID:24296650

  8. Sudden cardiac and sudden unexpected death related to antipsychotics: A meta-analysis of observational studies.

    PubMed

    Salvo, F; Pariente, A; Shakir, S; Robinson, P; Arnaud, M; Thomas, Shl; Raschi, E; Fourrier-Réglat, A; Moore, N; Sturkenboom, M; Hazell On Behalf Of Investigators Of The Aritmo Consortium, L

    2016-03-01

    To estimate the risk of sudden cardiac death (SCD) or sudden unexpected death (SUD) related to individual antipsychotics, a meta-analysis of observational studies was performed. Adjusted odds ratio (OR) of SCD/SUD with 95% confidence intervals (CI) were extracted and pooled; heterogeneity was studied using Q statistic and I(2) index, and its potential causes (e.g., hERG blockade potency) explored using meta-regression. Two cohort (740,306 person-years) and four case-control (2,557 cases; 17,670 controls) studies, investigating nine antipsychotics, were included. Compared with nonusers, the risk was increased for quetiapine (OR = 1.72, 95% CI: 1.33-2.23), olanzapine (OR = 2.04, 1.52-2.74), risperidone (OR = 3.04, 2.39-3.86), haloperidol (OR = 2.97, 1.59-5.54), clozapine (OR = 3.67, 1.94-6.94), and thioridazine (OR = 4.58, 2.09-10.05). Heterogeneity was found (Q = 20.0, P = 0.01; I(2) = 60.0%), and the increasing mean hERG blockade potency (P = 0.01) accounted for 43% of this. The SCD/SUD risk differed between individual antipsychotics, and mean hERG blockade potency could be an explanatory factor. This should be considered when initiating antipsychotic treatment. PMID:26272741

  9. Cardiac and other abnormalities in the sudden infant death syndrome.

    PubMed

    Naeye, R L; Whalen, P; Ryser, M; Fisher, R

    1976-01-01

    Many victims of the sudden infant death syndrome (SIDS) have abnormally heavy cardiac right ventricles. The degree of this abnormality is directly proportional to: a) the mass of muscle about small pulmonary arteries, b) the amount of brown fat retention about adrenal glands, and c) the presence of hepatic erythropoiesis. The pulmonary arterial abnormality is probably the result of chronic alveolar hypoventilation, while brown fat retention and hepatic erythropoiesis are likely consequences of chronic hypoxemia. These abnormalities are found in both SIDS victims who die with and those who die without mild respiratory tract infections. However, there are some differences between the two SIDS groups. Infected victims die at an older age and have smaller thymus glands and larger spleens; there is a greater proportion of males in the infected victims than in the noninfected victims. PMID:1247080

  10. [Sudden cardiac death during a city marathon run].

    PubMed

    Beutler, J; Schmid, E; Fischer, S; Hürlimann, S; Konrad, C

    2015-06-01

    Sudden cardiac death (SCD) in young athletes during physical stress is a rare event with an incidence of 1-3 deaths per 100,000 athletes per year. A coronary anomaly is the second most common cause of death following hypertrophic cardiomyopathy. Symptomatic prodromes occur in 20% of cases prior to the SCD event. This case report describes a 35-year-old male who collapsed near the finishing line of a half marathon run. Despite immediate resuscitation attempts and initial return of spontaneous circulation (ROSC), a pulseless electrical activity (PEA) followed and the patient died 1 h after arrival in the resuscitation unit. The autopsy revealed an anomalous left coronary artery (ALCA), which can lead to ischemia of the respective heart muscles under severe stress. PMID:26031561

  11. Cardiac Conduction System Anomalies and Sudden Cardiac Death: Insights from Murine Models

    PubMed Central

    Aránega, Amelia; De La Rosa, Angel J.; Franco, Diego

    2012-01-01

    The cardiac conduction system (CCS) is composed of a group of myocardial tissues that control and coordinate the heart. Alterations in the CCS – especially in the His–Purkinje system, have been identified as a major cause of lethal arrhythmias. Unstable arrhythmias secondary to channelopathies significantly increase the risk of sudden cardiac death (SCD). SCD is a major contributor to mortality in industrialized countries, and most cases of SCD in the young are related to inherited ion channel diseases. In this paper, we review a series of studies with murine transgenic models that revealed that some arrhythmias are associated with the CCS and may lead to SCD PMID:22783196

  12. Sudden cardiac death: ethical considerations in the return to play.

    PubMed

    Piantanida, Nicholas A; Oriscello, Ralph G; Pettrone, Frank A; O'Connor, Francis G

    2004-04-01

    The team physician-athlete relationship prompts many basic questions in medical ethics. Return-to-play decisions form many of the core responsibilities facing team physicians, and occasionally these decisions can have overriding ethical dilemmas. Therefore, a structured ethical decision-making process is a valuable skill for every successful sports medicine physician. An ethical question is confronted here in a case presentation that weighs the risk of repeat sudden cardiac death and the potential for failed cardiac resuscitation against the athlete's interest to play competitive basketball. The article applies a four-step framework for ethical decision making in sports medicine. The important first step includes gathering medical information and understanding the preferences of the athlete. Step 2 brings together the decision-making stakeholders, the team physician as a member, to define ethical issues and apply ethical principles: beneficence, non-maleficence, and patient autonomy. Step 3 selects a course of action with unbiased analysis and arrives at a good choice that merits an action plan in step 4. This decision need not be perfect, but should reinforce the team physician's responsibilities to the athlete and center on the athlete's welfare. PMID:14980137

  13. Early repolarization syndrome: A cause of sudden cardiac death

    PubMed Central

    Ali, Abdi; Butt, Nida; Sheikh, Azeem S

    2015-01-01

    Early repolarization syndrome (ERS), demonstrated as J-point elevation on an electrocardiograph, was formerly thought to be a benign entity, but the recent studies have demonstrated that it can be linked to a considerable risk of life - threatening arrhythmias and sudden cardiac death (SCD). Early repolarization characteristics associated with SCD include high - amplitude J-point elevation, horizontal and/or downslopping ST segments, and inferior and/or lateral leads location. The prevalence of ERS varies between 3% and 24%, depending on age, sex and J-point elevation (0.05 mV vs 0.1 mV) being the main determinants. ERS patients are sporadic and they are at a higher risk of having recurrent cardiac events. Implantable cardioverter-defibrillator implantation and isoproterenol are the suggested therapies in this set of patients. On the other hand, asymptomatic patients with ERS are common and have a better prognosis. The risk stratification in asymptomatic patients with ERS still remains a grey area. This review provides an outline of the up-to-date evidence associated with ERS and the risk of life - threatening arrhythmias. Further prospective studies are required to elucidate the mechanisms of ventricular arrhythmogenesis in patients with ERS. PMID:26322186

  14. Multimodal Imaging after Sudden Cardiac Arrest in an 18-Year-Old Athlete

    PubMed Central

    Rehman, Mobeen Ur; Atalay, Michael K.; Broderick, Ryan J.

    2015-01-01

    We report the case of a previously healthy 18-year-old male athlete who twice presented with sudden cardiac arrest. Our use of electrocardiography, echocardiography, cardiac magnetic resonance, coronary angiography, coronary computed tomographic angiography, and nuclear stress testing enabled the diagnoses of apical hypertrophic cardiomyopathy and anomalous origin of the right coronary artery. We discuss the patient's treatment and note the useful role of multiple cardiovascular imaging methods in cases of sudden cardiac arrest. PMID:26664308

  15. Multimodal Imaging after Sudden Cardiac Arrest in an 18-Year-Old Athlete.

    PubMed

    Afari, Maxwell E; Rehman, Mobeen Ur; Atalay, Michael K; Broderick, Ryan J

    2015-12-01

    We report the case of a previously healthy 18-year-old male athlete who twice presented with sudden cardiac arrest. Our use of electrocardiography, echocardiography, cardiac magnetic resonance, coronary angiography, coronary computed tomographic angiography, and nuclear stress testing enabled the diagnoses of apical hypertrophic cardiomyopathy and anomalous origin of the right coronary artery. We discuss the patient's treatment and note the useful role of multiple cardiovascular imaging methods in cases of sudden cardiac arrest. PMID:26664308

  16. Cardiac Tropism of Borrelia burgdorferi: An Autopsy Study of Sudden Cardiac Death Associated with Lyme Carditis.

    PubMed

    Muehlenbachs, Atis; Bollweg, Brigid C; Schulz, Thadeus J; Forrester, Joseph D; DeLeon Carnes, Marlene; Molins, Claudia; Ray, Gregory S; Cummings, Peter M; Ritter, Jana M; Blau, Dianna M; Andrew, Thomas A; Prial, Margaret; Ng, Dianna L; Prahlow, Joseph A; Sanders, Jeanine H; Shieh, Wun Ju; Paddock, Christopher D; Schriefer, Martin E; Mead, Paul; Zaki, Sherif R

    2016-05-01

    Fatal Lyme carditis caused by the spirochete Borrelia burgdorferi rarely is identified. Here, we describe the pathologic, immunohistochemical, and molecular findings of five case patients. These sudden cardiac deaths associated with Lyme carditis occurred from late summer to fall, ages ranged from young adult to late 40s, and four patients were men. Autopsy tissue samples were evaluated by light microscopy, Warthin-Starry stain, immunohistochemistry, and PCR for B. burgdorferi, and immunohistochemistry for complement components C4d and C9, CD3, CD79a, and decorin. Post-mortem blood was tested by serology. Interstitial lymphocytic pancarditis in a relatively characteristic road map distribution was present in all cases. Cardiomyocyte necrosis was minimal, T cells outnumbered B cells, plasma cells were prominent, and mild fibrosis was present. Spirochetes in the cardiac interstitium associated with collagen fibers and co-localized with decorin. Rare spirochetes were seen in the leptomeninges of two cases by immunohistochemistry. Spirochetes were not seen in other organs examined, and joint tissue was not available for evaluation. Although rare, sudden cardiac death caused by Lyme disease might be an under-recognized entity and is characterized by pancarditis and marked tropism of spirochetes for cardiac tissues. PMID:26968341

  17. Left Ventricular Diameter and Risk Stratification for Sudden Cardiac Death

    PubMed Central

    Narayanan, Kumar; Reinier, Kyndaron; Teodorescu, Carmen; Uy‐Evanado, Audrey; Aleong, Ryan; Chugh, Harpriya; Nichols, Gregory A.; Gunson, Karen; London, Barry; Jui, Jonathan; Chugh, Sumeet S.

    2014-01-01

    Background Left ventricular (LV) diameter is routinely measured on the echocardiogram but has not been jointly evaluated with the ejection fraction (EF) for risk stratification of sudden cardiac death (SCD). Methods and Results From a large ongoing community‐based study of SCD (The Oregon Sudden Unexpected Death Study; population ≈1 million), SCD cases were compared with geographic controls. LVEF and LV diameter, measured using the LV internal dimension in diastole (categorized as normal, mild, moderate, or severe dilatation using American Society of Echocardiography definitions) were assessed from echocardiograms prior but unrelated to the SCD event. Cases (n=418; 69.5±13.8 years), compared with controls (n=329; 67.7±11.9 years), more commonly had severe LV dysfunction (EF ≤35%; 30.5% versus 18.8%; P<0.01) and larger LV diameter (52.2±10.5 mm versus 49.7±7.9 mm; P<0.01). Moderate or severe LV dilatation (16.3% versus 8.2%; P=0.001) and severe LV dilatation (8.1% versus 2.1%; P<0.001) were significantly more frequent in cases. In multivariable analysis, severe LV dilatation was an independent predictor of SCD (odds ratio 2.5 [95% CI 1.03 to 5.9]; P=0.04). In addition, subjects with both EF ≤35% and severe LV dilatation had higher odds for SCD compared with those with low EF only (odds ratio 3.8 [95% CI 1.5 to 10.2] for both versus 1.7 [95% CI 1.2 to 2.5] for low EF only), suggesting that severe LV dilatation additively increased SCD risk. Conclusion LV diameter may contribute to risk stratification for SCD independent of the LVEF. This readily available echocardiographic measure warrants further prospective evaluation. PMID:25227407

  18. Sudden Cardiac Arrest During Sports Activity in Middle Age

    PubMed Central

    Marijon, Eloi; Uy-Evanado, Audrey; Reinier, Kyndaron; Teodorescu, Carmen; Narayanan, Kumar; Jouven, Xavier; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S.

    2015-01-01

    Background Sports-associated sudden cardiac arrests (SCAs) occur mostly during middle age. We sought to determine burden, characteristics, and outcomes of SCA during sports among middle aged residents of a large US community. Methods and Results SCA cases aged 35–65 years were identified in a large, prospective, population-based study (2002–2013), with systematic and comprehensive assessment of their lifetime medical history. Of the 1,247 SCA cases, 63 (5%) occurred during sports activities at a mean age of 51.1±8.8 years, yielding an incidence of 21.7 (95%CI 8.1–35.4) per million per year. The incidence varied significantly based on sex, with a higher incidence among men (RR 18.68 95%CI 2.50–139.56) for sports SCA, as compared to all other SCA (RR 2.58, 95%CI 2.12–3.13). Sports SCA was also more likely to be a witnessed event (87 vs. 53%, P<0.001), with cardiopulmonary resuscitation (44 vs. 25%, P=0.001) and ventricular fibrillation (84 vs. 51%, P<0.0001). Survival to hospital discharge was higher for sports-associated SCA (23.2 vs. 13.6%, P=0.04). Sports SCA cases presented with known pre-existing cardiac disease in 16%, ≥1 cardiovascular risk factor in 56%, and overall, 36% of cases had typical cardiovascular symptoms during the week preceding SCA. Conclusions Sports-associated SCA in middle age represents a relatively small proportion of the overall SCA burden, reinforcing the idea of the high benefit-low risk nature of sports activity. Especially in light of current population aging trends, our findings emphasize that targeted education could maximize both safety and acceptance of sports activity in the older athlete. PMID:25847988

  19. A New Insight Into Sudden Cardiac Death in Young People

    PubMed Central

    Wang, Yueyue; Xia, Lei; Shen, Xiaodong; Han, Guoxin; Feng, Dan; Xiao, Hongju; Zhai, Yongzhi; Chen, Xin; Miao, Yuanyuan; Zhao, Chunhong; Wang, Yingchan; Guo, Mingguang; Li, Tanshi; Zhu, Hai Yan

    2015-01-01

    Abstract Takotsubo cardiomyopathy (TTC) causes sudden cardiac death and has garnered increased attention worldwide in recent years. However, few studies have clearly classified the risk factors for this disease, including gender, race and morbidity, as well as the physical and mental stressors that can exacerbate the disease, particularly in young patients. To better analyze the characteristics of young TTC patients, we performed a systematic review of reported cases involving young patients. A computer-assisted search was performed using prominent electronic medical information sources to identify literature published between January 1965 and December 2013. Relevant studies containing clinical data of young TTC patients were included. Ninety-six records that included information about 104 cases were ultimately selected for our review. Several of the following results were noted: First, physical stress was more likely to exacerbate TTC than was mental stress in young patients. Second, more female than male TTC patients were noted among both young patients and the general population. Third, ethnicity appears to play no role in the disease, as no significant differences were noted among individuals of different races with respect to clinical characteristics, morbidity or stressors. Fourth, the clinical manifestations of TTC were similar to those of other cardiac diseases, including coronary heart disease. However, TTC may be detected using the combination of echocardiography and ventriculography. Clinicians should consider TTC if young patients present with symptoms similar to those of coronary heart disease so that harmful treatments such as coronary artery stent placement may be avoided. Moreover, the answers to questions regarding the clinical diagnostic criteria, etiology, pathophysiology, and the management of this syndrome in youth remain unclear; therefore, further research is needed. PMID:26266349

  20. Ventricular fibrillation and sudden cardiac death during myocardial infarction.

    PubMed

    Jabbari, Reza

    2016-05-01

    In this PhD thesis, we report that VF is still a common complication of STEMI, with an incidence of 11.6% in the population of Danish STEMI patients who survive to reach the hospital. In this STEMI population, we identified several risk factors associated with VF independent of MI. We identified and confirmed findings from several previous studies and found several risk factors, such as younger age, a family history of sudden death, a TIMI flow grade of 0, the absence of angina, anterior infarction (i.e., VF before PPCI), and inferior infarction (i.e., VF during PPCI) that were associated with VF in a Danish cohort. Furthermore, a history of atrial fibrillation and alcohol intake were identified as novel risk factors for VF. To the best of our knowledge, this study contains data on the largest VF cohort with the longest reported follow-up published; we found that VF mortality is significantly higher within the first 30 days for patients who experience VF before and during PPCI compared with STEMI patients without VF. However, the long-term mortality rates of the three groups are the same. Importantly, our results contradict the previous understanding that VF during PPCI is "benign"; the mortality rate within the first 30 days was as high for patients with VF during PPCI as the mortality rate of patients with VF before PPCI. Finally, although it is difficult to draw clinical implications from a descriptive study, due to the comprehensiveness of Danish death certificates, we reported a high incidence of cardiac symptoms and contact with healthcare professionals based on cardiac symptoms in young SCD patients who died due to CAD, although death was not avoided. PMID:27127021

  1. Risk of sudden cardiac death in chronic kidney disease.

    PubMed

    Poulikakos, Dimitrios; Banerjee, Debasish; Malik, Marek

    2014-02-01

    The review discusses the epidemiology and the possible underlying mechanisms of sudden cardiac death (SCD) in chronic kidney disease (CKD), and highlights the unmet clinical need for noninvasive risk stratification strategies in these patients. Although renal dysfunction shares common risk factors and often coexists with atherosclerotic cardiovascular disease, the presence of renal impairment increases the risk of arrhythmic complications to an extent that cannot be explained by the severity of the atherosclerotic process. Renal impairment is an independent risk factor for SCD from the early stages of CKD; the risk increases as renal function declines and reaches very high levels in patients with end-stage renal disease on dialysis. Autonomic imbalance, uremic cardiomyopathy, and electrolyte disturbances likely play a role in increasing the arrhythmic risk and can be potential targets for treatment. Cardioverter defibrillator treatment could be offered as lifesaving treatment in selected patients, although selection strategies for this treatment mode are presently problematic in dialyzed patients. The review also examines the current experience with risk stratification tools in renal patients and suggests that noninvasive electrophysiological testing during dialysis may be of clinical value as it provides the necessary standardized environment for reproducible measurements for risk stratification purposes. PMID:24256575

  2. Prevention of sudden cardiac death in hemodialysis patients.

    PubMed

    O'Shaughnessy, Michelle M; O'Regan, John A; Lavin, Peter J

    2014-01-01

    One quarter of all hemodialysis patients will succumb to sudden cardiac death (SCD), a rate far exceeding that observed in the general population. A high prevalence of atherosclerotic coronary artery disease amongst patients with end-stage kidney disease (ESKD) partly explains this exaggerated risk. However, uremia and dialysis related factors are also of critical importance. Interventions aimed at preventing SCD have been inadequately studied in patients with ESKD. Data extrapolated from non-renal populations cannot necessarily be applied to hemodialysis patients, who possess relatively unique risk factors for SCD including "uremic cardiomyopathy", electrolyte shifts, fluctuations in intravascular volume and derangements of mineral and bone metabolism. Pending data derived from proposed randomized controlled clinical trials, critical appraisal of existing evidence and the selective application of guidelines developed for the general population to dialysis patients are required if therapeutic nihilism, or excessive intervention, are to be avoided. We discuss the evidence supporting a role for medical therapies, dialysis prescription refinements, revascularization procedures and electrical therapies as potential interventions to prevent SCD amongst hemodialysis patients. Based on current best available evidence, we present suggested strategies for the prevention of arrhythmia-mediated death in this highly vulnerable patient population. PMID:24720456

  3. Primary Prevention of Sudden Cardiac Death in Adults with Transposition of the Great Arteries: A Review of Implantable Cardioverter-Defibrillator Placement

    PubMed Central

    Cedars, Ari M.

    2015-01-01

    Transposition of the great arteries encompasses a set of structural congenital cardiac lesions that has in common ventriculoarterial discordance. Primarily because of advances in medical and surgical care, an increasing number of children born with this anomaly are surviving into adulthood. Depending upon the subtype of lesion or the particular corrective surgery that the patient might have undergone, this group of adult congenital heart disease patients constitutes a relatively new population with unique medical sequelae. Among the more common and difficult to manage are cardiac arrhythmias and other sequelae that can lead to sudden cardiac death. To date, the question of whether implantable cardioverter-defibrillators should be placed in this cohort as a preventive measure to abort sudden death has largely gone unanswered. Therefore, we review the available literature surrounding this issue. PMID:26413012

  4. Roadway Proximity and Risk of Sudden Cardiac Death in Women

    PubMed Central

    Hart, Jaime E; Chiuve, Stephanie E; Laden, Francine; Albert, Christine M

    2015-01-01

    Background Sudden cardiac death (SCD) is a major source of mortality and is the first manifestation of heart disease for the majority of cases. Thus, there is a definite need to identify risk factors for SCD that can be modified on the population level. Exposure to traffic, measured by residential roadway proximity, has been shown to be associated with an increased risk of cardiovascular disease. Our objective was to determine if roadway proximity was associated with an increased risk of SCD and to compare to the risk of other coronary heart disease (CHD) outcomes. Methods and Results A total of 523 cases of SCD were identified over 26 years of follow-up among 107,130 members of the prospective Nurses’ Health Study. We calculated residential distance to roadways at all residential addresses from 1986–2012. In age- and race-adjusted models, women living within 50 meters of a major roadway had an elevated risk of SCD (HR=1.56; 95%CI: 1.18–2.05). The association was attenuated but still statistically significant after controlling for potential confounders and mediators (HR=1.38; 95%CI:1.04–1.82). The equivalent adjusted HRs for nonfatal myocardial infarction and fatal CHD were 1.08 (95%CI: 0.96–1.23) and 1.24 (95%CI: 1.03–1.50), respectively. Conclusions Among this sample of middle-aged and older women, roadway proximity was associated with an elevated and statistically significant risks of SCD and fatal CHD, even after controlling for other cardiovascular risk factors. PMID:25332277

  5. Incidence of Sudden Cardiac Death in a Young Active Population

    PubMed Central

    Farioli, Andrea; Christophi, Costas A; Quarta, Candida Cristina; Kales, Stefanos N

    2015-01-01

    Background Little is known about the burden of sudden cardiac death (SCD) among active, presumably healthy persons. We investigated the incidence of SCD among US male career firefighters. Methods and Results All on-duty SCDs among US male career firefighters between 1998 and 2012 were identified from the US Fire Administration and the US National Institute for Occupational Safety and Health databases. Age-specific incidence rates (IRs) of SCD with 95% CIs were computed. A joinpoint model was fitted to analyze the trend in IR and to help estimate the annual percentage change of SCD rates over the years. The effects of seasonality were assessed through a Poisson regression model. We identified 182 SCDs; based on 99 available autopsy reports, the leading underlying cause of death was coronary heart disease (79%). The overall IR was 18.1 SCDs per 100 000 person-years. The age-specific IRs of SCD ranged between 3.8 (for those aged 18 to 24 years) and 45.2 (for those aged 55 to 64 years) per 100 000 person-years. The annual rate of SCD steadily declined over time (annual percentage change −3.9%, 95% CI −5.8 to −2.0). SCD events were more frequent during January (peak-to-low ratio 1.70; 95% CI 1.09 to 2.65). In addition, the IR was 3 times higher during high-risk duties compared with low-risk duties. IRs among firefighters were lower than those observed among the US general population and US military personnel. Conclusions SCD risk in this active working population is overestimated using statistics from the general population. To address public health questions among these subpopulations, more specific studies of active adults should be conducted. PMID:26066031

  6. Early markers for myocardial ischemia and sudden cardiac death.

    PubMed

    Sabatasso, Sara; Mangin, Patrice; Fracasso, Tony; Moretti, Milena; Docquier, Mylène; Djonov, Valentin

    2016-09-01

    The post-mortem diagnosis of acute myocardial ischemia remains a challenge for both clinical and forensic pathologists. We performed an experimental study (ligation of left anterior descending coronary artery in rats) in order to identify early markers of myocardial ischemia, to further apply to forensic and clinical pathology in cases of sudden cardiac death. Using immunohistochemistry, Western blots, and gene expression analyses, we investigated a number of markers, selected among those which are currently used in emergency departments to diagnose myocardial infarction and those which are under investigation in basic research and autopsy pathology studies on cardiovascular diseases. The study was performed on 44 adult male Lewis rats, assigned to three experimental groups: control, sham-operated, and operated. The durations of ischemia ranged between 5 min and 24 h. The investigated markers were troponins I and T, myoglobin, fibronectin, C5b-9, connexin 43 (dephosphorylated), JunB, cytochrome c, and TUNEL staining. The earliest expressions (≤30 min) were observed for connexin 43, JunB, and cytochrome c, followed by fibronectin (≤1 h), myoglobin (≤1 h), troponins I and T (≤1 h), TUNEL (≤1 h), and C5b-9 (≤2 h). By this investigation, we identified a panel of true early markers of myocardial ischemia and delineated their temporal evolution in expression by employing new technologies for gene expression analysis, in addition to traditional and routine methods (such as histology and immunohistochemistry). Moreover, for the first time in the autopsy pathology field, we identified, by immunohistochemistry, two very early markers of myocardial ischemia: dephosphorylated connexin 43 and JunB. PMID:27392959

  7. State of the art in forensic investigation of sudden cardiac death.

    PubMed

    Oliva, Antonio; Brugada, Ramon; D'Aloja, Ernesto; Boschi, Ilaria; Partemi, Sara; Brugada, Josep; Pascali, Vincenzo L

    2011-03-01

    The sudden death of a young person is a devastating event for both the family and community. Over the last decade, significant advances have been made in understanding both the clinical and genetic basis of sudden cardiac death. Many of the causes of sudden death are due to genetic heart disorders, which can lead to both structural (eg, hypertrophic cardiomyopathy) and arrhythmogenic abnormalities (eg, familial long QT syndrome, Brugada syndrome). Most commonly, sudden cardiac death can be the first presentation of an underlying heart problem, leaving the family at a loss as to why an otherwise healthy young person has died. Not only is this a tragic event for those involved, but it also presents a great challenge to the forensic pathologist involved in the management of the surviving family members. Evaluation of families requires a multidisciplinary approach, which should include cardiologists, a clinical geneticist, a genetic counselor, and the forensic pathologist directly involved in the sudden death case. This multifaceted cardiac genetic service is crucial in the evaluation and management of the clinical, genetic, psychological, and social complexities observed in families in which there has been a young sudden cardiac death. The present study will address the spectrum of structural substrates of cardiac sudden death with particular emphasis given to the possible role of forensic molecular biology techniques in identifying subtle or even merely functional disorders accounting for electrical instability. PMID:20083991

  8. Causes of sudden unexpected cardiac death in the first two decades of life.

    PubMed

    Steinberger, J; Lucas, R V; Edwards, J E; Titus, J L

    1996-05-01

    Sudden, unexpected cardiac death in the age group 1 to 21 years usually is due to myocarditis, hypertrophic cardiomyopathy, aortic valvar stenosis, and coronary arterial abnormalities. The hearts of 70 patients <21 years of age who died suddenly were reviewed. Twenty patients were <1 year of age and 50 were 1 to 21 years old. The cardiac findings were compared with those in 68 age-matched controls with known cardiac disease who did not die suddenly. Significant cardiac abnormalities were present in 13 (65%) of the 20 infants; 10 (50%) had anomalies of the aortic origin of the coronary arteries. Among the 50 older patients, cardiac abnormalities were found in 40 (80%), among whom coronary arterial anomalies existed in 12 (24%). Anomalies of aortic origin more frequently involved the left main than the right coronary artery in both groups. PMID:8644651

  9. Sudden cardiac death associated with occult hypertrophic cardiomyopathy in a dog under anesthesia

    PubMed Central

    2005-01-01

    Abstract A 6-year-old, 3.0 kg, neutered female, Yorkshire terrier was referred for orthopedic surgery. Cardiac arrest followed unsuccessful treatment of bradycardia and systemic arterial hypotension under general anesthesia. Postmortem examination revealed hypertrophic cardiomyopathy. A possible relationship between treatment of bradycardia, systemic arterial hypotension, and sudden cardiac death is described. PMID:16422064

  10. F-MARC: promoting the prevention and management of sudden cardiac arrest in football.

    PubMed

    Kramer, Efraim Benjamin; Dvorak, J; Schmied, C; Meyer, T

    2015-05-01

    Sudden cardiac death is the most common cause of unnatural death in football. To prevent and urgently manage sudden cardiac arrest on the football field-of-play, F-MARC (FIFA Medical and Research Centre) has been fully committed to a programme of research, education, standardisation and practical implementation. This strategy has detected football players at medical risk during mandatory precompetition medical assessments. Additionally, FIFA has (1) sponsored internationally accepted guidelines for the interpretation of an athlete's ECG, (2) developed field-of-play-specific protocols for the recognition, response, resuscitation and removal of a football player having sudden cardiac arrest and (3) introduced and distributed the FIFA medical emergency bag which has already resulted in the successful resuscitation of a football player who had a sudden cardiac arrest on the field-of-play. Recently FIFA, in association with the Institute of Sports and Preventive Medicine in Saarbrücken, Germany, established a worldwide Sudden Death Registry with a view to documenting fatal events on the football field-of-play. These activities by F-MARC are testimony to FIFA's continued commitment to minimising sudden cardiac arrest while playing football. PMID:25878076

  11. Abortion

    MedlinePlus

    An abortion is a procedure to end a pregnancy. It uses medicine or surgery to remove the embryo or ... personal. If you are thinking of having an abortion, most healthcare providers advise counseling.

  12. Abortion.

    PubMed

    1993-09-01

    Vacuum aspiration, dilatation and curettage, hysterotomy, and, in some cases, hysterectomy comprise surgical methods of abortion. Oral administration of RU-486, epostane, prostaglandins E and F2 and vaginal suppositories of prostaglandins E and F2 are medical abortion methods. The traditional or clandestine methods are usually performed by unqualified persons and pregnant women themselves. These methods tend to be inefficient and harmful. They include oral preparations of herbs and drugs (e.g., quinine and ergot), introduction of fluids (e.g., household disinfectants) into the vagina, introduction of foreign bodies (e.g., twigs, stems, hollow tubes, needles, wire) into the uterus. Hospital records, death certificates, and community-based surveys are common sources of data on abortion. Worldwide, 40-70/1000 women of childbearing age undergo an abortion. 20-33% of all pregnancies are terminated. Abortion is always legal when it is performed to save a pregnant woman's life. In most countries, it is legal to protect the woman's physical or mental health against serious danger. The risk of death from a legal abortion is rare. On the other hand, when an abortion is performed by an unqualified, unskilled abortionist and/or under unhygienic conditions (all of which are common in countries who have a law against abortion) the risk of death is much higher. In fact, abortion is one of the leading causes of maternal death in many countries (25% and 86% of maternal deaths in Bangladesh and Romania, respectively). Common complications of abortion are incomplete abortion, trauma to pelvic organs (e.g., uterine perforation), tetanus, and infertility. In some developing countries, the cost of treating abortion complications account for up to 50% of maternity hospital budgets. Ways to reduce mortality from unsafe abortion include promoting contraceptive use, legalizing abortion, allowing trained practitioners to perform abortions for health reasons, and improving clinical management

  13. [Treatment of ventricular tachyarrhythmias and prevention of sudden cardiac death: commentary on the 2016 ESC guideline].

    PubMed

    Eckardt, Lars; Köbe, Julia; Wasmer, Kristina

    2016-08-01

    The 2016 ESC guideline on prevention and therapy of ventricular tachyarrhythmias and sudden cardiac death present an excellent recommendation and summary for all forms of ventricular tachyarrhythmias in patients with and without structural or electrical heart disease. This includes cardiomyopathies as well as conditions such as proarrhythmia, neurologic/psychaitric disorders, or pregnancy. Some aspects are novel; (1) the guideline emphasizes for the first time genetic work-up in sudden cardiac death victims; (2) for prevention of sudden cardiac death systematic re-evaluation 6-12 weeks after myocardial infarction is recommended; (3) subcutaneous ICD as well as the wearable cardioverter/defibrillator are for the first time included in the guidelines; (4) automatic external defibrillators are recommended for public places; (5) for patients with recurrent ventricular tachyarrhythmias the role of catheter ablation has been upgraded. PMID:27509343

  14. Risk Stratification for Sudden Cardiac Death In Patients With Non-ischemic Dilated Cardiomyopathy

    PubMed Central

    Shekha, Karthik; Ghosh, Joydeep; Thekkoott, Deepak; Greenberg, Yisachar

    2005-01-01

    Non ischemic dilated cardiomyopathy (NIDCM) is a disorder of myocardium. It has varying etiologies. Albeit the varying etiologies of this heart muscle disorder, it presents with symptoms of heart failure, and rarely as sudden cardiac death (SCD). Manifestations of this disorder are in many ways similar to its counterpart, ischemic dilated cardiomyopathy (IDCM). A proportion of patients with NIDCM carries a grave prognosis and is prone to sudden cardiac death from sustained ventricular arrhythmias. Identification of this subgroup of patients who carry the risk of sudden cardiac death despite adequate medical management is a challenge .Yet another method is a blanket treatment of patients with this disorder with anti arrhythmic medications or anti tachyarrhythmia devices like implantable cardioverter defibrillators (ICD). However this modality of treatment could be a costly exercise even for affluent economies. In this review we try to analyze the existing data of risk stratification of NIDCM and its clinical implications in practice. PMID:16943952

  15. Sudden cardiac arrest as a presentation of Brugada syndrome unmasked by thyroid storm.

    PubMed

    Korte, Anna K M; Derde, Lennie; van Wijk, Jeroen; Tjan, David H

    2015-01-01

    An 18-year-old man suffered a sudden cardiac arrest with ventricular fibrillation and was successfully resuscitated. He had neither a medical nor family history of cardiac disease/sudden death, but was known to have Graves' disease, for which he was treated with radioactive iodine. Recently, block-and-replacement therapy had been discontinued to evaluate thyroid functioning. On admission, thyroid hormone levels were markedly elevated, suggesting thyroid storm due to residual Graves' disease. The patient was treated with propylthiouracil, hydrocortisone and Lugol solution. ECG showed repolarisation patterns suggestive of an underlying type 1 Brugada syndrome (BS). These findings were confirmed by an additional ajmaline test. An implantable cardioverter defibrillator was implanted to prevent future arrhythmias. The patient underwent total thyroidectomy 9 months later and recovered completely. To the best of our knowledge, this is the first reported case of a sudden cardiac arrest as a presentation of BS unmasked by thyroid storm. PMID:26718704

  16. Alternative research funding to improve clinical outcomes: model of prediction and prevention of sudden cardiac death.

    PubMed

    Myerburg, Robert J; Ullmann, Steven G

    2015-04-01

    Although identification and management of cardiovascular risk markers have provided important population risk insights and public health benefits, individual risk prediction remains challenging. Using sudden cardiac death risk as a base case, the complex epidemiology of sudden cardiac death risk and the substantial new funding required to study individual risk are explored. Complex epidemiology derives from the multiple subgroups having different denominators and risk profiles, while funding limitations emerge from saturation of conventional sources of research funding without foreseeable opportunities for increases. A resolution to this problem would have to emerge from new sources of funding targeted to individual risk prediction. In this analysis, we explore the possibility of a research funding strategy that would offer business incentives to the insurance industries, while providing support for unresolved research goals. The model is developed for the case of sudden cardiac death risk, but the concept is applicable to other areas of the medical enterprise. PMID:25669654

  17. Sudden cardiac death in epilepsy disappoints, but epileptologists keep faith.

    PubMed

    Scorza, Fulvio A; Cavalheiro, Esper A; Costa, Jaderson Costa da

    2016-07-01

    Sudden unexpected death in epilepsy (SUDEP) is the most common cause of death in people with intractable epilepsy. Probably, optimization of seizure control will prevent some of these deaths. Briefly, we integrated in this paper some data about the epidemiology, risk factors, etiology, and preventative measures in the management of SUDEP. PMID:27487377

  18. Facts about Sudden Cardiac Death in the Young

    MedlinePlus

    ... sports. Any young person who has experienced unexplained fainting should be tested. It is extremely important that ... arrhythmias (like LQTS) are frequently misdiagnosed as vasovagal syncope, asthma or epilepsy without any cardiac evaluation. Thus, ...

  19. [Abortion].

    PubMed

    Dourlen-rollier, A M

    1971-01-01

    The historical and current (1969) abortion laws in France as well as those in other Western countries are analyzed. France has had a series of punitive abortion codes since the Napoleonic Code of 1810 prescribing solitary confinement for the woman. The reforms of 1920 and 1923 made provocation of abortion or contraceptional propaganda a "crime" (felony), later a "delit" (misdemeanor), called for trial before magistr ate instead of jury, but resulted in only about 200 convictions a year. The decree of 1939 extended the misdemeanor to women who aborted even if they were not pregnant, and provided for professional licenses such as that of surgeon or pharmacist to be suspended. The law of 1942 made abortion a social crime and increased the maximum penalty to capital punishment, which was exercised in 2 cases. About 4000 per year were convicted from 1942-1944. Now the law still applies to all who intend to abort, whether or not pregnant or successful, but punishemnt is limited to 1-5 years imprisonment, and 72,000 francs fine, or suspension of medical practice for 5 years. About 500 have been convicted per year. Since 1955 legal abortion has been available (to about 130 women over 4 years) if it is the only means to save the woman's life. Although pregnancy tests are controlled, the population desregards the law by resorting to clandestine abortion. The wealthy travel to Switzerland (where 68% of legal abortions are done on French women) or to England. Numbers are estimated by the French government at 250,000-300,000 per year, or 1 for every 2 live births, but by hospital statistics at 400,000-1,000,000 per year. The rest of the review covers abortion laws in Scandinavian, Central European, and individual US states as of 1969. PMID:12333138

  20. Motivation to Pursue Genetic Testing in Individuals with a Personal or Family History of Cardiac Events or Sudden Cardiac Death

    PubMed Central

    Erskine, Kathleen E.; Hidayatallah, Nadia Z.; Walsh, Christine A.; McDonald, Thomas V.; Cohen, Lilian; Marion, Robert W.; Dolan, Siobhan M.

    2014-01-01

    Genetic testing is becoming increasingly available for cardiac channelopathies, such as long QT syndrome and Brugada syndrome, which can lead to sudden cardiac death. Test results can be used to shape an individual’s medical management and to identify at-risk family members. In our qualitative study, all participants had a personal or family history of a diagnosed cardiac arrhythmia syndrome or sudden cardiac death. Open-ended interviews were conducted individually and in focus groups. Interviews were audio recorded, transcribed verbatim, and analyzed using a qualitative grounded-theory approach. Of 50 participants, 37 described their motivations for pursuing genetic testing for long QT syndrome or another cardiac channelopathy. Participants’ motivations included: to find an explanation for a family member’s sudden death, to relieve uncertainty regarding a diagnosis, to guide future medical management, to allay concern about children or other family members, and to comply with recommendations of physicians or family members. Perceived reasons not to pursue genetic testing included denial, fear, and lack of information. The genetic counseling and informed consent process can be enhanced by understanding and addressing an individual’s internal and external motivations either for or against pursuing genetic testing. PMID:24664857

  1. Sudden chest pain and cardiac emergencies in the obstetric patient.

    PubMed

    Mabie, W C; Freire, C M

    1995-03-01

    The differential diagnosis and work-up of a patient with chest pain during pregnancy is presented in this article. This is followed by discussions of cardiac emergencies including hypertensive crisis, pulmonary edema, arrhythmias, cardiopulmonary resuscitation, myocardial infarction, and aortic dissection. PMID:7784039

  2. Rare Titin (TTN) Variants in Diseases Associated with Sudden Cardiac Death

    PubMed Central

    Campuzano, Oscar; Sanchez-Molero, Olallo; Mademont-Soler, Irene; Riuró, Helena; Allegue, Catarina; Coll, Monica; Pérez-Serra, Alexandra; Mates, Jesus; Picó, Ferran; Iglesias, Anna; Brugada, Ramon

    2015-01-01

    A leading cause of death in western countries is sudden cardiac death, and can be associated with genetic disease. Next-generation sequencing has allowed thorough analysis of genes associated with this entity, including, most recently, titin. We aimed to identify potentially pathogenic genetic variants in titin. A total of 1126 samples were analyzed using a custom sequencing panel including major genes related to sudden cardiac death. Our cohort was divided into three groups: 432 cases from patients with cardiomyopathies, 130 cases from patients with channelopathies, and 564 post-mortem samples from individuals showing anatomical healthy hearts and non-conclusive causes of death after comprehensive autopsy. None of the patients included had definite pathogenic variants in the genes analyzed by our custom cardio-panel. Retrospective analysis comparing the in-house database and available public databases also was performed. We identified 554 rare variants in titin, 282 of which were novel. Seven were previously reported as pathogenic. Of these 554 variants, 493 were missense variants, 233 of which were novel. Of all variants identified, 399 were unique and 155 were identified at least twice. No definite pathogenic variants were identified in any of genes analyzed. We identified rare, mostly novel, titin variants that seem to play a potentially pathogenic role in sudden cardiac death. Additional studies should be performed to clarify the role of these variants in sudden cardiac death. PMID:26516846

  3. Sudden Cardiac Death in Children and Adolescents: Can We Prevent It?

    ERIC Educational Resources Information Center

    Berger, Stuart

    2001-01-01

    Sudden cardiac death (SCD) can occur at any age in apparently healthy people. Early identification and intervention are essential. This article examines SCD in children and adolescents, explaining: who is at risk; the importance of training school personnel for SCD emergencies and having automated external defibrillators (AED) within the schools;…

  4. Aldosterone and cortisol affect the risk of sudden cardiac death in haemodialysis patients

    PubMed Central

    Drechsler, Christiane; Ritz, Eberhard; Tomaschitz, Andreas; Pilz, Stefan; Schönfeld, Stephan; Blouin, Katja; Bidlingmaier, Martin; Hammer, Fabian; Krane, Vera; März, Winfried; Allolio, Bruno; Fassnacht, Martin; Wanner, Christoph

    2013-01-01

    Background Sudden cardiac death is common and accounts largely for the excess mortality of patients on maintenance dialysis. It is unknown whether aldosterone and cortisol increase the incidence of sudden cardiac death in dialysis patients. Methods and results We analysed data from 1255 diabetic haemodialysis patients participating in the German Diabetes and Dialysis Study (4D Study). Categories of aldosterone and cortisol were determined at baseline and patients were followed for a median of 4 years. By Cox regression analyses, hazard ratios (HRs) were determined for the effect of aldosterone, cortisol, and their combination on sudden death and other adjudicated cardiovascular outcomes. The mean age of the patients was 66 ± 8 years (54% male). Median aldosterone was <15 pg/mL (detection limit) and cortisol 16.8 µg/dL. Patients with aldosterone levels >200 pg/mL had a significantly higher risk of sudden death (HR: 1.69; 95% CI: 1.06–2.69) compared with those with an aldosterone <15 pg/mL. The combined presence of high aldosterone (>200 pg/mL) and high cortisol (>21.1 µg/dL) levels increased the risk of sudden death in striking contrast to patients with low aldosterone (<15 pg/mL) and low cortisol (<13.2 µg/dL) levels (HR: 2.86, 95% CI: 1.32–6.21). Furthermore, all-cause mortality was significantly increased in the patients with high levels of both hormones (HR: 1.62, 95% CI: 1.01–2.62). Conclusions The joint presence of high aldosterone and high cortisol levels is strongly associated with sudden cardiac death as well as all-cause mortality in haemodialysed type 2 diabetic patients. Whether a blockade of the mineralocorticoid receptor decreases the risk of sudden death in these patients must be examined in future trials. PMID:23211232

  5. Primary Cardiac Fibroma and Cardiac Conduction System Alterations in a Case of Sudden Death of a 4-month-old Infant

    PubMed Central

    Mecchia, Donatella; Lavezzi, Anna Maria; Matturri, Luigi

    2013-01-01

    A 4-month-old female infant considered to be in good health died suddenly and unexpectedly. Post- mortem examination was requested, with clinical diagnosis of sudden infant death syndrome. At autopsy the infant was described in good health. Histo- logical examination of the heart found a cardiac fibroma compressing the atrio-ventricular node and the examination of the cardiac conduction system showed an accessory fiber of Mahaim (nodo-ventricular) and cartilaginous metaplasia of the cardiac fibrous body. Probably the concomitant presence of cardiac conduction system abnormalities and a septal fibroma, compressing the atrio-ventricular node, could have an important role in causing the sudden death. PMID:23847693

  6. Brain-heart interactions. The neurocardiology of arrhythmia and sudden cardiac death.

    PubMed Central

    Davis, A M; Natelson, B H

    1993-01-01

    Neuroanatomic connections between the brain and the heart provide links that allow cardiac arrhythmias to occur in response to brain activation. Recognition and analysis of such links in the pathogenesis of malignant cardiac arrhythmia are emphasized in this review. Neurocardiac links have been shown to produce arrhythmia both experimentally and clinically; specific examples, including stroke, epilepsy, and environmental stress are presented. We hypothesize that the individual with a diseased heart has a greater likelihood of experiencing cardiac arrhythmia and sudden cardiac death when the neurocardiac axis is activated. Reviewing possible mechanisms of brain-related arrhythmias, we suggest that the nervous system directs the events leading to cardiac damage by raising catecholamine levels and potentially inducing arrhythmia. PMID:8219819

  7. Arrhythmias, Sudden Cardiac Death and incapacitation of pilots

    PubMed Central

    Mantziari, L; Styliadis, C; Kourtidou-Papadeli, C; Styliadis, I

    2008-01-01

    Inflight medical emergencies occur at a rate of 20 to 100 per million passengers, with a death rate of 0.1 to 1 per million. Cardiac, neurologic, and respiratory complaints comprise the more serious emergencies, as defined by aircraft diversion or use of ground-based medical assistance. In this paper, we review changes seen in the resting electrocardiogram in normal individuals exposed to high altitude, alongside important implications for patients with heart diseases in high altitude exposures and the possible effects of high altitude to permanent cardiac pacemakers. Arrhythmias in pilots and public safety are revisited together with the guidelines of the Joint Aviation Requirements (JAR) in Europe. The situation of Military flights is also discussed. Physicians ought to become knowledgeable about the specific medical job standards for their patients when asked to render opinions regarding fitness to fly. A database must be established to obtain prospective data that defines the risk of accidents in patients who are or were being treated for arrhythmias. Current guidelines could then be updated and revised as appropriate. PMID:19050752

  8. Sudden death of an infant with cardiac, nervous system and genetic involvement – a case report

    PubMed Central

    2013-01-01

    Abstract We present a case of sudden death of a 1-month-old male infant with heart, brainstem and genetic polymorphism involvement. Previously considered quite healthy, the child died suddenly and unexpectedly during sleep. The autopsy protocol included an in-depth anatomopathological examination of both the autonomic nervous system and the cardiac conduction system, and molecular analysis of the serotonin transporter gene promoter region, in which a specific genetic condition seems to be associated with sudden infant death. Histological examination revealed the presence of congenital cardiac alterations (hypertrophic cardiomyopathy and an accessory Mahaim fiber in the cardiac conduction system), severe hypodevelopment of all the raphe nuclei and a heterozygous genotype L/S related to the serotonin transporter gene. The sudden death of this infant was the unavoidable outcome of a complex series of congenital anomalies, each predisposing to SIDS. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3480540091031788 PMID:24053176

  9. Sudden cardiac death in the young: the molecular autopsy and a practical approach to surviving relatives.

    PubMed

    Semsarian, Christopher; Ingles, Jodie; Wilde, Arthur A M

    2015-06-01

    The sudden death of a young, apparently fit and healthy person is amongst the most challenging scenarios in clinical medicine. Sudden cardiac death (SCD) is a devastating and tragic outcome of a number of underlying cardiovascular diseases. While coronary artery disease and acute myocardial infarction are the most common causes of SCD in older populations, genetic (inherited) cardiac disorders comprise a substantial proportion of SCD cases aged 40 years and less. This includes the primary arrhythmogenic disorders such as long QT syndromes and inherited cardiomyopathies, namely hypertrophic cardiomyopathy. In up to 30% of young SCD, no cause of death is identified at postmortem, so-called autopsy-negative or sudden arrhythmic death syndrome (SADS). Management of families following SCD begins with a concerted effort to identify the cause of death in the decedent, based on either premorbid clinical details or the pathological findings at postmortem. Where no cause of death is identified, genetic testing of deoxyribonucleic acid extracted from postmortem blood (the molecular autopsy) may identify a cause of death in up to 30% of SADS cases. Irrespective of the genetic testing considerations, all families in which a sudden unexplained death has occurred require targeted and standardized clinical testing in an attempt to identify relatives who may be at-risk of having the same inherited heart disease and therefore also predisposed to an increased risk of SCD. Optimal care of SCD families therefore requires dedicated and appropriately trained staff in the setting of a specialized multidisciplinary cardiac genetic clinic. PMID:25765769

  10. Does cardiac conduction pathology contribute to sudden unexpected death in epilepsy?

    PubMed

    Opeskin, K; Thomas, A; Berkovic, S F

    2000-06-01

    Heart weights have been reported to be increased in those dying suddenly and unexpectedly from epilepsy (SUDEP) and it has been suggested that cardiac pathology including cardiac conduction pathology and coronary artery atheroma may contribute to SUDEP. The purpose of this study was to perform a detailed controlled study of the microscopic pathology of the cardiac conduction system in SUDEP cases, in addition to assessing coronary artery atheroma and other cardiac pathology. The hearts of ten SUDEPs and ten control subjects (no history of epilepsy and a cause of death not primarily cardiac) were examined macroscopically and microscopically by two pathologists blinded to the patient group. Morphological abnormalities of the cardiac conduction system that could have possibly contributed to death were not increased in the SUDEP group (four cases showed such changes in the SUDEP group vs. six in the control). There was no significant difference between the maximal percentage coronary artery stenoses between the two groups and no increased prevalence of other cardiac pathology in the SUDEP group. However, since subtle abnormalities of the conduction system were identified in some of the epileptic deaths, it is still feasible that these may contribute to death by causing cardiac arrhythmia, when associated with apnoea, bradycardia or other cardiac arrhythmia related to an epileptic seizure. PMID:10771254

  11. Ion Channel Macromolecular Complexes in Cardiomyocytes: Roles in Sudden Cardiac Death

    PubMed Central

    Abriel, Hugues; Rougier, Jean-Sébastien; Jalife, José

    2015-01-01

    The movement of ions across specific channels embedded on the membrane of individual cardiomyocytes is crucial for the generation and propagation of the cardiac electrical impulse. Emerging evidence over the last 20 years strongly suggests that the normal electrical function of the heart is the result of dynamic interactions of membrane ion channels working in an orchestrated fashion as part of complex molecular networks. Such networks work together with exquisite temporal precision to generate each action potential and contraction. Macromolecular complexes play crucial roles in transcription, translation, oligomerization, trafficking, membrane retention, glycosylation, posttranslational modification, turnover, function and degradation of all cardiac ion channels known to date. In addition, the accurate timing of each cardiac beat and contraction demands, a comparable precision on the assembly and organizations of sodium, calcium and potassium channel complexes within specific subcellular microdomains, where physical proximity allows for prompt and efficient interaction. This review article, part of the Compendium on Sudden Cardiac Death, discusses the major issues related to the role of ion channel macromolecular assemblies in normal cardiac electrical function and the mechanisms of arrhythmias leading to sudden cardiac death. It provides an idea of how these issues are being addressed in the laboratory and in the clinic, which important questions remain unanswered, and what future research will be needed to improve knowledge and advance therapy. PMID:26044251

  12. Abortion.

    PubMed

    Blumenthal, P D

    1991-08-01

    In 1990 abortion literature was characterized by articles relating to 1) the safety of surgical abortion procedures, 2) advances in knowledge and experience with medical abortifacients such as mifepristone (RU 486), and 3) reviews of psychologic and ethical considerations. Although technical methods differ greatly between countries and continents, there is increasing similarity between termination protocols in the United States, the United Kingdom, and Europe. The advent of mifepristone will make this even more so. Surgically, although dilatation and evacuation procedures are far more common in the United States than in other countries, the literature reflects a fine-tuning of analysis and technique, with safety the major consideration. Knowledge about the effectiveness of mifepristone continues to grow, and the effective dose for early first-trimester termination appears established. There is increasing evidence that at least in the short term, the negative psychologic sequelae of abortion are infrequent and are inconsequential as a public health issue. PMID:1878507

  13. Mechanisms of cardiac arrhythmias and sudden death in transgenic rabbits with long QT syndrome

    PubMed Central

    Brunner, Michael; Peng, Xuwen; Liu, Gong Xin; Ren, Xiao-Qin; Ziv, Ohad; Choi, Bum-Rak; Mathur, Rajesh; Hajjiri, Mohammed; Odening, Katja E.; Steinberg, Eric; Folco, Eduardo J.; Pringa, Ekatherini; Centracchio, Jason; Macharzina, Roland R.; Donahay, Tammy; Schofield, Lorraine; Rana, Naveed; Kirk, Malcolm; Mitchell, Gary F.; Poppas, Athena; Zehender, Manfred; Koren, Gideon

    2008-01-01

    Long QT syndrome (LQTS) is a heritable disease associated with ECG QT interval prolongation, ventricular tachycardia, and sudden cardiac death in young patients. Among genotyped individuals, mutations in genes encoding repolarizing K+ channels (LQT1:KCNQ1; LQT2:KCNH2) are present in approximately 90% of affected individuals. Expression of pore mutants of the human genes KCNQ1 (KvLQT1-Y315S) and KCNH2 (HERG-G628S) in the rabbit heart produced transgenic rabbits with a long QT phenotype. Prolongations of QT intervals and action potential durations were due to the elimination of IKs and IKr currents in cardiomyocytes. LQT2 rabbits showed a high incidence of spontaneous sudden cardiac death (>50% at 1 year) due to polymorphic ventricular tachycardia. Optical mapping revealed increased spatial dispersion of repolarization underlying the arrhythmias. Both transgenes caused downregulation of the remaining complementary IKr and IKs without affecting the steady state levels of the native polypeptides. Thus, the elimination of 1 repolarizing current was associated with downregulation of the reciprocal repolarizing current rather than with the compensatory upregulation observed previously in LQTS mouse models. This suggests that mutant KvLQT1 and HERG interacted with the reciprocal wild-type α subunits of rabbit ERG and KvLQT1, respectively. These results have implications for understanding the nature and heterogeneity of cardiac arrhythmias and sudden cardiac death. PMID:18464931

  14. Next generation sequencing for molecular confirmation of hereditary sudden cardiac death syndromes.

    PubMed

    Márquez, Manlio F; Cruz-Robles, David; Ines-Real, Selene; Vargas-Alarcón, Gilberto; Cárdenas, Manuel

    2015-01-01

    Hereditary sudden cardiac death syndromes comprise a wide range of diseases resulting from alteration in cardiac ion channels. Genes involved in these syndromes represent diverse mutations that cause the altered encoding of the diverse proteins constituting these channels, thus affecting directly the currents of the corresponding ions. In the present article we will briefly review how to arrive to a clinical diagnosis and we will present the results of molecular genetic studies made in Mexican subjects attending the SCD Syndromes Clinic of the National Institute of Cardiology of Mexico City. PMID:25661095

  15. Identifying sudden cardiac death risk and specifying its occurrence time by analyzing electrocardiograms in natural time

    NASA Astrophysics Data System (ADS)

    Varotsos, P. A.; Sarlis, N. V.; Skordas, E. S.; Lazaridou, M. S.

    2007-08-01

    Sudden cardiac death (SCD) is a frequent cause of death and may occur even if the electrocardiogram seems to be similar to that of a healthy individual. A method which not only identifies the risk but also provides an estimate of the time of an impending cardiac arrest is proposed. Analyzing 159 electrocardiograms in natural time, the authors find that the key quantity is the entropy change under time reversal. After it becomes maximum at the scale of 13 heartbeats, ventricular fibrillation starts within ˜3h in 16 out of 18 SCDs. The method also distinguishes congestive heart failure patients from SCD.

  16. Successful extracorporeal life support in sudden cardiac arrest due to coronary anomaly

    PubMed Central

    Park, Jung Wan; Lee, Jae Hyuk; Kim, Ki-Sik; Bang, Duk Won; Hyon, Min-Su; Lee, Min-Ho; Park, Byoung-Won

    2016-01-01

    Extracorporeal life support (ECLS) has recently been reported to have a survival benefit in patients with cardiac arrest. It is now used widely as a lifesaving modality. Here, we describe a case of sudden cardiac arrest (SCA) in a young athlete with an anomalous origin of the right coronary artery from the left coronary sinus. Resuscitation was successful using ECLS before curative bypass surgery. We highlight the efficacy of ECLS for a patient with SCA caused by a rare, unexpected aetiology. In conclusion, ECLS was a lifesaving modality for SCA due to an anomalous coronary artery in this young patient. PMID:27354896

  17. Next-Generation Sequencing in Post-mortem Genetic Testing of Young Sudden Cardiac Death Cases

    PubMed Central

    Lahrouchi, Najim; Behr, Elijah R.; Bezzina, Connie R.

    2016-01-01

    Sudden cardiac death (SCD) in the young (<40 years) occurs in the setting of a variety of rare inherited cardiac disorders and is a disastrous event for family members. Establishing the cause of SCD is important as it permits the pre-symptomatic identification of relatives at risk of SCD. Sudden arrhythmic death syndrome (SADS) is defined as SCD in the setting of negative autopsy findings and toxicological analysis. In such cases, reaching a diagnosis is even more challenging and post-mortem genetic testing can crucially contribute to the identification of the underlying cause of death. In this review, we will discuss the current achievements of “the molecular autopsy” in young SADS cases and provide an overview of key challenges in assessing pathogenicity (i.e., causality) of genetic variants identified through next-generation sequencing. PMID:27303672

  18. Predicting sudden cardiac death from T wave alternans of the surface electrocardiogram: promise and pitfalls

    NASA Technical Reports Server (NTRS)

    Rosenbaum, D. S.; Albrecht, P.; Cohen, R. J.

    1996-01-01

    Sudden cardiac death remains a preeminent public health problem. Despite advances in preventative treatment for patients known to be at risk, to date we have been able to identify, and thus treat, only a small minority of these patients. Therefore, there is a major need to develop noninvasive diagnostic technologies to identify patients at risk. Recent studies have demonstrated that measurement of microvolt-level T wave alternans is a promising technique for the accurate identification of patients at risk for ventricular arrhythmias and sudden cardiac death. In this article, we review the clinical data establishing the relationship between microvolt T wave alternans and susceptibility to ventricular arrhythmias. We also review the methods and technology that have been developed to measure microvolt levels of T wave alternans noninvasively in broad populations of ambulatory patients. In particular, we examine techniques that permit the accurate measurement of T wave alternans during exercise stress testing.

  19. [Assessment of risk of sudden cardiac death in patients with hypertrophic cardiomyopathy].

    PubMed

    Attanasio, Philipp; Blaschke, Florian; Pieske, Burkert; Tschöpe, Carsten; Haverkamp, Wilhelm

    2016-07-01

    Hypertrophic cardiomyopathy (HCM) is a hereditary disease characterized by left ventricular hypertrophy with or without concomitant outflow tract obstruction. Identification of patients with HCM who are at high risk of sudden cardiac death (SCD) is crucial as those patients are likely to benefit from an implantable cardioverter defibrillator (ICD). Based on the HCM Risk-SCD study published in 2013, that included 3675 HCM patients with 24 313 years of follow up, a new clinical risk prediction model for sudden cardiac death was developed. This model was included in the recently released 2014 ESC guidelines. This review summarizes the changes in the prediction model and the resulting recommendations and discusses potential risks and limitations of the new score. PMID:27404936

  20. Sudden cardiac arrest following ventricular fibrillation attributed to anabolic steroid use in an adolescent.

    PubMed

    Lichtenfeld, Jana; Deal, Barbara J; Crawford, Susan

    2016-06-01

    Anabolic androgenic steroids are synthetic derivatives of testosterone that promote the growth of skeletal muscles and have many recognised cardiovascular effects. We report the clinical presentation and pathological findings of an adolescent male whose sudden cardiac arrest following ventricular fibrillation was attributed to anabolic androgenic steroid use. The age of our patient reflects the usage of anabolic androgenic steroids among younger athletes and highlights the need for increased awareness among practitioners. PMID:26980272

  1. [Massive cardiac lipomatosis, an autopsy finding in a patient with sudden death].

    PubMed

    Zamarrón-de Lucas, Ester; García-Fernández, Eugenia; Carpio, Carlos; Alcolea, Sergio; Martínez-Abad, Yolanda; Álvarez-Sala, Rodolfo

    2016-06-17

    The fat replacement of myocardial cells is a degenerative process that usually affects the right ventricle and is found in 50% of the elderly. The problem arises when this degeneration occurs to a massive degree, a differential diagnosis with other pathologies being necessary. We present the case of a patient who died suddenly and a massive cardiac lipomatosis was found on autopsy, as the only explanation of the outcome. PMID:27143526

  2. Risk of sudden cardiac death in young athletes: which screening strategies are appropriate?

    PubMed

    Bader, Rima S; Goldberg, Linn; Sahn, David J

    2004-10-01

    Resources are not available to comprehensively evaluate all young athletes before participation in competitive sports. Therefore, the cardiovascular evaluation of young athletes needs to be targeted at high-risk areas and focus on the individuals who are at greatest possible risk: those who have suggestive, even if minor, symptoms, and those who have a family history of sudden death or premature cardiac disease. PMID:15331292

  3. Polymorphic Ventricular Tachycardia/Ventricular Fibrillation and Sudden Cardiac Death in the Normal Heart.

    PubMed

    Shah, Ashok J; Hocini, Meleze; Denis, Arnaud; Derval, Nicolas; Sacher, Frederic; Jais, Pierre; Haissaguerre, Michel

    2016-09-01

    Primary electrical diseases manifest with polymorphic ventricular tachycardia (PMVT) and ventricular fibrillation (VF) and along with idiopathic VF contribute to about 10% of sudden cardiac deaths (SCDs) overall. These disorders include long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, short QT syndrome, and early repolarization syndrome. This article reviews the clinical electrophysiological management of PMVT/VF in a structurally normal heart affected with these disorders. PMID:27521091

  4. Cardiac Magnetic Resonance Scar Imaging for Sudden Cardiac Death Risk Stratification in Patients with Non-Ischemic Cardiomyopathy

    PubMed Central

    Kim, Eun Kyoung; Chattranukulchai, Pairoj

    2015-01-01

    In patients with non-ischemic cardiomyopathy (NICM), risk stratification for sudden cardiac death (SCD) and selection of patients who would benefit from prophylactic implantable cardioverter-defibrillators remains challenging. We aim to discuss the evidence of cardiac magnetic resonance (CMR)-derived myocardial scar for the prediction of adverse cardiovascular outcomes in NICM. From the 15 studies analyzed, with a total of 2747 patients, the average prevalence of myocardial scar was 41%. In patients with myocardial scar, the risk for adverse cardiac events was more than 3-fold higher, and risk for arrhythmic events 5-fold higher, as compared to patients without scar. Based on the available observational, single center studies, CMR scar assessment may be a promising new tool for SCD risk stratification, which merits further investigation. PMID:26175568

  5. Factors Affecting the Occurrence of Out-of-Hospital Sudden Cardiac Arrest

    PubMed Central

    Uchmanowicz, Izabella; Bartkiewicz, Wiesław; Sowizdraniuk, Jarosław; Rosińczuk, Joanna

    2015-01-01

    Objective. This paper aims to discover the risk factors for sudden cardiac arrest (out-of-hospital sudden cardiac arrest (OHSCA)) which significantly affect the decision about prioritizing emergency interventions before dispatching medical emergency teams, risk of deterioration of the patient's condition at the scene, and emergency procedures. Methods. A retrospective study taking into account the international classification of diseases ICD-10 based on an analysis of medical records of Emergency Medical Service in Wroclaw (Poland). Results. The main risk factor of OHSCA is coexistence of external cause leading to illness or death (ICD Group V-10) as well as the occurrence of diseases from the group of endocrine disorders (group E), in particular diabetes. The increase in the risk of OHSCA incidence is affected by nervous system diseases (group G), especially epilepsy of various etiologies, respiratory diseases (group J), mainly COPD, and bronchial asthma or mental and behavioral disorders (group F), with particular emphasis on the drugs issue. The procedure for receiving calls for Emergency Notification Centre does not take into account clinical risk factors for sudden cardiac arrest (SCA). Conclusion. Having knowledge of OHSCA risk factors can increase the efficiency of rescue operations from rapid assessment and provision of appropriate medical team, through effective performance of medical emergency treatment and prevention of SCA or finally reducing the costs. PMID:25705520

  6. Chronic kidney disease and risk factors responsible for sudden cardiac death: a whiff of hope?

    PubMed Central

    Kiuchi, Márcio G.; Mion, Decio

    2015-01-01

    Several studies have shown a strong independent association between chronic kidney disease (CKD) and cardiovascular events, including death, heart failure, and myocardial infarction. Recent clinical trials extend this range of adverse cardiovascular events, also including ventricular arrhythmias and sudden cardiac death. Furthermore, other studies suggest structural remodeling of the heart and electrophysiological alterations in this population. These processes may explain the increased risk of arrhythmia in kidney disease and help to identify patients who are at increased risk of sudden cardiac death. Sympathetic hyperactivity is well known to increase cardiovascular risk in CKD patients and is a hallmark of essential hypertensive state that occurs early in the clinical course of the disease. In CKD, the sympathetic hyperactivity seems to be expressed at the earliest clinical stage of the disease, showing a direct relationship with the severity of the condition of renal failure, being more pronounced in the terminal stage of CKD. The sympathetic efferent and afferent neural activity in kidney failure is a key mediator for the maintenance and progression of the disease. The aim of this review was to show that the feedback loop of this cycle, due to adrenergic hyperactivity, also aggravates many of the risk factors responsible for causing sudden cardiac death and may be a potential target modifiable by percutaneous renal sympathetic denervation. If it is feasible and effective in end-stage renal disease, little is known. PMID:27069851

  7. Chemoreflexsensitivity in patients with survived sudden cardiac arrest and prior myocardial infarction.

    PubMed

    Hennersdorf, M G; Perings, C; Niebch, V; Hillebrand, S; Vester, E G; Strauer, B E

    2000-04-01

    For evaluation of patients with an increased risk of sudden cardiac death, the analyses of ventricular late potentials, heart rate variability, and baroreflexsensitivity are helpful. But so far, the prediction of a malignant arrhythmic event is not possible with sufficient accuracy. For a better risk stratification other methods are necessary. In this study the importance of the ChRS for the identification of patients at risk for ventricular tachyarrhythmic events should be investigated. Of 41 patients included in the study, 26 were survivors of sudden cardiac arrest. Fifteen patients were not resuscitated, of whom 6 patients had documented monomorphic ventricular tachycardia and 9 had no ventricular tachyarrhythmias in their prior history. All patients had a history of an old myocardial infarction (> 1 year ago). For determination of the ChRS the ratio between the difference of the RR intervals in the ECG and the venous pO2 before and after a 5-minute oxygen inhalation via a nose mask was measured (ms/mmHg). The 26 patients with survived sudden cardiac death showed a significantly decreased ChRS compared to those patients without a tachyarrhythmic event (1.74 +/- 1.02 vs 6.97 +/- 7.14 ms/mmHg, P < 0.0001). The sensitivity concerning a survived sudden cardiac death amounted to 88% for a ChRS below 3.0 ms/mmHg. During a 12-month follow-up period, the ChRS was significantly different between patients with and without an arrhythmic event (1.64 +/- 1.06 vs 4.82 +/- 5.83 ms/mmHg, P < 0.01). As a further method for evaluation of patients with increased risk of sudden cardiac death after myocardial infarction the analysis of ChRS seems to be suitable and predicts arrhythmias possibly more sensitive than other tests of neurovegetative imbalance. The predictive importance has to be examined by prospective investigations in larger patient populations. PMID:10793434

  8. Sudden cardiac death and chronic kidney disease: From pathophysiology to treatment strategies.

    PubMed

    Di Lullo, L; Rivera, R; Barbera, V; Bellasi, A; Cozzolino, M; Russo, D; De Pascalis, A; Banerjee, D; Floccari, F; Ronco, C

    2016-08-15

    Chronic kidney disease (CKD) patients demonstrate higher rates of cardiovascular mortality and morbidity; and increased incidence of sudden cardiac death (SCD) with declining kidney failure. Coronary artery disease (CAD) associated risk factors are the major determinants of SCD in the general population. However, current evidence suggests that in CKD patients, traditional cardiovascular risk factors may play a lesser role. Complex relationships between CKD-specific risk factors, structural heart disease, and ventricular arrhythmias (VA) contribute to the high risk of SCD. In dialysis patients, the occurrence of VA and SCD could be exacerbated by electrolyte shifts, divalent ion abnormalities, sympathetic overactivity, inflammation and iron toxicity. As outcomes in CKD patients after cardiac arrest are poor, primary and secondary prevention of SCD and cardiac arrest could reduce cardiovascular mortality in patients with CKD. PMID:27174593

  9. Prevention of sudden cardiac death in dialysis patients: drugs, defibrillators or what else.

    PubMed

    Passman, Rod

    2013-01-01

    Death from cardiovascular disease in general and sudden cardiac arrest (SCA) in particular are exponentially proportional to declining renal function and are a major cause of mortality among those with chronic kidney disease (CKD). The greatest risk, however, is reserved for those patients on chronic dialysis. These individuals have an extraordinarily high rate of death, with cardiac disease accounting for 45% and SCA responsible for 25% of all-cause mortality. Once cardiac arrest occurs, survival is extremely poor. Thus, reducing mortality from cardiovascular disease and SCA in dialysis patients is a global health challenge. The main objectives of this review are to elucidate the nature of SCA in the dialysis population, describe possible mechanisms and risk factors, and discuss options for prevention. PMID:23343546

  10. The school nurse role in preparing for sudden cardiac arrest in the school setting.

    PubMed

    Evans, Warna K; Ficca, Michelle

    2012-12-01

    Automated external defibrillators (AEDs) were introduced for first responders in 1992 to manage adult cardiac arrest and are now common in many public places. Today AEDs are capable of shocking children under 8 years of age, or less than 55 pounds. This presents a challenge for school nurses, particularly as the prevalence of chronic medical conditions of school children continues to increase. Preparing for a cardiac emergency for a person of any age is stressful and requires a coordinated approach to best manage sudden cardiac arrest (SCA). The school nurse's responsibility is to assess the school setting and the need for an AED, and when indicated, determine the best AED guidelines in schools that accommodate people of all ages. PMID:22733830

  11. Exercise-related sudden cardiac arrest in London: incidence, survival and bystander response

    PubMed Central

    Edwards, Melanie J; Fothergill, Rachael T

    2015-01-01

    Objective The study aimed to (1) establish the incidence of exercise-related sudden cardiac arrest (SCA) in London, (2) investigate survival from exercise-related SCA and (3) examine factors related to survival. Method This retrospective observational study examined 2 years’ data from the London Ambulance Service (LAS) cardiac arrest registry for patients in whom resuscitation was attempted following an out-of-hospital cardiac arrest (OHCA), a cardiac cause was presumed and the arrest occurred during or within 1 h of exercise. Results The incidence of exercise-related SCA in London was estimated to be 0.6 per 100 000 person-years which equated to 0.5% of all OHCA, and 1.5% of all OHCA with presumed cardiac aetiology and resuscitation attempted. The majority of cases were male and the incidence increased from age 40 years. Just under one-third of patients survived to hospital discharge. Survival in the Utstein comparator group (cases with presumed cardiac aetiology, resuscitation attempted, bystander witnessed and a presenting cardiac rhythm of ventricular fibrillation or tachycardia) was higher at 42%. Survival was significantly associated with initial cardiac rhythm (χ2=17.5, df=2, p<0.001) and bystander defibrillation (Fisher's exact test, p<0.05). Conclusions Incidence of exercise-related SCA in the general population in London is rare. Survival following exercise-related SCA was considerably higher than survival for all OHCA with presumed cardiac aetiology and resuscitation attempted attended by the LAS during the same period. The major limitation of the study is the likely under identification of cases of exercise-related SCA. PMID:26468401

  12. Surviving Sudden Cardiac Arrest: A Pilot Qualitative Survey Study of Survivors.

    PubMed

    Sawyer, Kelly N; Brown, Frances; Christensen, Roxanne; Damino, Colleen; Newman, Mary M; Kurz, Michael C

    2016-06-01

    Research describing survivors of sudden cardiac arrest (SCA) has centered on quantifying functional ability, perceived quality of life, and neurocognitive assessment. Many gaps remain, however, regarding survivors' psychosocial perceptions of life in the aftermath of cardiac arrest. An important influence upon those perceptions is the presence of support and its role in a survivor's life. An Internet-based pilot survey study was conducted to gather data from SCA survivors and friends and/or family members (FFMs) representing their support system. The survey was distributed to members of the Sudden Cardiac Arrest Foundation (SCAF) via the Internet by SCAF leadership. Questions included both discrete multiple-choice and open-ended formats. Inductive thematic analyses were completed by three independent researchers trained in qualitative research methodology to identify primary themes consistent among study participants until thematic saturation was achieved. No statistical inferences were made. A total of 205 surveys were returned over the 5-month study period (July to November 2013); nine were received blank, leaving 196 surveys available for review. Major themes identified for survivors (N = 157) include the significance of and desire to share experiences with others; subculture identification (unique experience from those suffering a heart attack); and the need to seek a new normal, both personally and inter-personally. Major themes identified for FFMs (N = 39) include recognition of loved one's memory loss; a lack of information at discharge, including expectations after discharge; and concern for the patient experiencing another cardiac arrest. This pilot, qualitative survey study suggests several common themes important to survivors, and FFMs, of cardiac arrest. These themes may serve as a basis for future patient-centered focus groups and the development of patient-centered guidelines for patients and support persons of those surviving cardiac arrest

  13. Abortion.

    PubMed

    Savage, A

    1979-09-15

    I refer for termination anyone who requests it for--pace Mr V Tunkel, (28 July, p 253)--the law is generally regarded as being one of "abortion on demand." I have some misgivings as I do not believe that women in early pregnancy are always in a fit state to make a considered decision, and they cannot in the nature of things be given time. I have, however, become increasingly worried about the morbidity arising from the procedure, and it is interesting that letters on the subject (25 August, pp 495 and 496) should be followed by one reporting rupture of the uterus during prostaglandin-induced abortion--yet another complication to add to those of cervical incompetence, pelvic sepsis, and permanent neurological damage. In so far as these tragedies usually follow late terminations Mr John Corrie's Bill is to be welcomed. A few further points. I am not so cynical as to think that every impregnation is the result of a thoughtless act of male lust. Unlike Professor Peter Huntingford (25 August, p 496), I listen to men as well as women, and many of them are deeply involved emotionally in the pregnancy they have helped to produce. Certainly I think a man should have the right to be consulted if his wife is to undergo a procedure that might damage her health. It is unfair contemptuously to dismiss as "whims" opinions that differ from ones own. These may result from genuine conscientious doubts or inability to cope from overwork and understaffing. Abortion is quite the most expensive form of contraception, and perhaps in these days of financial stringency this should be taken into account. "Bigotry" is defined in my dictionary as "blind zeal." This could be said of those who enthusiastically promote a course of action without regard to circumstances, safety, or cost. PMID:497770

  14. Application of Next Generation Sequencing for personalized medicine for sudden cardiac death

    PubMed Central

    Morini, Elena; Sangiuolo, Federica; Caporossi, Daniela; Novelli, Giuseppe; Amati, Francesca

    2015-01-01

    Sudden cardiac death (SCD) is a serious public health problem. In the United States, more than 300,000 people are affected by SCD every year. Significantly, sudden deaths represent 20% of the total mortality and 50% of cardiovascular mortality in Western countries. In addition, SCD constitutes one of the most important unsolved challenges in the practice of forensic pathology because of the failure to determine the exact cause of sudden death. In young individuals, SCD is frequently caused by cardiomyopathies and channelopathies, that have generally an autosomal dominant pattern of inheritance. The impact of genetics and genetic testing on the clinical management of these diseases is unquestioned. In particular, genetic tests are an important tool for identifying pre-symptomatic individuals carrying genetic variant that predisposes them to SCD. High-throughput sequencing technologies offer novel opportunities to deeper investigate the genetic background underlying these fatal diseases and to early identify individuals at risk for SCD. In this review, we provide an overview of the development of Next-Generation Sequencing (NGS) technologies and of guidelines useful to design an efficient sequencing protocol and to perform an accurate data analysis. We suggest a flow chart to follow for the set up of a genetic screening protocol for the prevention of cardiac pathologies, in particular SCD events, in young athletes. PMID:25784923

  15. Leaky RyR2 channels unleash a brainstem spreading depolarization mechanism of sudden cardiac death.

    PubMed

    Aiba, Isamu; Wehrens, Xander H T; Noebels, Jeffrey L

    2016-08-16

    Cardiorespiratory failure is the most common cause of sudden unexplained death in epilepsy (SUDEP). Genetic autopsies have detected "leaky" gain-of-function mutations in the ryanodine receptor-2 (RyR2) gene in both SUDEP and sudden cardiac death cases linked to catecholaminergic polymorphic ventricular tachycardia that feature lethal cardiac arrhythmias without structural abnormality. Here we find that a human leaky RyR2 mutation, R176Q (RQ), alters neurotransmitter release probability in mice and significantly lowers the threshold for spreading depolarization (SD) in dorsal medulla, leading to cardiorespiratory collapse. Rare episodes of sinus bradycardia, spontaneous seizure, and sudden death were detected in RQ/+ mutant mice in vivo; however, when provoked, cortical seizures frequently led to apneas, brainstem SD, cardiorespiratory failure, and death. In vitro studies revealed that the RQ mutation selectively strengthened excitatory, but not inhibitory, synapses and facilitated SD in both the neocortex as well as brainstem dorsal medulla autonomic microcircuits. These data link defects in neuronal intracellular calcium homeostasis to the vulnerability of central autonomic brainstem pathways to hypoxic stress and implicate brainstem SD as a previously unrecognized site and mechanism contributing to premature death in individuals with leaky RYR2 mutations. PMID:27482086

  16. Biallelic PPA2 Mutations Cause Sudden Unexpected Cardiac Arrest in Infancy.

    PubMed

    Guimier, Anne; Gordon, Christopher T; Godard, François; Ravenscroft, Gianina; Oufadem, Myriam; Vasnier, Christelle; Rambaud, Caroline; Nitschke, Patrick; Bole-Feysot, Christine; Masson, Cécile; Dauger, Stéphane; Longman, Cheryl; Laing, Nigel G; Kugener, Béatrice; Bonnet, Damien; Bouvagnet, Patrice; Di Filippo, Sylvie; Probst, Vincent; Redon, Richard; Charron, Philippe; Rötig, Agnès; Lyonnet, Stanislas; Dautant, Alain; de Pontual, Loïc; di Rago, Jean-Paul; Delahodde, Agnès; Amiel, Jeanne

    2016-09-01

    Sudden unexpected death in infancy occurs in apparently healthy infants and remains largely unexplained despite thorough investigation. The vast majority of cases are sporadic. Here we report seven individuals from three families affected by sudden and unexpected cardiac arrest between 4 and 20 months of age. Whole-exome sequencing revealed compound heterozygous missense mutations in PPA2 in affected infants of each family. PPA2 encodes the mitochondrial pyrophosphatase, which hydrolyzes inorganic pyrophosphate into two phosphates. This is an essential activity for many biosynthetic reactions and for energy metabolism of the cell. We show that deletion of the orthologous gene in yeast (ppa2Δ) compromises cell viability due to the loss of mitochondria. Expression of wild-type human PPA2, but not PPA2 containing the mutations identified in affected individuals, preserves mitochondrial function in ppa2Δ yeast. Using a regulatable (doxycycline-repressible) gene expression system, we found that the pathogenic PPA2 mutations rapidly inactivate the mitochondrial energy transducing system and prevent the maintenance of a sufficient electrical potential across the inner membrane, which explains the subsequent disappearance of mitochondria from the mutant yeast cells. Altogether these data demonstrate that PPA2 is an essential gene in yeast and that biallelic mutations in PPA2 cause a mitochondrial disease leading to sudden cardiac arrest in infants. PMID:27523598

  17. Pokkuri Death Syndrome; sudden cardiac death cases without coronary atherosclerosis in South Asian young males.

    PubMed

    Nakajima, Katsuyuki; Takeichi, Sanae; Nakajima, Yasuhiro; Fujita, Masaki Q

    2011-04-15

    Sudden death is one of the major concerns in forensic medicine. Especially when the deceased is a young subject without significant history, the case will be of major interest to the authorities. Sudden unexplained cardiac death has been known as "Pokkuri Death Syndrome" (PDS) in Japan, "Lai Tai" in Thailand, "Bangungut" in the Philippines, "Dream Disease" in Hawaii, and "Sudden Unexpected Nocturnal Death Syndrome" among South Asian immigrants in the USA. However, the clinical and pathological features of these sudden death cases, especially the characteristics of no coronary atherosclerosis, are surprisingly similar and mainly occur among Southeast Asian young males during sleep in the midnight. In this manuscript, we have reviewed the pathological characteristics and the possible mechanism of death in PDS cases, which were associated with significantly elevated remnant lipoproteins in plasma as revealed from our studies during the past 15 years in Japan. Although elevated plasma remnant lipoproteins have been known to be strongly atherogenic, coronary atherosclerosis was not observed in PDS cases. PDS cases were shown to be an interesting cardiovascular disease death discovered in forensic medicine research, which may suggest the difference between the occurrence of cardiovascular events and the severity of coronary atherosclerosis as separate factors. These observations in PDS cases suggest the possibility that the intervention could be more targeted to suppress the cardiovascular events rather than to slow down the progression of atherosclerosis, which is now most extensively targeted for the therapy of cardiovascular disease in Western countries. PMID:21084168

  18. Electrophysiologic testing guided risk stratification approach for sudden cardiac death beyond the left ventricular ejection fraction.

    PubMed

    Gatzoulis, Konstantinos A; Tsiachris, Dimitris; Arsenos, Petros; Tousoulis, Dimitris

    2016-01-26

    Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators (ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death. PMID:26839662

  19. Addressing Disparities in Sudden Cardiac Arrest Care and the Under-Utilization of Effective Therapies

    PubMed Central

    Kong, Melissa H.; Peterson, Eric D.; Fonarow, Gregg C.; Sanders, Gillian D.; Yancy, Clyde W.; Russo, Andrea M.; Curtis, Anne B.; Sears, Samuel F.; Thomas, Kevin L.; Campbell, Susan; Carlson, Mark D.; Chiames, Chris; Cook, Nakela L.; Hayes, David L.; LaRue, Michelle; Hernandez, Adrian F.; Lyons, Edward L.; Al-Khatib, Sana M.

    2010-01-01

    Sudden cardiac arrest (SCA) is the most common cause of death in the Unites States. Despite its major impact on public health, significant challenges exist at the patient, provider, public, and policy levels with respect to raising more widespread awareness and understanding of SCA risks, identifying patients at risk for SCA, addressing barriers to SCA care, and eliminating disparities in SCA care and outcomes. To address many of these challenges, the Duke Center for the Prevention of Sudden Cardiac Death at the Duke Clinical Research Institute (Durham, NC) held a think tank meeting on December 7, 2009, convening experts on this issue from clinical cardiology, cardiac electrophysiology, health policy and economics, the US Food and Drug Administration, the Centers for Medicare and Medicaid Services, the Agency for Health Care Research and Quality, and device and pharmaceutical manufacturers. The specific goals of the meeting were to examine existing educational tools on SCA for patients, health care providers and the public and explore ways to enhance and disseminate these tools, to propose a framework for improved identification of patients at risk of SCA, and to review the latest data on disparities in SCA care and explore ways to reduce these disparities. This paper summarizes the discussions that occurred at the meeting. PMID:20934553

  20. Left ventricular apical hypoplasia: Case report on cardiomyopathy and a history of sudden cardiac death

    PubMed Central

    Alizadeh Sani, Zahra; Vojdanparast, Mohammad; Rezaeian, Nahid; Seifi, Azin; Omidvar Tehrani, Sahar; Nezafati, Pouya

    2016-01-01

    BACKGROUND Isolated left ventricular apical hypoplasia with several different unrecognized dimensions is a newly discovered congenital anomaly of the heart. CASE REPORT In this report, we describe a case of cardiomyopathy of this type occurring in a 13-year-old male with a history of mental retardation and sudden cardiac death (SCD) of second-degree relatives. The patient was referred for an evaluation of cardiac status. An echocardiography analysis demonstrated a spherical left ventricle (LV) appearance with mild mitral regurgitation. Cardiac magnetic resonance imaging (MRI) confirmed a spherical and truncated LV appearance. The right ventricle was found to have elongated and wrapped around the LV, and diverticulum was also seen in the cardiac MRI. CONCLUSION To the best of our knowledge, this is to present the first case of LV apical hypoplasia combined with LV diverticulum and a family history of SCD. As more cases featuring this cardiomyopathy type are recognized, it will be easier to elucidate the natural history and management of such cardiac anomalies. PMID:27114737

  1. Sudden cardiac arrest during pregnancy: a rare complication of acquired maternal diaphragmatic hernia.

    PubMed

    Jacobs, R; Honore, P M; Hosseinpour, N; Nieboer, K; Spapen, H D

    2012-01-01

    Acute cardiac arrest during pregnancy is a rare but devastating event. Major causes are haemorrhagic, septic or anaphylactic shock, trauma, pulmonary or amniotic fluid embolism, and congenital or acquired cardiac disease. We present a case of massive intrathoracic migration of viscera through a left diaphragmatic hernia in a pregnant multipara, causing acute obstructive shock and cardiac arrest. Complications of intrathoracic herniation occur when the intruding viscera cause left lung and cardiac compression or mediastinal "tamponade" with decreased venous return. Intrathoracic strangulation of viscera is also common and may cause ischaemia, gangrene and eventual perforation. Sudden cardiac arrest as first sign of left diaphragmatic rupture during pregnancy, however, has rarely been described. In contrast with our patient, this catastrophic event is mostly seen in nulli- and primipara with a known congenital left diaphragmatic defect. Management of a diaphragmatic hernia depends on the clinical presentation and the period of gestation during which it is detected. Despite prolonged resuscitation with more than 1 hour of chest compressions, our patient recovered completely. PMID:22897068

  2. Is There a Role for Genetics in the Prevention of Sudden Cardiac Death?

    PubMed

    Faragli, Alessandro; Underwood, Katherine; Priori, Silvia G; Mazzanti, Andrea

    2016-09-01

    The identification of patients at risk for sudden cardiac death (SCD) is fundamental for both acquired cardiovascular diseases (such as coronary artery diseases, CAD) and inherited arrhythmia syndromes (such as the long-QT syndrome, LQTS). Genetics may play a role in both situations, although the potential to exploit this information to reduce the burden of SCD varies among these two groups. Concerning acquired cardiovascular diseases, which affect most of the general population, preliminary data suggest an association between genetics and the risk of dying suddenly. The maximal utility, instead, is reached in inherited arrhythmia syndromes, where the discovery of monogenic diseases such as LQTS tracked the way for the first genotype-phenotype correlations. The aim of this review is to provide a general overview focusing on the current genetic knowledge and on the present and future applicability for prevention in these two populations at risk for SCD. PMID:27279603

  3. A survey of the causes of sudden cardiac death in the under 35-year-age group.

    PubMed

    Quigley, F; Greene, M; O'Connor, D; Kelly, F

    2005-09-01

    CRY (Cardiac Risk in the Young) is a registered Irish charity established by parents who are bereaved as a result of sudden cardiac death. The aim of this study is to establish the incidence and causes of sudden cardiac death in Dublin city in the 10-year period from 1st January 1993 to 31st December 2002. All sudden cardiac deaths in the under 35-year age group which were reported to the city coroner in the study period were examined. Details regarding age, sex, previous symptoms, investigations, circumstances of death and main pathological finding were recorded in each case. A total of 72 cases of sudden cardiac death in the under-35 year age group were reported. 52 were men. The median age was 26.5 years (range 12-34 years). The cause of death in 20 cases was reported as atherosclerotic Coronary Artery Disease. The second commonest cause of death (24% cases) was Hypertrophic Cardiomyopathy. Hypertrophic Cardiomyopathy was the commonest cause of death under the age of 25 years. Overall atherosclerotic coronary artery disease was the commonest cause of death in this group. The importance of Hypertrophic Cardiomyopathy is highlighted by the fact it was the commonest cause of death in the under 25-year age group. Screening those at high risk of sudden cardiac death especially the relatives of those affected by Hypertrophic Cardiomyopathy need to be discussed and implemented. PMID:16255113

  4. Enrollment of sudden cardiac death victims into a limited cardiac autopsy study in the emergency department.

    PubMed Central

    Denninghoff, K. R.

    2000-01-01

    The lack of balanced recruitment for racial and ethnic groups in research protocols is an important ethical issue. African Americans have a history of forced participation, unethical research, and unwilling human dissection/demonstration that leads to a lack of participation in clinical research. We have embarked on a study of the pathophysiology of sudden death among African Americans which requires a limited autopsy of the heart. Our objective was to improve the recruitment rate in this study when compared with historical rates seen in clinical research and organ donation. We have screened 14 and enrolled 10 African Americans with sudden death (95% CI 0.41-0.91). By addressing the concerns of the African-American community and involving qualified input in the planning stages of the study we have been able to significantly improve the recruitment rate for this important population subgroup. PMID:10800285

  5. Fat infiltration of left ventricle - a rare cause of sudden cardiac death.

    PubMed

    Kanchan, Tanuj; Acharya, Jenash; Ram, Pradhum; Khadilkar, Urmila N; Rana, Talvinder

    2016-09-01

    Cor adiposum is a rare disorder of the heart, where the normal heart tissue is replaced by fibro-fatty infiltrates. We report one such case of a middle-aged female who was declared dead shortly after a syncopal episode. At autopsy, the pericardium was intact and firmly adhered to the heart. Histopathology revealed fatty infiltrates extending into the left ventricle of the heart. A post-mortem diagnosis of Cor adiposum was made which is an uncommonly reported cause of sudden cardiac death. PMID:26975397

  6. Bacterial Pericarditis Accompanied by Sudden Cardiac Tamponade After Transbronchial Needle Aspiration Cytology.

    PubMed

    Matsumoto, Takeshi; Otsuka, Kojiro; Imai, Yukihiro; Tomii, Keisuke

    2016-04-01

    A 48-year-old man was referred for an abnormal shadow in his chest x-ray. Transbronchial needle aspiration cytology was performed at the mediastinal necrotic lymph node #7, and he was diagnosed as having small cell carcinoma. Fifteen days after bronchoscopy, sudden cardiac tamponade occurred and pericardial drainage suggested a diagnosis of bacterial pericarditis. He was successfully treated by drainage and administration of antibiotics. Complication of bacterial pericarditis associated with bronchoscopy is rare. However, physicians should watch for the appearance of this condition for up to 3 weeks after bronchoscopy, especially in cases with necrotic lymph nodes. PMID:27058720

  7. Exercising arrhythmias and sudden cardiac death in horses: Review of the literature and comparative aspects.

    PubMed

    Navas de Solis, C

    2016-07-01

    Arrhythmias are common in equine athletes during and immediately after exercise. Many of these rhythm variations are not clinically relevant. In horses, a link between different exercising arrhythmias and poor performance or between exercising arrhythmias and sudden cardiac death (SCD) is strongly suspected but not fully understood or proven. SCD during races or competitions is rare, but has catastrophic consequences for the safety of the human partner and public perceptions of welfare during equestrian sports. This review summarises current knowledge of equine exercise arrhythmias and their implications in SCD and compares existing principles and recommendations for equine subjects with those for human athletes. PMID:27156002

  8. Sudden cardiac death: mandatory exclusion of athletes at risk is a step too far.

    PubMed

    Anderson, Lynley; Exeter, Dan; Bowyer, Lynne

    2012-04-01

    Sudden cardiac death (SCD) in young athletes is a distressing event and it is not surprising that some physicians working with sports people are proposing that preventive action should be taken. There is a push for a system similar to that established in some countries, which involves screening and mandatory exclusion of those at risk. We argue that while screening can provide useful information to at-risk athletes making decisions about their future athletic careers, mandatory exclusion of athletes is paternalistic and such decisions are not rightfully within the domain of medicine. PMID:22039216

  9. Finding the rhythm of sudden cardiac death: new opportunities using induced pluripotent stem cell-derived cardiomyocytes.

    PubMed

    Sallam, Karim; Li, Yingxin; Sager, Philip T; Houser, Steven R; Wu, Joseph C

    2015-06-01

    Sudden cardiac death is a common cause of death in patients with structural heart disease, genetic mutations, or acquired disorders affecting cardiac ion channels. A wide range of platforms exist to model and study disorders associated with sudden cardiac death. Human clinical studies are cumbersome and are thwarted by the extent of investigation that can be performed on human subjects. Animal models are limited by their degree of homology to human cardiac electrophysiology, including ion channel expression. Most commonly used cellular models are cellular transfection models, which are able to mimic the expression of a single-ion channel offering incomplete insight into changes of the action potential profile. Induced pluripotent stem cell-derived cardiomyocytes resemble, but are not identical, adult human cardiomyocytes and provide a new platform for studying arrhythmic disorders leading to sudden cardiac death. A variety of platforms exist to phenotype cellular models, including conventional and automated patch clamp, multielectrode array, and computational modeling. Induced pluripotent stem cell-derived cardiomyocytes have been used to study long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, hypertrophic cardiomyopathy, and other hereditary cardiac disorders. Although induced pluripotent stem cell-derived cardiomyocytes are distinct from adult cardiomyocytes, they provide a robust platform to advance the science and clinical care of sudden cardiac death. PMID:26044252

  10. Sudden Cardiac Arrest in Patients with Preserved Left Ventricular Systolic Function: A Clinical Dilemma

    PubMed Central

    Sawhney, Navinder; Narayan, Sanjiv M.

    2009-01-01

    Stratifying the risk for sudden cardiac arrest (SCA) in individuals with preserved systolic function remains a pressing public health problem. Current guidelines for the implantation of cardiac defibrillators largely ignore patients with preserved systolic function, even though they account for the majority of cases. However, risk stratification for such individuals is increasingly feasible. Notably, most individuals who experience SCA have structural heart disease, even if undiagnosed. Thus, clinical risk scores have been developed to identify high risk. Moreover, there are now promising data that T-Wave Alternans (TWA), alone and in combination with other indices, effectively predicts SCA in this population. This article presents our current understanding of SCA due to ventricular arrhythmias in patients with preserved LV systolic function, and attempts to build a framework to predict risk in this population. PMID:19251226

  11. Risk Stratification for Sudden Cardiac Death: Current Approaches and Predictive Value

    PubMed Central

    Lopera, Gustavo; Curtis, Anne B.

    2009-01-01

    Sudden cardiac death (SCD) is a serious public health problem; the annual incidence of out-of-hospital cardiac arrest in North America is approximately 166,200. Identifying patients at risk is a difficult proposition. At the present time, left ventricular ejection fraction (LVEF) remains the single most important marker for risk stratification. According to current guidelines, most patients with LVEF <35% could benefit from prophylactic ICD implantation, particularly in the setting of symptomatic heart failure. Current risk stratification strategies fail to identify patients at risk of SCD in larger population groups encompassing a greater number of potential SCD victims. However, the best approach to identifying patients and the value of various risk stratification tools is not entirely clear. The goal of this review is to discuss the problem of SCD and the value of the different risk stratification markers and their potential clinical use either alone or in combination with other risk stratification markers. PMID:20066150

  12. Sudden cardiac death while playing Australian Rules football: a retrospective 14 year review.

    PubMed

    Parsons, Sarah; Lynch, Matthew

    2016-06-01

    Australian Rules football is a sport which evolved from Gaelic football and which is played by a large number of predominantly male participants in a number of countries. The highest participation rates are in the southern states of Australia. A retrospective review over a period of 14 years identified 14 cases of sudden cardiac death that occurred in individuals while playing the sport. All were male and ranged in age from 13 to 36 years with a mean and median age of 23 years. A spectrum of cardiac causes was identified including coronary artery atherosclerosis, myocarditis, anomalous coronary artery anatomy, arrhythmogenic right ventricular cardiomyopathy, and healed Kawasaki disease. In 5 cases the heart was morphologically normal raising the possibility of a channelopathy. No traumatic deaths were identified. Some of the individuals had experienced symptoms prior to the fatal episode and the role of pre participation screening in reducing mortality is discussed. PMID:26972904

  13. Update: Causes and symptoms of sudden cardiac death in young athletes.

    PubMed

    Asif, Irfan M; Yim, Eugene S; Hoffman, Jacob M; Froelicher, Vic

    2015-02-01

    Abstract Sudden cardiac death (SCD) is the leading cause of death during exercise. While initial reports suggested that the most common cause of SCD in young athletes was due to hypertrophic cardiomyopathy (HCM), a critical review of investigations in several populations (athletes, non-athletes, military, national, and international) supports that the most common finding at autopsy of young individuals with SCD is actually a structurally normal heart (SNH). This information is vital for sports medicine clinicians, especially with regard to the pre-participation evaluation (PPE) since cardiac death associated with a SNH is likely attributed to disorders such as arrhythmia or ion channel diseases. This comprehensive review explores the causes of SCD, along with the symptoms preceding death, which ultimately may help refine the PPE and maximize the ability to detect potentially lethal disease prior to competition. PMID:25656358

  14. Electrocardiographic T Wave Abnormalities and the Risk of Sudden Cardiac Death: The Finnish Perspective.

    PubMed

    Tikkanen, Jani T; Kenttä, Tuomas; Porthan, Kimmo; Huikuri, Heikki V; Junttila, M Juhani

    2015-11-01

    The identification of patients at risk for sudden cardiac death (SCD) is still a significant challenge to clinicians and scientists. Noninvasive identification of high-risk patients has been of great interest, and several ventricular depolarization and repolarization abnormalities in the standard 12-lead electrocardiogram (ECG) have been associated with increased vulnerability to lethal ventricular arrhythmias. Several benign and pathological conditions can induce changes in repolarization detected as alteration of the ST segment or T wave. Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population. In this review, we will discuss the current knowledge of the SCD risk with standard 12-lead ECG T wave abnormalities in the general population, and possible T wave changes in various cardiac conditions predisposing to SCD. PMID:26391699

  15. Pre-participation screening for the prevention of sudden cardiac death in athletes

    PubMed Central

    Borrione, Paolo; Quaranta, Federico; Ciminelli, Emanuela

    2013-01-01

    Pre-partecipation screening is the systematic practice of medically evaluating large populations of athletes before participation in sport activities for the purpose of identifying abnormalities that could cause disease progression or sudden death. In order to prevent sudden cardiac death (SCD), cardiovascular screening should include a strategy for excluding high-risk subjects from athletic and vigorous exercise. There are two major screening programmes in the world. In the United States competitive athletes are screened by means of family and personal history and physical examination. In Italy there is a mandatory screening for competitive athletes, which includes a resting electrocardiogram (ECG) for the detection of cardiac abnormalities. The most important issue to be addressed is whether a screened subject is really guaranteed that she/he is not suffering from any cardiac disease or at risk for SCD. Conceivably, the introduction of echocardiogram during the pre-participation screening, could be reasonable, despite the discrete sensitivity of ECG, in raising clinical suspicions of severe cardiac alterations predisposing to SCD. It is clear that the cost-benefit ratio per saved lives of the ECG screening is a benchmark of the Public Health policy. On the contrary, the additional introduction of echocardiography in a large population screening programme seems to be too much expansive for the Public Health and for this reason not easily practicable, even if useful and not invasive. Even if we strongly believe that a saved life is more important than any cost-efficacy evaluation, the issue of the economical impact of this approach should be further assessed. PMID:25237617

  16. Pre-participation screening for the prevention of sudden cardiac death in athletes.

    PubMed

    Borrione, Paolo; Quaranta, Federico; Ciminelli, Emanuela

    2013-03-26

    Pre-partecipation screening is the systematic practice of medically evaluating large populations of athletes before participation in sport activities for the purpose of identifying abnormalities that could cause disease progression or sudden death. In order to prevent sudden cardiac death (SCD), cardiovascular screening should include a strategy for excluding high-risk subjects from athletic and vigorous exercise. There are two major screening programmes in the world. In the United States competitive athletes are screened by means of family and personal history and physical examination. In Italy there is a mandatory screening for competitive athletes, which includes a resting electrocardiogram (ECG) for the detection of cardiac abnormalities. The most important issue to be addressed is whether a screened subject is really guaranteed that she/he is not suffering from any cardiac disease or at risk for SCD. Conceivably, the introduction of echocardiogram during the pre-participation screening, could be reasonable, despite the discrete sensitivity of ECG, in raising clinical suspicions of severe cardiac alterations predisposing to SCD. It is clear that the cost-benefit ratio per saved lives of the ECG screening is a benchmark of the Public Health policy. On the contrary, the additional introduction of echocardiography in a large population screening programme seems to be too much expansive for the Public Health and for this reason not easily practicable, even if useful and not invasive. Even if we strongly believe that a saved life is more important than any cost-efficacy evaluation, the issue of the economical impact of this approach should be further assessed. PMID:25237617

  17. Explaining the clinical manifestations of T wave alternans in patients at risk for sudden cardiac death

    PubMed Central

    Cutler, Michael J; Rosenbaum, David S.

    2009-01-01

    The mechanisms underlying sudden cardiac death (SCD) are complex and diverse. Therefore, correct application of any marker to risk stratify patients for appropriate therapy requires knowledge regarding how the marker is reflective of a particular electro-anatomical substrate for arrhythmias. Non-invasive measurement of beat-to-beat alternation of the electrocardiographic T-wave, referred to as T-wave alternans (TWA), is an important marker of risk for sudden cardiac death (SCD). Is this relationship a mere association or is TWA mechanistically linked to SCD? Recent experimental evidence strongly supports a mechanistic relationship between TWA and SCD. This review will consider the underlying mechanisms of TWA derived from experimental studies, as they relate to clinical observations of TWA in humans, addressing the following questions derived from common clinical observations: 1) Where does TWA on the surface ECG come from? 2) Why is controlled heart rate elevation required to elicit TWA? 3) Why is TWA associated with risk for SCD? 4) Why is TWA associated with a broad range of ventricular arrhythmias? and 5) How do commonly used medications affect TWA? PMID:19168395

  18. Basis for Sudden Cardiac Death Prediction by T-Wave Alternans from an Integrative Physiology Perspective

    PubMed Central

    Verrier, Richard L.; Kumar, Kapil; Nearing, Bruce D.

    2009-01-01

    Detection of microvolt levels of T-wave alternans (TWA) has been shown to be useful in identifying individuals at heightened risk for sudden cardiac death. The mechanistic bases for TWA are complex, at the cellular level involving multiple mechanisms, particularly instabilities in membrane voltage (i.e., steep action potential duration restitution slope) and disruptions in intracellular calcium cycling dynamics. The integrative factors influencing TWA at the systemic level are also multifold. We focus on three main variables, namely, heart rate, autonomic nervous system activities, and myocardial ischemia. Clinically, there is growing interest in extending TWA testing to include ambulatory ECG monitoring as well as exercise. The former modality permits assessment of the influence of diverse provocative stimuli of daily life, including circadian factors, mental stress, and sleep-state related disturbances in respiratory and cardiovascular function. Two major emerging concepts in clinical TWA testing are discussed, namely, quantitative analysis of TWA level, to complement the current binary classification scheme, and risk stratification of patients with preserved left ventricular function, the population with the largest absolute number of sudden cardiac deaths. PMID:19251221

  19. Implementation of Ultraportable Echocardiography in an Adolescent Sudden Cardiac Arrest Screening Program

    PubMed Central

    Vanhecke, Thomas E; Weber, James E; Ebinger, Matthew; Bonzheim, Kimberly; Tilli, Frank; Rao, Sunilkumar; Osman, Abdulfatah; Silver, Marc; Fliegner, Karsten; Almany, Steve; Haines, David

    2014-01-01

    BACKGROUND Over a 12-month period, adolescent heart-screening programs were performed for identifying at-risk adolescents for sudden cardiac death (SCD) in our community. Novel to our study, all adolescents received an abbreviated, ultraportable echocardiography (UPE). In this report, we describe the use of UPE in this screening program. METHODS AND RESULTS Four hundred thirty-two adolescents underwent cardiac screening with medical history questionnaire, physical examination, 12-lead electrocardiogram (ECG), and an abbreviated transthoracic echocardiographic examination. There were 11 abnormalities identified with uncertain/varying clinical risk significance. In this population, 75 adolescents had a murmur or high ECG voltage, of which only three had subsequent structural abnormalities on echocardiography that may pose risk. Conversely, UPE discovered four adolescents who had a cardiovascular structural abnormality that was not signaled by the 12-lead ECG, medical history questionnaire, and/or physical examination. CONCLUSIONS The utilization of ultraportable, handheld echocardiography is feasible in large-scale adolescent cardiovascular screening programs. UPE appears to be useful for finding additional structural abnormalities and for risk-stratifying abnormalities of uncertain potential of adolescents’ sudden death. PMID:25249762

  20. Sudden Cardiac Death in Young Athletes; a Literature Review and Special Considerations in Asia

    PubMed Central

    Halabchi, Farzin; Seif-Barghi, Tohid; Mazaheri, Reza

    2011-01-01

    Sudden cardiac death (SCD) in a young athlete is rare, but catastrophic. Exercise acts as a risk factor for SCD in people with cardiovascular disease. A diversity of cardiovascular disorders including hypertrophic cardiomyopathy, congenital coronary anomalies, arrhythmogenic right ventricular dysplasia, dilated cardiomyopathy, aortic rupture due to Marfan syndrome, myocarditis, valvular disease and electrical disorders (Wolff–Parkinson–White syndrome, long QT syndrome, Brugada syndrome), as well as commotio cordis represent the common causes of SCD in young athletes. As the outcome of lethal cardiovascular disorders is not reversible except in few cases, effective measures should be addressed to reduce the burden of sudden cardiac death in young athletes. Currently, two types of recommendations are proposed by American and European countries. It seems that there are some special considerations in Asia, entirely different from North America or Europe, which warrant more comprehensive research on epidemiology and etiology of SCD in young Asian athletes by country and evaluation of current national preventive strategies and their achievements in decreasing the risk. Using these data and considering regional restrictions, an expert group will be able to plan a practical and feasible preventive strategy. PMID:22375212

  1. Usefulness of combined history, physical examination, electrocardiogram, and limited echocardiogram in screening adolescent athletes for risk for sudden cardiac death.

    PubMed

    Anderson, Jeffrey B; Grenier, Michelle; Edwards, Nicholas M; Madsen, Nicolas L; Czosek, Richard J; Spar, David S; Barnes, Allison; Pratt, Jesse; King, Eileen; Knilans, Timothy K

    2014-12-01

    Sudden cardiac death in the young (SCDY) is the leading cause of death in young athletes during sport. Screening young athletes for high-risk cardiac defects is controversial. The purpose of this study was to assess the utility and feasibility of a comprehensive cardiac screening protocol in an adolescent population. Adolescent athletes were recruited from local schools and/or sports teams. Each subject underwent a history and/or physical examination, an electrocardiography (ECG), and a limited echocardiography (ECHO). The primary outcome measure was identification of cardiac abnormalities associated with an elevated risk for sudden death. We secondarily identified cardiac abnormalities not typically associated with a short-term risk of sudden death. A total of 659 adolescent athletes were evaluated; 64% men. Five subjects had cardiac findings associated with an elevated risk for sudden death: prolonged QTc >500 ms (n = 2) and type I Brugada pattern (n = 1), identified with ECG; dilated cardiomyopathy (n = 1) and significant aortic root dilation; and z-score = +5.5 (n = 1). History and physical examination alone identified 76 (11.5%) subjects with any cardiac findings. ECG identified 76 (11.5%) subjects in which a follow-up ECHO or cardiology visit was recommended. Left ventricular mass was normal by ECHO in all but 1 patient with LVH on ECG. ECHO identified 34 (5.1%) subjects in whom a follow-up ECHO or cardiology visit was recommended. In conclusion, physical examination alone was ineffective in identification of subjects at elevated risk for SCDY. Screening ECHO identified patients with underlying cardiac disease not associated with immediate risk for SCDY. Cost of comprehensive cardiac screening is high. PMID:25307198

  2. Kcne2 Deletion Creates a Multisystem Syndrome Predisposing to Sudden Cardiac Death

    PubMed Central

    Hu, Zhaoyang; Kant, Ritu; Anand, Marie; King, Elizabeth C.; Krogh-Madsen, Trine; Christini, David J.; Abbott, Geoffrey W.

    2014-01-01

    Background Sudden cardiac death (SCD) is the leading global cause of mortality, exhibiting increased incidence in diabetics. Ion channel gene perturbations provide a well-established ventricular arrhythmogenic substrate for SCD. However, most arrhythmia susceptibility genes - including the KCNE2 K+ channel β subunit - are expressed in multiple tissues, suggesting potential multiplex SCD substrates. Methods and Results Using “whole transcript” transcriptomics, we uncovered cardiac angiotensinogen upregulation and remodeling of cardiac angiotensinogen interaction networks in P21 Kcne2−/− mouse pups, and adrenal remodeling consistent with metabolic syndrome in adult Kcne2−/− mice. This led to the discovery that Kcne2 disruption causes multiple acknowledged SCD substrates of extracardiac origin: diabetes, hypercholesterolemia, hyperkalemia, anemia and elevated angiotensin II. Kcne2 deletion was also prerequisite for aging-dependent QT prolongation, ventricular fibrillation and SCD immediately following transient ischemia, and fasting-dependent hypoglycemia, myocardial ischemia and atrioventricular block. Conclusions Disruption of a single, widely expressed arrhythmia susceptibility gene can generate a multisystem syndrome comprising manifold electrical and systemic substrates and triggers of SCD. This paradigm is expected to apply to other arrhythmia susceptibility genes, the majority of which encode ubiquitously expressed ion channel subunits or regulatory proteins. PMID:24403551

  3. Prevention of sudden cardiac death in patients with chronic kidney disease.

    PubMed

    Franczyk-Skóra, Beata; Gluba, Anna; Banach, Maciej; Kozłowski, Dariusz; Małyszko, Jolanta; Rysz, Jacek

    2012-01-01

    Cardiovascular deaths account for about 40% of all deaths of patients with chronic kidney disease (CKD), particularly those on dialysis, while sudden cardiac death (SCD) might be responsible for as many as 60% of SCD in patients undergoing dialysis. Studies have demonstrated a number of factors occurring in hemodialysis (HD) that could lead to cardiac arrhythmias. Patients with CKD undergoing HD are at high risk of ventricular arrhythmia and SCD since changes associated with renal failure and hemodialysis-related disorders overlap. Antiarrhythmic therapy is much more difficult in patients with CKD, but the general principles are similar to those in patients with normal renal function - at first, the cause of arrhythmias should be found and eliminated. Also the choice of therapy is narrowed due to the altered pharmacokinetics of many drugs resulting from renal failure, neurotoxicity of certain drugs and their complex interactions. Cardiac pacing in elderly patients is a common method of treatment. Assessment of patients' prognosis is important when deciding whether to implant complex devices. There are reports concerning greater risk of surgical complications, which depends also on the extent of the surgical site. The decision concerning implantation of a pacing system in patients with CKD should be made on the basis of individual assessment of the patient. PMID:23206758

  4. Sudden Cardiac Death Due to Deficiency of the Mitochondrial Inorganic Pyrophosphatase PPA2.

    PubMed

    Kennedy, Hannah; Haack, Tobias B; Hartill, Verity; Mataković, Lavinija; Baumgartner, E Regula; Potter, Howard; Mackay, Richard; Alston, Charlotte L; O'Sullivan, Siobhan; McFarland, Robert; Connolly, Grainne; Gannon, Caroline; King, Richard; Mead, Scott; Crozier, Ian; Chan, Wandy; Florkowski, Chris M; Sage, Martin; Höfken, Thomas; Alhaddad, Bader; Kremer, Laura S; Kopajtich, Robert; Feichtinger, René G; Sperl, Wolfgang; Rodenburg, Richard J; Minet, Jean Claude; Dobbie, Angus; Strom, Tim M; Meitinger, Thomas; George, Peter M; Johnson, Colin A; Taylor, Robert W; Prokisch, Holger; Doudney, Kit; Mayr, Johannes A

    2016-09-01

    We have used whole-exome sequencing in ten individuals from four unrelated pedigrees to identify biallelic missense mutations in the nuclear-encoded mitochondrial inorganic pyrophosphatase (PPA2) that are associated with mitochondrial disease. These individuals show a range of severity, indicating that PPA2 mutations may cause a spectrum of mitochondrial disease phenotypes. Severe symptoms include seizures, lactic acidosis, cardiac arrhythmia, and death within days of birth. In the index family, presentation was milder and manifested as cardiac fibrosis and an exquisite sensitivity to alcohol, leading to sudden arrhythmic cardiac death in the second decade of life. Comparison of normal and mutant PPA2-containing mitochondria from fibroblasts showed that the activity of inorganic pyrophosphatase was significantly reduced in affected individuals. Recombinant PPA2 enzymes modeling hypomorphic missense mutations had decreased activity that correlated with disease severity. These findings confirm the pathogenicity of PPA2 mutations and suggest that PPA2 is a cardiomyopathy-associated protein, which has a greater physiological importance in mitochondrial function than previously recognized. PMID:27523597

  5. Risk stratification for sudden cardiac death: current status and challenges for the future†

    PubMed Central

    Wellens, Hein J.J.; Schwartz, Peter J.; Lindemans, Fred W.; Buxton, Alfred E.; Goldberger, Jeffrey J.; Hohnloser, Stefan H.; Huikuri, Heikki V.; Kääb, Stefan; La Rovere, Maria Teresa; Malik, Marek; Myerburg, Robert J.; Simoons, Maarten L.; Swedberg, Karl; Tijssen, Jan; Voors, Adriaan A.; Wilde, Arthur A.

    2014-01-01

    Sudden cardiac death (SCD) remains a daunting problem. It is a major public health issue for several reasons: from its prevalence (20% of total mortality in the industrialized world) to the devastating psycho-social impact on society and on the families of victims often still in their prime, and it represents a challenge for medicine, and especially for cardiology. This text summarizes the discussions and opinions of a group of investigators with a long-standing interest in this field. We addressed the occurrence of SCD in individuals apparently healthy, in patients with heart disease and mild or severe cardiac dysfunction, and in those with genetically based arrhythmic diseases. Recognizing the need for more accurate registries of the global and regional distribution of SCD in these different categories, we focused on the assessment of risk for SCD in these four groups, looking at the significance of alterations in cardiac function, of signs of electrical instability identified by ECG abnormalities or by autonomic tests, and of the progressive impact of genetic screening. Special attention was given to the identification of areas of research more or less likely to provide useful information, and thereby more or less suitable for the investment of time and of research funds. PMID:24801071

  6. Risk stratification for sudden cardiac death: current status and challenges for the future.

    PubMed

    Wellens, Hein J J; Schwartz, Peter J; Lindemans, Fred W; Buxton, Alfred E; Goldberger, Jeffrey J; Hohnloser, Stefan H; Huikuri, Heikki V; Kääb, Stefan; La Rovere, Maria Teresa; Malik, Marek; Myerburg, Robert J; Simoons, Maarten L; Swedberg, Karl; Tijssen, Jan; Voors, Adriaan A; Wilde, Arthur A

    2014-07-01

    Sudden cardiac death (SCD) remains a daunting problem. It is a major public health issue for several reasons: from its prevalence (20% of total mortality in the industrialized world) to the devastating psycho-social impact on society and on the families of victims often still in their prime, and it represents a challenge for medicine, and especially for cardiology. This text summarizes the discussions and opinions of a group of investigators with a long-standing interest in this field. We addressed the occurrence of SCD in individuals apparently healthy, in patients with heart disease and mild or severe cardiac dysfunction, and in those with genetically based arrhythmic diseases. Recognizing the need for more accurate registries of the global and regional distribution of SCD in these different categories, we focused on the assessment of risk for SCD in these four groups, looking at the significance of alterations in cardiac function, of signs of electrical instability identified by ECG abnormalities or by autonomic tests, and of the progressive impact of genetic screening. Special attention was given to the identification of areas of research more or less likely to provide useful information, and thereby more or less suitable for the investment of time and of research funds. PMID:24801071

  7. Malignant Course of Anomalous Left Coronary Artery Causing Sudden Cardiac Arrest: A Case Report and Review of the Literature

    PubMed Central

    Anantha Narayanan, Mahesh; DeZorzi, Christopher; Akinapelli, Abhilash; Mahfood Haddad, Toufik; Smer, Aiman; Baskaran, Janani; Biddle, William P.

    2015-01-01

    Sudden cardiac arrest has been reported to occur in patients with congenital anomalous coronary artery disease. About 80% of the anomalies are benign and incidental findings at the time of catheterization. We present a case of sudden cardiac arrest caused by anomalous left anterior descending artery. 61-year-old African American female was brought to the emergency department after sudden cardiac arrest. Initial EKG showed sinus rhythm with RBBB and LAFB with nonspecific ST-T wave changes. Coronary angiogram revealed no atherosclerotic disease. The left coronary artery was found to originate from the right coronary cusp. Cardiac CAT scan revealed similar findings with interarterial and intramural course. Patient received one-vessel arterial bypass graft to her anomalous coronary vessel along with a defibrillator for secondary prevention. Sudden cardiac arrest secondary to congenital anomalous coronary artery disease is characterized by insufficient coronary flow by the anomalous left coronary artery to meet elevated left ventricular (LV) myocardial demand. High risk defects include those involved with the proximal coronary artery or coursing of the anomalous artery between the aorta and pulmonary trunk. Per guidelines, our patient received one vessel bypass graft to her anomalous vessel. It is important for clinicians to recognize such presentations of anomalous coronary artery. PMID:26257964

  8. Forensic Pathological Study of 1656 Cases of Sudden Cardiac Death in Southern China

    PubMed Central

    Wu, Qiuping; Zhang, Liyong; Zheng, Jinxiang; Zhao, Qianhao; Wu, Yeda; Yin, Kun; Huang, Lei; Tang, Shuangbo; Cheng, Jianding

    2016-01-01

    Abstract Sudden cardiac death (SCD) is progressively threatening the lives of young people throughout the world. We conducted a retrospective study of SCD cases identified among sudden death cases based on comprehensive autopsies and pathological examinations in the Center for Medicolegal Expertise of Sun Yat-Sen University to investigate the exact etiological distribution and epidemiological features of SCD. One thousand six hundred fifty-six cases were identified, and SCD accounted for 43.0% of these sudden death cases. The mean age of the SCD cases—where the data of definite ages were accessible—was 38.2 years, and the highest incidence occurred among the 31- to 40-year-old cases (25.6%). The male-to-female ratio among SCD cases was 4.3:1, and this ratio peaked in the 41- to 50-year-old group (7.7:1). The places of death were confirmed in 1411 cases, and predominantly in hospitals (46.3%) and at home (33.8%). SCD occurred throughout the year with a marginally increase in April and May. The major causes of SCD were coronary atherosclerotic disease (CAD, 41.6%), unexplained sudden death (15.1%), and myocarditis (11.8%). Our data indicated that in the age group of younger affected persons (below 35 years old), sudden unexplained death and myocarditis were much more prevalent than CAD. According to anatomical examinations of the CAD-related SCD cases, the proportion of cases with coronary artery stenosis exceeding 75% (grade IV) was 67.2%. Moreover, the percentages of higher grades of coronary atherosclerosis increased with age. Among all branches of the coronary arteries, the left anterior descending branch was the most prone to atherosclerosis; atherosclerosis was present in this branch in 95.4% of the cases with atherosclerosis. Additionally, lesions of multiple branches of the coronary artery were associated with ageing. This is the first study to report the causes of death and basic epidemiological data related to SCD in Southern China. PMID:26844513

  9. [New strategies for assessing the risk of sudden cardiac death in hypertrophic cardiomyopathy].

    PubMed

    Jaworski, Krzysztof; Możeńska, Olga; Kosior, Dariusz A

    2016-07-01

    Hypertrophic cardiomyopathy (HCM) is characterized by a primarily increased ventricular wall thickness, usually caused by the mutations in genes encoding sarcomere proteins. Thanks to the growing awareness in the medical community as well as advances in diagnostic techniques HCM can be diagnosed at earlier stages than ever before. However, in some cases the first symptom of this disease is a sudden cardiac death (SCD) and diagnosis remains unknown until post-mortem examination. Implantation of a cardioverterdefibrillator (ICD) provides the most effective method of SCD prevention. Nevertheless, due to a number of risks associated with surgery as well as the possession of such devices, predictive factors of serious ventricular arrhythmia in individual patients have been sought for many years. The aim of this review is to present the current strategies of risk assessment and prevention of SCD in patients with HCM. PMID:27590646

  10. [New strategies for assessing the risk of sudden cardiac death in hypertrophic cardiomyopathy].

    PubMed

    Jaworski, Krzysztof; Możeńska, Olga; Kosior, Dariusz A

    2016-08-01

    Hypertrophic cardiomyopathy (HCM) is characterized by a primarily increased ventricular wall thickness, usually caused by the mutations in genes encoding sarcomere proteins. Thanks to the growing awareness in the medical community as well as advances in diagnostic techniques HCM can be diagnosed at earlier stages than ever before. However, in some cases the first symptom of this disease is a sudden cardiac death (SCD) and diagnosis remains unknown until post-mortem examination. Implantation of a cardioverterdefibrillator (ICD) provides the most effective method of SCD prevention. Nevertheless, due to a number of risks associated with surgery as well as the possession of such devices, predictive factors of serious ventricular arrhythmia in individual patients have been sought for many years. The aim of this review is to present the current strategies of risk assessment and prevention of SCD in patients with HCM. PMID:27591441

  11. A contemporary assessment of the risk for sudden cardiac death in patients with congenital heart disease.

    PubMed

    Silka, Michael J; Bar-Cohen, Yaniv

    2012-03-01

    Assessment of the risk for sudden cardiac death (SCD) after surgery for congenital heart disease (CHD) remains a difficult challenge. In the study of this problem, the focus has evolved from concern regarding late-onset heart block to a subsequent focus on ventricular and reentrant atrial arrhythmias, with the most recent emphasis on ventricular dysfunction and heart failure. Sudden cardiac death in CHD patients has been studied most extensively in tetralogy of Fallot. More than 30 risk factors have been proposed, with age at repair, QRS duration, right ventricular enlargement, and left ventricular dysfunction considered the most predictive risk factors. Additionally, SCD has been studied in patients with atrial repair for transposition of the great arteries, left heart obstructive lesions, and to a limited extent, patients with univentricular physiology. This review discusses current risk factors for SCD in CHD and the limited positive predictive value of any individual factor. The emphasis is on contemporary patients with CHD, who differ markedly from those who had repair of CHD decades earlier. This is characterized by complete repairs during the neonatal period, improved physiologic outcomes, and extended survival of patients with complex forms of CHD. Therefore, earlier data and conclusions may not be relevant to newer generations of patients with CHD. According to current perspectives, systemic ventricular dysfunction becomes a major risk factor beyond the age of 20 years. The first symptomatic arrhythmia may result in SCD, and defibrillators are increasingly implanted despite the lack of risk stratification criteria. The large number of potential risk factors and therapeutic options, in contrast to the low incidence of actual events, results in a difficult clinical challenge in the assessment of the risk for SCD in the individual patient with CHD. PMID:22311569

  12. Coach, Are You Ready to Save a Life? Injury and Care Knowledge Check for Sudden Cardiac Arrest

    ERIC Educational Resources Information Center

    Plos, Jennifer M.; Polubinsky, Renee L.

    2014-01-01

    Coaches need to become familiar with foundational knowledge on sudden cardiac arrest (SCA), while becoming confident, competent, and proficient in their emergency action plans for using CPR [cardiopulmonary resuscitation] and an AED [automated external defibrillators] to provide immediate and appropriate care to athletes. This article refers to a…

  13. Roles and indications for use of implantable defibrillator and resynchronization therapy in the prevention of sudden cardiac death in heart failure.

    PubMed

    Biton, Yitschak; Baman, Jayson R; Polonsky, Bronislava

    2016-07-01

    Implantable devices are indicated in the primary and secondary prevention of potentially life-threatening ventricular tachyarrhythmias in patients with heart failure. Early studies, including the landmark MADIT trials, showed that implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices can play a significant role in aborting and preventing ventricular arrhythmias, respectively, that can cause sudden cardiac death. To this day, there have been a number of randomized controlled trials, with respective substudy analyses, that have attempted to better understand the indications for these interventions in patient care. Here, we summarize the major results of these studies, and we discuss the role of ICD therapy for both ischemic and non-ischemic cardiomyopathy, emerging evidence in support of wearable defibrillators, and the impact of modified ICD programming strategies on patient outcomes. Regarding CRT therapy, the phenomenon of ventricular reverse remodeling is an important prognostic indicator in preventing future ventricular tachyarrhythmia episodes. In summation, we provide an overview of the possible selection criteria that can be used in identifying appropriate patients for ICD and/or CRT therapy, as supported by the data. PMID:26910804

  14. Role of Sodium and Calcium Dysregulation in Tachyarrhythmias in Sudden Cardiac Death

    PubMed Central

    Wagner, Stefan; Maier, Lars S.; Bers, Donald M.

    2015-01-01

    Despite improvements in the therapy of underlying heart disease sudden cardiac death (SCD) is a major cause of death worldwide. Disturbed Na and Ca handling is known to be a major predisposing factor for life-threatening tachyarrhythmias. In cardiomyocytes many ion channels and transporters, including voltage-gated Na and Ca channels, cardiac ryanodine receptors, Na/Ca-exchanger and SR Ca-ATPase are involved in this regulation. We have learned a lot about the pathophysiological relevance of disturbed ion channel function from monogenetic disorders. Changes in the gating of a single ion channel and/or the activity of an ion pump suffice to dramatically increase the propensity for arrhythmias even in structurally normal hearts. Nevertheless, patients with heart failure (HF) with acquired dysfunction in many ion channels and transporters exhibit profound dysregulation of Na and Ca handling and Ca/calmodulin dependent protein kinase, and are especially prone to arrhythmias. A deeper understanding of the underlying arrhythmic principles is mandatory if we are to improve their outcome. This review addresses basic tachy-arrhythmic mechanisms, the underlying ionic mechanisms and the consequences for ion homeostasis, and the situation in complex diseases like HF. PMID:26044250

  15. Height and Risk of Sudden Cardiac Death: The Atherosclerosis Risk in Communities and Cardiovascular Health Studies

    PubMed Central

    Rosenberg, Michael A.; Lopez, Faye L.; Bůžková, Petra; Adabag, SelcukPhD; Chen, Lin Y.; Sotoodehnia, Nona; Kronmal, Richard A.; Siscovick, David S.; Alonso, Alvaro; Buxton, Alfred; Folsom, Aaron R.; Mukamal, Kenneth J.

    2014-01-01

    Purpose Sudden cardiac death (SCD) is an important cause of mortality in the adult population. Height has been associated with cardiac hypertrophy and an increased risk of arrhythmias, but also with decreased risk of coronary heart disease, suggesting a complex association with SCD. Methods We examined the association of adult height with the risk of physician-adjudicated SCD in two large population-based cohorts: the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities (ARIC) study. Results Over an average follow-up time of 11.7 years in CHS, there were 199 (3.6%) cases of SCD among 5,556 participants. In ARIC, over 12.6 years, there were 227 (1.5%) cases of SCD among 15,633 participants. In both cohorts, there was a trend towards decreased SCD with taller height. In fixed effects meta-analysis, the pooled hazard ratio per 10 cm of height was 0.84 (95%CI 0.73, 0.98, p=0.03). The association of increased height with lower risk of SCD was slightly attenuated after inclusion of risk factors associated with height, such as hypertension and left ventricular hypertrophy. The association appeared stronger among men than women in both cohorts. Conclusion In two population-based prospective cohorts of different ages, greater height was associated with lower risk of SCD. PMID:24360853

  16. Plasma Fatty Acid Binding Protein 4 and Risk of Sudden Cardiac Death in Older Adults

    PubMed Central

    Djoussé, Luc; Maziarz, Marlena; Biggs, Mary L.; Ix, Joachim H.; Zieman, Susan J.; Kizer, Jorge R.; Lemaitre, Rozenn N.; Mozaffarian, Dariush; Tracy, Russell P.; Mukamal, Kenneth J.; Siscovick, David S.; Sotoodehnia, Nona

    2013-01-01

    Although fatty acid binding protein 4 (FABP4) may increase risk of diabetes and exert negative cardiac inotropy, it is unknown whether plasma concentrations of FABP4 are associated with incidence of sudden cardiac death (SCD). We prospectively analyzed data on 4,560 participants of the Cardiovascular Health Study. FABP4 was measured at baseline using ELISA, and SCD events were adjudicated through review of medical records. We used Cox proportional hazards to estimate effect measures. During a median followup of 11.8 years, 146 SCD cases occurred. In a multivariable model adjusting for demographic, lifestyle, and metabolic factors, relative risk of SCD associated with each higher standard deviation (SD) of plasma FABP4 was 1.15 (95% CI: 0.95–1.38), P = 0.15. In a secondary analysis stratified by prevalent diabetes status, FABP4 was associated with higher risk of SCD in nondiabetic participants, (RR per SD higher FABP4: 1.33 (95% CI: 1.07–1.65), P = 0.009) but not in diabetic participants (RR per SD higher FABP4: 0.88 (95% CI: 0.62–1.27), P = 0.50), P for diabetes-FABP4 interaction 0.049. In summary, a single measure of plasma FABP4 obtained later in life was not associated with the risk of SCD in older adults overall. Confirmation of our post-hoc results in nondiabetic people in other studies is warranted. PMID:24455402

  17. Detection and prediction of sudden cardiac death (SCD) for personal healthcare.

    PubMed

    Shen, Tsu-Wang; Shen, Hsiao-Ping; Lin, Ching-Heng; Ou, Yi-Ling

    2007-01-01

    Sudden Cardiac Death (SCD) is one of continuing challenges to the modern clinician. It is responsible for an estimated 400,000 deaths per year in the United States and millions of deaths worldwide. This research developed a personal cardiac homecare system by sensing Lead-I ECG signals for detecting and predicting SCD events, which also builds in ECG identity verification. A MIT/BIH SCD Holter Database plus our ECG database were investigated. The system includes a self-made ECG amplifier, a NI DAQ card, a laptop computer, LabView and MatLab programs. The wavelet analysis was applied to detect SCD and the overall performance is 87.5% correct detection rate. In addition, artificial neural networks (ANN) were used to predict SCD events. The correct prediction rates by applying least mean square (LMS), decision based neural network (DBNN), and back propagation (BP) neural network were 67.44%, 58.14% and 55.81% respectively. PMID:18002521

  18. QT dispersion as a risk factor for sudden cardiac death and fatal myocardial infarction in a coronary risk population.

    PubMed Central

    Mänttäri, M.; Oikarinen, L.; Manninen, V.; Viitasalo, M.

    1997-01-01

    OBJECTIVE: To test in a prospective study the hypothesis that increased QT dispersion in resting 12-lead ECG is a predictor of sudden cardiac death. DESIGN: A nested case-control study during a mean (SD) follow up time of 6.5 (2.8) years. SETTING: A prospective, placebo controlled, coronary prevention trial with gemfibrozil among dyslipidaemic middle aged men in primary (occupational) health care units: the Helsinki heart study. PATIENTS: 24 victims of fatal myocardial infarction, 48 victims of sudden cardiac death without acute myocardial infarction, and their matched controls. MAIN OUTCOME MEASURES: QT dispersion in baseline and pre-event electrocardiograms. RESULTS: At study baseline, QT dispersion was similar in all victims and controls. When estimated from the pre-event ECG on average 14 months before death, the risk of sudden cardiac death in the highest QTPEAK (up to the peak of the T wave) dispersion tertile (> or = 50 ms) was 6.2-fold (95% confidence interval 1.7 to 23.5) compared with the risk in the lowest tertile (< or = 30 ms), and 4.9-fold (1.2 to 19.5) after adjustment for the presence of left ventricular hypertrophy, while QTPEAK dispersion could not predict fatal myocardial infarction. QTEND dispersion (up to the end of the T wave) in pre-event ECGs could not discriminate victims of either sudden cardiac death or fatal myocardial infarction from their matched controls. CONCLUSIONS: In middle aged men with a normal conventional QT interval in 12-lead resting ECG, increased QTPEAK dispersion is an independent risk factor for sudden cardiac death, but not for fatal myocardial infarction. PMID:9391289

  19. Improving Ascertainment of Sudden Cardiac Death in Patients with End Stage Renal Disease

    PubMed Central

    Pun, Patrick H.; Herzog, Charles A.; Middleton, John P.

    2012-01-01

    Summary Background and objectives Data collected by the US Renal Data System (USRDS) identify sudden cardiac death (SCD) as the leading cause of death among hemodialysis patients. However, evidence suggests that clinical events captured on the USRDS death notification form may be inaccurate. A new method for classifying SCD was recently developed to enhance the accuracy of SCD classification. This study examined the performance characteristics of this refined definition using a cohort of hemodialysis patients who experienced a witnessed SCD as the reference standard. Design, setting, participants, & measurements This is a retrospective cohort study of 363 patients who experienced a witnessed SCD in US Gambro (DaVita) outpatient dialysis clinics. Sensitivity of SCD defined by death notification forms and SCD defined using additional administrative sources was compared. Clinical data recorded near time of death were also examined. Results Existing USRDS death notification forms reported 70.8% of witnessed SCD as “cardiac arrest/cause unknown” or “arrhythmia.” The refined definition significantly improved identification to 83.8% of witnessed SCD events (P<0.001). Verified SCD cases that were not identified by either definition were more likely to be reported on the death notification form as death due to myocardial infarction, hyperkalemia, sepsis, malignancy, or unknown cause. Conclusions Compared with the death notification form alone, the refined SCD definition significantly improves the sensitivity of reporting of witnessed SCD occurring within outpatient hemodialysis clinics. More accurate reporting of cardiac events by clinicians and refinements to existing death notification forms may further improve recognition and understanding of SCD. PMID:22076878

  20. Predictive Value of Beat-to-Beat QT Variability Index across the Continuum of Left Ventricular Dysfunction: Competing Risks of Non-cardiac or Cardiovascular Death, and Sudden or Non-Sudden Cardiac Death

    PubMed Central

    Tereshchenko, Larisa G.; Cygankiewicz, Iwona; McNitt, Scott; Vazquez, Rafael; Bayes-Genis, Antoni; Han, Lichy; Sur, Sanjoli; Couderc, Jean-Philippe; Berger, Ronald D.; de Luna, Antoni Bayes; Zareba, Wojciech

    2012-01-01

    Background The goal of this study was to determine the predictive value of beat-to-beat QT variability in heart failure (HF) patients across the continuum of left ventricular dysfunction. Methods and Results Beat-to-beat QT variability index (QTVI), heart rate variance (LogHRV), normalized QT variance (QTVN), and coherence between heart rate variability and QT variability have been measured at rest during sinus rhythm in 533 participants of the Muerte Subita en Insuficiencia Cardiaca (MUSIC) HF study (mean age 63.1±11.7; males 70.6%; LVEF >35% in 254 [48%]) and in 181 healthy participants from the Intercity Digital Electrocardiogram Alliance (IDEAL) database. During a median of 3.7 years of follow-up, 116 patients died, 52 from sudden cardiac death (SCD). In multivariate competing risk analyses, the highest QTVI quartile was associated with cardiovascular death [hazard ratio (HR) 1.67(95%CI 1.14-2.47), P=0.009] and in particular with non-sudden cardiac death [HR 2.91(1.69-5.01), P<0.001]. Elevated QTVI separated 97.5% of healthy individuals from subjects at risk for cardiovascular [HR 1.57(1.04-2.35), P=0.031], and non-sudden cardiac death in multivariate competing risk model [HR 2.58(1.13-3.78), P=0.001]. No interaction between QTVI and LVEF was found. QTVI predicted neither non-cardiac death (P=0.546) nor SCD (P=0.945). Decreased heart rate variability (HRV) rather than increased QT variability was the reason for increased QTVI in this study. Conclusions Increased QTVI due to depressed HRV predicts cardiovascular mortality and non-sudden cardiac death, but neither SCD nor excracardiac mortality in HF across the continuum of left ventricular dysfunction. Abnormally augmented QTVI separates 97.5% of healthy individuals from HF patients at risk. PMID:22730411

  1. Incidence, Etiology, and Comparative Frequency of Sudden Cardiac Death in NCAA Athletes: A Decade in Review

    PubMed Central

    Harmon, Kimberly G.; Asif, Irfan M.; Maleszewski, Joseph J.; Owens, David S.; Prutkin, Jordan M.; Salerno, Jack C.; Zigman, Monica L.; Ellenbogen, Rachel; Rao, Ashwin; Ackerman, Michael J.; Drezner, Jonathan A.

    2015-01-01

    Background The incidence and etiology of sudden cardiac death (SCD) in athletes is debated with hypertrophic cardiomyopathy (HCM) often reported as the most common etiology. Methods and Results A database of all NCAA deaths (2003 – 2013) was developed. Additional information and autopsy reports were obtained when possible. Cause of death was adjudicated by an expert panel. There were 4,242,519 athlete-years (AY) and 514 total student athlete deaths. Accidents were the most common cause of death (257, 50%, 1:16,508 AY) followed by medical causes (147, 29%, 1:28,861 AY). The most common medical cause of death was SCD (79, 15%, 1:53,703 AY). Males were at higher risk than females 1:37,790 AY vs. 1:121,593 AY (IRR 3.2, 95% CI, 1.9-5.5, p < .00001), and black athletes were at higher risk than white athletes 1:21,491 AY vs. 1:68,354 AY (IRR 3.2, 95% CI, 1.9-5.2, p < .00001). The incidence of SCD in Division 1 male basketball athletes was 1:5,200 AY. The most common findings at autopsy were autopsy negative sudden unexplained death (AN-SUD) in 16 (25%) and definitive evidence for HCM was seen in 5 (8%). Media reports identified more deaths in higher divisions (87%, 61%, and 44%) while percentages from the internal database did not vary (87%, 83%, and 89%). Insurance claims identified only 11% of SCDs. Conclusions The rate of SCD in NCAA athletes is high, with males, black athletes and basketball players at substantially higher risk. The most common finding at autopsy is AN-SUD. Media reports are more likely to capture high profile deaths, while insurance claims are not a reliable method for case identification. PMID:25977310

  2. Hypothesis Holiday sudden cardiac death: food and alcohol inhibition of SULT1A enzymes as a precipitant

    PubMed Central

    Eagle, Ken

    2012-01-01

    Sudden cardiac death is a significant health issue, causing millions of deaths worldwide annually. Studies have found that the likelihood of such death is higher in winter. Further studies identified that the highest likelihood occurs on Christmas Day and New Years Day, but not the interim period. Thanksgiving, Independence Day and the Islamic holiday Eid Al-Fitr also show significant increases in the rate of cardiac events or death. A number of mechanisms have been proposed, but none have satisfactorily explained the evidence. This article reviews the data supporting the existence of a holiday cardiac death phenomenon, the involvement of catecholamines and the normal modes of human catecholamine deactivation. Further evidence is reviewed that supports a hypothesized mechanism whereby critical SULT1A catecholamine deactivation enzymes can in some patients be inhibited by naturally-occurring phenols and polyphenols in foods and alcohols. If deactivation is inhibited by holiday consumption excesses, holiday stress or excitement could lead to a buildup of catecholamines that can cause fatal arrhythmias. Awareness of this mechanism could reduce deaths, both through doctor/patient education leading to a moderation in consumption and through the potential identification of patients with a predisposition to SULT1A inhibition. This hypothesis also raises parallels between sudden cardiac death in adults and Sudden Infant Death Syndrome (SIDS). The possible involvement of SULT1A inhibition in SIDS is discussed. Copyright © 2012 John Wiley & Sons, Ltd. PMID:22678655

  3. Hypothesis: holiday sudden cardiac death: food and alcohol inhibition of SULT1A enzymes as a precipitant.

    PubMed

    Eagle, Ken

    2012-10-01

    Sudden cardiac death is a significant health issue, causing millions of deaths worldwide annually. Studies have found that the likelihood of such death is higher in winter. Further studies identified that the highest likelihood occurs on Christmas Day and New Years Day, but not the interim period. Thanksgiving, Independence Day and the Islamic holiday Eid Al-Fitr also show significant increases in the rate of cardiac events or death. A number of mechanisms have been proposed, but none have satisfactorily explained the evidence. This article reviews the data supporting the existence of a holiday cardiac death phenomenon, the involvement of catecholamines and the normal modes of human catecholamine deactivation. Further evidence is reviewed that supports a hypothesized mechanism whereby critical SULT1A catecholamine deactivation enzymes can in some patients be inhibited by naturally-occurring phenols and polyphenols in foods and alcohols. If deactivation is inhibited by holiday consumption excesses, holiday stress or excitement could lead to a buildup of catecholamines that can cause fatal arrhythmias. Awareness of this mechanism could reduce deaths, both through doctor/patient education leading to a moderation in consumption and through the potential identification of patients with a predisposition to SULT1A inhibition. This hypothesis also raises parallels between sudden cardiac death in adults and Sudden Infant Death Syndrome (SIDS). The possible involvement of SULT1A inhibition in SIDS is discussed. PMID:22678655

  4. Intrapulmonary aquaporin-5 expression as a possible biomarker for discriminating smothering and choking from sudden cardiac death: a pilot study.

    PubMed

    Wang, Qi; Ishikawa, Takaki; Michiue, Tomomi; Zhu, Bao-Li; Guan, Da-Wei; Maeda, Hitoshi

    2012-07-10

    The diagnosis of mechanical asphyxia as a cause of death, especially smothering and choking lacking evident injury, is one of the most difficult tasks in forensic pathology. The present study investigated the intrapulmonary expressions of aquaporins (AQPs; AQP-1 and AQP-5), as markers of water homeostasis, in forensic autopsy cases (total n=64, within 48 h postmortem) of mechanical asphyxiation due to neck compression (strangulation, n=24), including manual/ligature strangulation (n=12) and atypical hanging (n=12), smothering (n=7) and choking (n=8), compared with sudden cardiac death (n=14) and acute brain injury (n=11). Quantification of mRNA using a Taqman real-time PCR assay system demonstrated suppressed expression of AQP-5, but not AQP-1, in smothering and choking, compared with that in strangulation as well as sudden cardiac death and acute brain injury death. Immunostaining of AQP-5 was weakly detected in a linear pattern in the type I alveolar epithelial cells in smothering and choking cases, while cardiac and brain injury death showed marked positivity, and most strangulation cases had AQP-5-positive granular aggregates and fragments in intra-alveolar spaces. These observations indicate a partial difference in pulmonary molecular pathology among these causes of death, suggesting a procedure for possible discrimination of smothering and choking from sudden cardiac death. PMID:22421325

  5. Sudden Unexplained Cardiac Arrest in Apparently Healthy Children: A Single Center Experience

    PubMed Central

    Alapati, Srilatha; Strobel, Nathaniel; Hashmi, Sharukh; Bricker, John T.; Gupta-Malhotra, Monesha

    2012-01-01

    Objective To determine the causes of sudden cardiac arrest (SCA) in apparently healthy children in a single center in the era of primary prevention (screening questionnaire, SQ) and secondary prevention (automated external defibrillator, AED and automated implantable cardioverter defibrillator, AICD). Study Design Any child (0–18 year’s age) without prior known disease except for attention deficit disorder who underwent out-of-the hospital cardiopulmonary resuscitation was included in the study as SCA. Using retrospective chart review we evaluated the efficacy of the SQ, electrocardiogram (EKG), chest roentgenogram (CXR) and an echocardiogram. Results We found 44 out of 6,656 children admitted to intensive care with SCA; an AED was used in 39%, AICD placed in 18% and survival to hospital discharge was 50%. The etiology for SCA was identified in 57% of the cases, mostly in those above one year of age and among these the majority of had a cardiac etiology (50%) while 7% had rupture of an arteriovenous malformation. Stimulant medication use was seen in 11% of the SCA. In the best case scenario of hypothesized primary prevention, a prior SQ, CXR, EKG and echocardiogram may have detected 18%, 9%, 23% and 16% of at-risk cases respectively and 32% may have been detected with EKG and SQ together. Based on a historical control cohort, a positive EKG was significantly higher in children with SCA (p = 0.014). Conclusion An EKG along with a screening SQ may be more effective in identifying children who are potentially at-risk for SCA than a SQ alone. PMID:23052663

  6. Family History of Sudden Cardiac Death of the Young: Prevalence and Associated Factors

    PubMed Central

    White, Michelle J.; Duquette, Debra; Bach, Janice; Rafferty, Ann P.; Fussman, Chris; Sharangpani, Ruta; Russell, Mark W.

    2015-01-01

    Sudden cardiac death of the young (SCDY) is a devastating event for families and communities. Family history is a significant risk factor for this potentially preventable cause of death, however a complete and detailed family history is not commonly obtained during routine health maintenance visits. To estimate the proportion of adults with a family history of SCDY, the Michigan Department of Health and Human Services (MDHHS) Genomics Program included two questions within the 2007 Michigan Behavioral Risk Factor Survey (MiBRFS). Prevalence estimates and 95% confidence intervals were calculated. Among adults in Michigan, 6.3% reported a family history of SCDY, with a greater prevalence among blacks, those with lower household income, and those with less education. Among those reporting a family history of SCDY, 42.3% had at least one first-degree relative and 26.2% had multiple affected family members. This is the first study to demonstrate the prevalence of family history of SCDY while also highlighting key sociodemographic characteristics associated with increased prevalence. These findings should guide evidence-based interventions to reach those at greatest risk.

  7. Experience With the Wearable Cardioverter-Defibrillator in Patients at High Risk for Sudden Cardiac Death

    PubMed Central

    Günther, Michael; Quick, Silvio; Pfluecke, Christian; Rottstädt, Fabian; Szymkiewicz, Steven J.; Ringquist, Steven; Strasser, Ruth H.; Speiser, Uwe

    2016-01-01

    Background: This study evaluated the wearable cardioverter-defibrillator (WCD) for use and effectiveness in preventing sudden death caused by ventricular tachyarrhythmia or fibrillation. Methods: From April 2010 through October 2013, 6043 German WCD patients (median age, 57 years; male, 78.5%) were recruited from 404 German centers. Deidentified German patient data were used for a retrospective, nonrandomized analysis. Results: Ninety-four patients (1.6%) were treated by the WCD in response to ventricular tachyarrhythmia/fibrillation. The incidence rate was 8.4 (95% confidence interval, 6.8–10.2) per 100 patient-years. Patients with implantable cardioverter-defibrillator explantation had an incidence rate of 19.3 (95% confidence interval, 12.2–29.0) per 100 patient-years. In contrast, an incidence rate of 8.2 (95% confidence interval, 6.4–10.3) was observed in the remaining cardiac diagnosis groups, including dilated cardiomyopathy, myocarditis, and ischemic and nonischemic cardiomyopathies. Among 120 shocked patients, 112 (93%) survived 24 hours after treatment, whereas asystole was observed in 2 patients (0.03%) with 1 resulting death. ConclusionS: This large cohort represents the first nationwide evaluation of WCD use in patients outside the US healthcare system and confirms the overall value of the WCD in German treatment pathways. PMID:27458236

  8. [The morphological changes in the myocardial tissue after sudden cardiac death from alcoholic cardiomyopathy].

    PubMed

    Sokolova, O V

    2016-01-01

    This paper was designed to report the results of the retrospective analysis of the protocols of 180 forensic medical autopsy sections stored in the archives of Sankt-Petersburg Bureau of Forensic Medical Expertise and the data of the histological studies of myocardial tissues obtained after sudden cardiac death from alcoholic cardiomyopathy. The study revealed the following most pathognomonic histological criteria for alcoholic heart lesions: the alternation of hypertrophic and atrophic cardiomyocytes in the state of severe parenchymatous degeneration, pronounced mesenchymal fatty dystrophy in combination with pathological changes of the vascular walls (vascular wall plasmatization), sub-endothelial accumulation of the PAS-positive tissue compounds, microcirculatory disorders in the form of erythrocyte stasis with the manifestations of the blood "sludge" phenomenon, and precapillary fibrosis. The signs of severe parenchymatous and stromal vascular dystrophy of the myocardial histohematic barrier (HHB) are supposed to reflect the toxic effects of ethanol and its metabolites that are directly involved in the mechanisms underlying the disturbances of intracellular metabolism and dyscirculatory events leading to the development of heart muscle hypoxia. PMID:27030089

  9. A case of sudden cardiac death following Domperidone self-medication.

    PubMed

    Fais, Paolo; Vermiglio, Elisa; Laposata, Chiara; Lockwood, Robert; Gottardo, Rossella; De Leo, Domenico

    2015-09-01

    The phenomenon of sudden cardiac death is usually related to the worsening of existing heart conditions leading to ventricular arrhythmia (VA). One of the well-known triggers of SCD is drug-induced prolongation of the QT interval, such as that caused by Domperidone (D). Despite its risk to prolong the QT interval and associated narrow therapeutic index, D is available as an over-the-counter (OTC) drug in many countries such as Italy, Ireland, Netherlands, China, South Africa, Mexico, New Zealand and Chile to treat gastroesophageal reflux and functional dyspepsia. The present paper reports a case of SCD that occurred some hours after D self-administration in a 47-year-old female subject with mitral valve prolapse, thus, predisposed to both VA and SCD. Despite the risks related to D administration, to the best of our knowledge, this particular issue has not been discussed in the medico-legal literature. For this reason, the forensic implications of D administration are discussed focusing on issues related to the self-administration as an OTC drug (as seen in this case), administration to incapacitated subjects, prescription to patients with contraindications and the off-label drug use of D at high and hazardous concentrations to stimulate lactation. PMID:26119456

  10. Soccer and Sudden Cardiac Death in Young Competitive Athletes: A Review

    PubMed Central

    Higgins, John P.; Andino, Aldo

    2013-01-01

    Sudden cardiac death (SCD) in young competitive athletes (<35 years old) is a tragic event that has been brought to public attention in the past few decades. The incidence of SCD is reported to be 1-2/100,000 per year, with athletes at a 2.5 times higher risk. Soccer is the most popular sport in the world, played by people of all ages. However, unfortunately it is cardiovascular diseases such as hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy that have subtly missed screening and claimed the lives of soccer stars such as Marc Vivien Foe and Antonio Puerta during live action on the field and on an internationally televised stage. This paper covers the physiological demands of soccer and the relationship between soccer and SCD. It also reviews the most common causes of SCD in young athletes, discusses the current guidelines in place by The Fédération Internationale de Football Association (FIFA) for screening among professional soccer players, and the precautions that have been put in place to prevent SCD on the field in professional soccer. PMID:26464886

  11. Rationale and design of the Pan-African Sudden Cardiac Death survey: the Pan-African SCD study

    PubMed Central

    Bonny, Aimé; Bonny, Aimé; Ngantcha, Marcus; Ndongo Amougou, Sylvie; Kane, Adama; Marrakchi, Sonia; Okello, Emmy; Taty, Georges; Gehani, Abdulrrazzak; Diakite, Mamadou; Talle, Mohammed A; Lambiase, Pier D; Houenassi, Martin; Chin, Ashley; Otieno, Harun; Temu, Gloria; Koffi Owusu, Isaac; Karaye, Kamilu M; Awad, Abdalla AM; Gregers Winkel, Bo; Priori, Silvia G; Priori, Silvia G

    2014-01-01

    Summary Background The estimated rate of sudden cardiac death (SCD) in Western countries ranges from 300 000 to 400 000 annually, which represents 0.36 to 1.28 per 1 000 inhabitants in Europe and the United States. The burden of SCD in Africa is unknown. Our aim is to assess the epidemiology of SCD in Africa. Methods The Pan-Africa SCD study is a prospective, multicentre, community-based registry monitoring all cases of cardiac arrest occurring in victims over 15 years old. We will use the definition of SCD as ‘witnessed natural death occurring within one hour of the onset of symptoms’ or ‘unwitnessed natural death within 24 hours of the onset of symptoms’. After appro val from institutional boards, we will record demographic, clinical, electrocardiographic and biological variables of SCD victims (including survivors of cardiac arrest) in several African cities. All deaths occurring in residents of districts of interest will be checked for past medical history, circumstances of death, and autopsy report (if possible). We will also analyse the employment of resuscitation attempts during the time frame of sudden cardiac arrest (SCA) in various patient populations throughout African countries. Conclusion This study will provide comprehensive, contemporary data on the epidemiology of SCD in Africa and will help in the development of strategies to prevent and manage cardiac arrest in this region of the world. PMID:25192301

  12. Tools for risk stratification of sudden cardiac death: A review of the literature in different patient populations

    PubMed Central

    Ragupathi, Loheetha; Pavri, Behzad B.

    2014-01-01

    While various modalities to determine risk of sudden cardiac death (SCD) have been reported in clinical studies, currently reduced left ventricular ejection fraction remains the cornerstone of SCD risk stratification. However, the absolute burden of SCD is greatest amongst populations without known cardiac disease. In this review, we summarize the evidence behind current guidelines for implantable cardioverter defibrillator (ICD) use for the prevention of SCD in patients with ischemic heart disease (IHD). We also evaluate the evidence for risk stratification tools beyond clinical guidelines in the general population, patients with IHD, and patients with other known or suspected medical conditions. PMID:24568833

  13. Short-term Exposure to Microgravity and the Associated Risk of Sudden Cardiac Arrest: Implications for Commercial Spaceflight

    NASA Astrophysics Data System (ADS)

    Laing, Kevin J. C.; Russamono, Thais

    2013-02-01

    The likelihood of trained astronauts developing a life threatening cardiac event during spaceflight is relatively rare, whilst the incidence in untrained individuals is unknown. Space tourists who live a sedentary lifestyle have reduced cardiovascular function, but the associated danger of sudden cardiac arrest (SCA) during a suborbital spaceflight (SOSF) is unclear. Risk during SOSF was examined by reviewing several microgravity studies and methods of determining poor cardiovascular condition. Accurately assessing cardiovascular function and improving baroreceptor sensitivity through exercise is suggested to reduce the incidence of SCA during future SOSFs. Future studies will benefit from past participants sharing medical history; allowing creation of risk profiles and suitable guidelines.

  14. Appraisal process in sheep (Ovis aries): interactive effect of suddenness and unfamiliarity on cardiac and behavioral responses.

    PubMed

    Désiré, Lara; Veissier, Isabelle; Després, Gérard; Delval, Eric; Toporenko, Gilles; Boissy, Alain

    2006-08-01

    Appraisal theories state that an emotion results from an individual's evaluation of a stimulating event, which is based on a set of criteria. Each criterion triggers specific expressions that can be modulated by the outcome of other criteria. The authors analyzed the effects of the criteria of suddenness, unfamiliarity, and their combination on behavioral and cardiac responses in lambs (Ovis aries). Lambs were exposed to a visual stimulus that appeared either rapidly or slowly and was either unfamiliar or familiar. Suddenness induced a startle response and an increase in heart rate. Unfamiliarity induced an orientation response. The combination of suddenness and unfamiliarity enhanced both the heart rate increase and the behavioral orientation response. These results support the hypotheses of specificity and modulation of emotional expressions. PMID:16893265

  15. An approach to predict Sudden Cardiac Death (SCD) using time domain and bispectrum features from HRV signal.

    PubMed

    Houshyarifar, Vahid; Chehel Amirani, Mehdi

    2016-08-12

    In this paper we present a method to predict Sudden Cardiac Arrest (SCA) with higher order spectral (HOS) and linear (Time) features extracted from heart rate variability (HRV) signal. Predicting the occurrence of SCA is important in order to avoid the probability of Sudden Cardiac Death (SCD). This work is a challenge to predict five minutes before SCA onset. The method consists of four steps: pre-processing, feature extraction, feature reduction, and classification. In the first step, the QRS complexes are detected from the electrocardiogram (ECG) signal and then the HRV signal is extracted. In second step, bispectrum features of HRV signal and time-domain features are obtained. Six features are extracted from bispectrum and two features from time-domain. In the next step, these features are reduced to one feature by the linear discriminant analysis (LDA) technique. Finally, KNN and support vector machine-based classifiers are used to classify the HRV signals. We used two database named, MIT/BIH Sudden Cardiac Death (SCD) Database and Physiobank Normal Sinus Rhythm (NSR). In this work we achieved prediction of SCD occurrence for six minutes before the SCA with the accuracy over 91%. PMID:27567781

  16. A Common Polymorphism of the Human Cardiac Sodium Channel Alpha Subunit (SCN5A) Gene Is Associated with Sudden Cardiac Death in Chronic Ischemic Heart Disease

    PubMed Central

    Marcsa, Boglárka; Dénes, Réka; Vörös, Krisztina; Rácz, Gergely; Sasvári-Székely, Mária; Rónai, Zsolt; Törő, Klára; Keszler, Gergely

    2015-01-01

    Cardiac death remains one of the leading causes of mortality worldwide. Recent research has shed light on pathophysiological mechanisms underlying cardiac death, and several genetic variants in novel candidate genes have been identified as risk factors. However, the vast majority of studies performed so far investigated genetic associations with specific forms of cardiac death only (sudden, arrhythmogenic, ischemic etc.). The aim of the present investigation was to find a genetic marker that can be used as a general, powerful predictor of cardiac death risk. To this end, a case-control association study was performed on a heterogeneous cohort of cardiac death victims (n=360) and age-matched controls (n=300). Five single nucleotide polymorphisms (SNPs) from five candidate genes (beta2 adrenergic receptor, nitric oxide synthase 1 adaptor protein, ryanodine receptor 2, sodium channel type V alpha subunit and transforming growth factor-beta receptor 2) that had previously been shown to associate with certain forms of cardiac death were genotyped using sequence-specific real-time PCR probes. Logistic regression analysis revealed that the CC genotype of the rs11720524 polymorphism in the SCN5A gene encoding a subunit of the cardiac voltage-gated sodium channel occurred more frequently in the highly heterogeneous cardiac death cohort compared to the control population (p=0.019, odds ratio: 1.351). A detailed subgroup analysis uncovered that this effect was due to an association of this variant with cardiac death in chronic ischemic heart disease (p=0.012, odds ratio = 1.455). None of the other investigated polymorphisms showed association with cardiac death in this context. In conclusion, our results shed light on the role of this non-coding polymorphism in cardiac death in ischemic cardiomyopathy. Functional studies are needed to explore the pathophysiological background of this association. PMID:26146998

  17. Obesity related risk of sudden cardiac death in the atherosclerosis risk in communities study

    PubMed Central

    Adabag, Selcuk; Huxley, Rachel R; Lopez, Faye L; Chen, Lin Y; Sotoodehnia, Nona; Siscovick, David; Deo, Rajat; Konety, Suma; Alonso, Alvaro; Folsom, Aaron R

    2016-01-01

    Objective To examine the association of body mass index (BMI), waist circumference (WC) and waist hip ratio (WHR) with sudden cardiac death (SCD) in community dwelling individuals. Methods Data from a multicentre, prospective, cohort study of 14 941 men and women (African American, and white), aged 45–64 years, participating in the Atherosclerosis Risk in Communities study was analysed. Obesity measures were assessed at baseline (1987–1989). SCD was adjudicated by a committee. Results At enrolment mean±SD age of the participants was 54±6 years (55% female; 26% African American). During 12.6±2.5 years of follow-up, 253 SCD occurred (incidence rate 1.34/100 person-years). The association between obesity and SCD differed by smoking status (interaction p≤0.01). In models adjusting for age, sex, race, study centre and education level, SCD risk was positively associated (p<0.001) with BMI, WC and WHR in non-smokers, but not in smokers. WHR was more strongly associated with SCD in non-smokers than was BMI or WC (HR per SD increment (95% CI) 2.00 (1.65 to 2.42); 1.34 (1.15 to 1.56) and 1.49 (1.28 to 1.74), respectively). After adjustment for potential mediators (hypertension, diabetes, lipid profile, prevalent coronary heart disease, heart failure, and LV hypertrophy), non-smokers in the highest WHR category (>0.95 in women; >1.01 in men) had double the risk of SCD (HR 2.03, 95% CI 1.19 to 3.46; incidence rate 1.43/1000 person-years) versus those with normal WHR. Conclusions General obesity is associated with increased risk of SCD in middle-aged, non-smoking individuals, mediated by traditional cardiovascular risk factors. Central obesity, however, is independently associated with SCD by pathways that remain to be elucidated. PMID:25410499

  18. Sudden cardiac death in adults with congenitally corrected transposition of the great arteries

    PubMed Central

    McCombe, A; Touma, F; Jackson, D; Canniffe, C; Choudhary, P; Pressley, L; Tanous, D; Robinson, Peter J; Celermajer, D

    2016-01-01

    Background Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital heart disease. There have been only few reports of sudden cardiac death (SCD) in patients with ccTGA and reasonable ventricular function. Methods A retrospective review of the medical records of all patients attending our adult congenital heart centre, with known ccTGA. Results From a database of over 3500 adult patients with congenital heart disease, we identified 39 (∼1%) with ccTGA and ‘two-ventricle’ circulations. 65% were male. The mean age at diagnosis was 12.4±11.4 years and the mean age at last time of review was 34.3±11.3 years. 24 patients (56%) had a history of surgical intervention. 8 (19%) had had pacemaker implantation and 2 had had a defibrillator implanted for non-sustained ventricular tachycardia (NSVT). In 544 years of patient follow-up, there had been five cases of SCD in our population; 1 death per 109 patient-years. Two of these patients had had previously documented supraventricular or NSVT. However, they were all classified as New York Heart Association (NYHA) class I or II, and systemic (right) ventricular function had been recorded as normal, mildly or mildly–moderately impaired, at most recent follow-up. Conclusions Our experience suggests the need for improved risk stratification and/or surveillance for malignant arrhythmia in adults with ccTGA, even in those with reasonable functional class on ventricular function. PMID:27493760

  19. Vitamin D, parathyroid hormone, and sudden cardiac death: results from the Cardiovascular Health Study.

    PubMed

    Deo, Rajat; Katz, Ronit; Shlipak, Michael G; Sotoodehnia, Nona; Psaty, Bruce M; Sarnak, Mark J; Fried, Linda F; Chonchol, Michel; de Boer, Ian H; Enquobahrie, Daniel; Siscovick, David; Kestenbaum, Bryan

    2011-12-01

    Recent studies have demonstrated greater risks of cardiovascular events and mortality among persons who have lower 25-hydroxyvitamin D (25-OHD) and higher parathyroid hormone (PTH) levels. We sought to evaluate the association between markers of mineral metabolism and sudden cardiac death (SCD) among the 2312 participants from the Cardiovascular Health Study who were free of clinical cardiovascular disease at baseline. We estimated associations of baseline 25-OHD and PTH concentrations individually and in combination with SCD using Cox proportional hazards models after adjustment for demographics, cardiovascular risk factors, and kidney function. During a median follow-up of 14 years, there were 73 adjudicated SCD events. The annual incidence of SCD was greater among subjects who had lower 25-OHD concentrations, 2 events per 1000 for 25-OHD ≥20 ng/mL and 4 events per 1000 for 25-OHD <20 ng/mL. Similarly, SCD incidence was greater among subjects who had higher PTH concentrations, 2 events per 1000 for PTH <65 pg/mL and 4 events per 1000 for PTH ≥65 pg/mL. Multivariate adjustment attenuated associations of 25-OHD and PTH with SCD. Finally, 267 participants (11.7% of the cohort) had high PTH and low 25-OHD concentrations. This combination was associated with a >2-fold risk of SCD after adjustment (hazard ratio: 2.19 [95% CI: 1.17-4.10]; P=0.017) compared with participants with normal levels of PTH and 25-OHD. The combination of lower 25-OHD and higher PTH concentrations appears to be associated independently with SCD risk among older adults without cardiovascular disease. PMID:22068871

  20. Sudden cardiac death after acute ST elevation myocardial infarction: insight from a developing country

    PubMed Central

    Rao, Hygriv B; Sastry, B K S; Korabathina, Radhika; Raju, Krishnam P

    2012-01-01

    Background There is no data concerning sudden cardiac death (SCD) following acute ST elevation myocardial infarction (STEMI) in India. We assessed the incidence and factors influencing SCD following STEMI. Methods Patients with STEMI admitted in our hospital from 2006 to 2009 were prospectively entered into a database. In the period 2010–2011, patients or their kin were periodically contacted and administered a questionnaire to ascertain their survival, and mode of death if applicable. Results Study population comprised of 929 patients with STEMI (mean age 55±17 years) having a mean follow-up of 41±16 months. The total number of deaths was 159, of which 78 were SCD (mean age 62.2±10 years). The cumulative incidence of total deaths and SCD at 1 month, 1, 2, 3 years and at conclusion of the study was 10.1%, 13.2%, 14.6%, 15.8%, 17.3% and 4.9%, 6.5%, 8.0%, 8.9% and 9.7%, respectively. The temporal distribution of SCD was 53.9% at first month, 19.2% at 1 month to 1 year, 15.4% in 1–2 years, 7.6% in 2–3 years and 3.8% beyond 3 years. Comparison between SCD and survivor cohorts by multivariate analysis showed five variables were found to be associated with SCD (age p=0.0163, female gender p=0.0042, severe LV dysfunction p=0.0292, absence of both reperfusion and revascularisation p=0.0373 and lack of compliance with medications p <0.0001). Conclusions SCD following STEMI accounts for about half of the total deaths. It involves younger population and most of these occur within the first month. This data has relevance in prioritising healthcare strategies in India. PMID:27326036

  1. Polymorphism identification and cardiac gene expression analysis of the calsequestrin 2 gene in broiler chickens with sudden death syndrome.

    PubMed

    Basaki, M; Asasi, K; Tabandeh, M R; Aminlari, M

    2016-04-01

    Sudden death syndrome (SDS) in broilers is a cardiac disease associated with ventricular tachycardia (VT) and ventricular fibrillation (VF); however, its pathogenesis at the molecular level is not precisely determined. Downregulation and mutations of calsequestrin 2 (CASQ2), a major intracellular Ca(2+) buffer, have been associated with VT and sudden cardiac death (SCD) in humans but in chickens there is no report describing CASQ2 abnormalities in cardiac diseases. In order to better understand the molecular mechanisms predisposing the myocardium to fatal arrhythmia in broilers, the mRNA expression level of chicken CASQ2 gene (chCASQ2) in the left ventricle of dead broilers with SDS was determined and compared to healthy broilers using quantitative real-time PCR (qPCR). To determine the probable mutations in chCASQ2, PCR and direct sequencing were also done. Results showed a reduction in chCASQ2 expression in broilers dead by SDS. Three novel mutations (K289R, P308S, D310H) which are absent in healthy broilers were observed in chCASQ2. It is concluded that susceptibility to fatal cardiac arrhythmia in SDS may be associated with changes in intracellular Ca(2+) balance due to mutation and downregulation of chCASQ2. PMID:26953612

  2. Genetic investigations of sudden unexpected deaths in infancy using next-generation sequencing of 100 genes associated with cardiac diseases.

    PubMed

    Hertz, Christin Loeth; Christiansen, Sofie Lindgren; Larsen, Maiken Kudahl; Dahl, Morten; Ferrero-Miliani, Laura; Weeke, Peter Ejvin; Pedersen, Oluf; Hansen, Torben; Grarup, Niels; Ottesen, Gyda Lolk; Frank-Hansen, Rune; Banner, Jytte; Morling, Niels

    2016-06-01

    Sudden infant death syndrome (SIDS) is the most frequent manner of post-perinatal death among infants. One of the suggested causes of the syndrome is inherited cardiac diseases, mainly channelopathies, that can trigger arrhythmias and sudden death. The purpose of this study was to investigate cases of sudden unexpected death in infancy (SUDI) for potential causative variants in 100 cardiac-associated genes. We investigated 47 SUDI cases of which 38 had previously been screened for variants in RYR2, KCNQ1, KCNH2 and SCN5A. Using the Haloplex Target Enrichment System (Agilent) and next-generation sequencing (NGS), the coding regions of 100 genes associated with inherited channelopathies and cardiomyopathies were captured and sequenced on the Illumina MiSeq platform. Sixteen (34%) of the SUDI cases had variants with likely functional effects, based on conservation, computational prediction and allele frequency, in one or more of the genes screened. The possible effects of the variants were not verified with family or functional studies. Eight (17%) of the SUDI cases had variants in genes affecting ion channel functions. The remaining eight cases had variants in genes associated with cardiomyopathies. In total, one third of the SUDI victims in a forensic setting had variants with likely functional effect that presumably contributed to the cause of death. The results support the assumption that channelopathies are important causes of SUDI. Thus, analysis of genes associated with cardiac diseases in SUDI victims is important in the forensic setting and a valuable supplement to the clinical investigation in all cases of sudden death. PMID:26350513

  3. Sudden Cardiac Risk Stratification with Electrocardiographic Indices - A Review on Computational Processing, Technology Transfer, and Scientific Evidence.

    PubMed

    Gimeno-Blanes, Francisco J; Blanco-Velasco, Manuel; Barquero-Pérez, Óscar; García-Alberola, Arcadi; Rojo-Álvarez, José L

    2016-01-01

    Great effort has been devoted in recent years to the development of sudden cardiac risk predictors as a function of electric cardiac signals, mainly obtained from the electrocardiogram (ECG) analysis. But these prediction techniques are still seldom used in clinical practice, partly due to its limited diagnostic accuracy and to the lack of consensus about the appropriate computational signal processing implementation. This paper addresses a three-fold approach, based on ECG indices, to structure this review on sudden cardiac risk stratification. First, throughout the computational techniques that had been widely proposed for obtaining these indices in technical literature. Second, over the scientific evidence, that although is supported by observational clinical studies, they are not always representative enough. And third, via the limited technology transfer of academy-accepted algorithms, requiring further meditation for future systems. We focus on three families of ECG derived indices which are tackled from the aforementioned viewpoints, namely, heart rate turbulence (HRT), heart rate variability (HRV), and T-wave alternans. In terms of computational algorithms, we still need clearer scientific evidence, standardizing, and benchmarking, siting on advanced algorithms applied over large and representative datasets. New scenarios like electronic health recordings, big data, long-term monitoring, and cloud databases, will eventually open new frameworks to foresee suitable new paradigms in the near future. PMID:27014083

  4. Sudden Cardiac Risk Stratification with Electrocardiographic Indices - A Review on Computational Processing, Technology Transfer, and Scientific Evidence

    PubMed Central

    Gimeno-Blanes, Francisco J.; Blanco-Velasco, Manuel; Barquero-Pérez, Óscar; García-Alberola, Arcadi; Rojo-Álvarez, José L.

    2016-01-01

    Great effort has been devoted in recent years to the development of sudden cardiac risk predictors as a function of electric cardiac signals, mainly obtained from the electrocardiogram (ECG) analysis. But these prediction techniques are still seldom used in clinical practice, partly due to its limited diagnostic accuracy and to the lack of consensus about the appropriate computational signal processing implementation. This paper addresses a three-fold approach, based on ECG indices, to structure this review on sudden cardiac risk stratification. First, throughout the computational techniques that had been widely proposed for obtaining these indices in technical literature. Second, over the scientific evidence, that although is supported by observational clinical studies, they are not always representative enough. And third, via the limited technology transfer of academy-accepted algorithms, requiring further meditation for future systems. We focus on three families of ECG derived indices which are tackled from the aforementioned viewpoints, namely, heart rate turbulence (HRT), heart rate variability (HRV), and T-wave alternans. In terms of computational algorithms, we still need clearer scientific evidence, standardizing, and benchmarking, siting on advanced algorithms applied over large and representative datasets. New scenarios like electronic health recordings, big data, long-term monitoring, and cloud databases, will eventually open new frameworks to foresee suitable new paradigms in the near future. PMID:27014083

  5. Sudden Cardiac Arrest in a Patient With Apical Hypertrophic Cardiomyopathy: Case Report and a Brief Review of Literature.

    PubMed

    Gupta, Tanush; Paul, Neha; Palaniswamy, Chandrasekar; Balasubramaniyam, Nivas; Aronow, Wilbert S; Kolte, Dhaval; Khera, Sahil; Shah, Amar B; Gass, Alan

    2016-01-01

    Apical hypertrophic cardiomyopathy (HCM) is a phenotypic variant of nonobstructive HCM, in which hypertrophy of the myocardium predominantly involves the left ventricular apex. It is common in Japanese and other Asian populations but is rare in the United States. Apical HCM has a relatively benign prognosis in terms of cardiovascular mortality; however, morbid events such as ventricular aneurysms, apical thrombi, diastolic dysfunction, atrial fibrillation, and myocardial infarction are not uncommon. We report a case of an 18-year-old white man who presented to our hospital after an out-of-hospital cardiac arrest. The patient had a witnessed collapse while playing basketball in the field. He was found to be pulseless and unresponsive by his coach, and cardiopulmonary resuscitation was immediately started. Upon arrival of emergency medical services, an automated external defibrillator advised shock and he was defibrillated thrice. Return of spontaneous circulation was achieved in 15 minutes. He was intubated for airway protection and was brought to the hospital. Therapeutic hypothermia was initiated. He demonstrated good neurological status after active rewarming. Subsequent cardiac magnetic resonance imaging was suggestive of apical HCM with right ventricular involvement. The patient underwent an implantable cardioverter defibrillator placement for secondary prevention and was subsequently discharged. In conclusion, apical HCM can rarely be associated with adverse cardiovascular events. The diagnosis may be missed on transthoracic 2-dimensional cardiac echocardiogram, and cardiac magnetic resonance imaging should be considered to exclude apical HCM in young patients who present after sudden cardiac arrest. PMID:25923227

  6. Inherited arrhythmia syndromes leading to sudden cardiac death in the young: A global update and an Indian perspective

    PubMed Central

    Chockalingam, Priya; Wilde, Arthur A.

    2014-01-01

    Inherited primary arrhythmias, namely congenital long QT syndrome, Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia, account for a significant proportion of sudden cardiac deaths in young and apparently healthy individuals. Genetic testing plays an integral role in the diagnosis, risk-stratification and treatment of probands and family members. It is increasingly obvious that collaborative efforts are required to understand and manage these relatively rare but potentially lethal diseases. This article aims to update readers on the recent developments in our knowledge of inherited arrhythmias and to lay the foundation for a national synergistic effort to characterize them in the Indian population. PMID:24568830

  7. Degree Of Diminution In Vagal-Cardiac Activity Predicts Sudden Death In Familial Dysautonomia When Resting Tachycardia Is Absent

    NASA Technical Reports Server (NTRS)

    Schlegel, T. T.; Marthol, H.; Bucchner, S.; Tutaj, M.; Berlin, D.; Axelrod, F. B.; Hilz, M. J.

    2004-01-01

    Patients with familial dysautonomia (FD) have an increased risk of sudden death, but sensitive and specific predictors of sudden death in FD are lacking. Methods. We recorded 10-min resting high-fidelity 12-lead ECGs in 14 FD patients and in 14 age/gender-matched healthy subjects and studied 25+ different heart rate variability (HRV) indices for their ability to predict sudden death in the FD patients. Indices studied included those from 4 "nonlinear" HRV techniques (detrended fluctuation analysis, approximate entropy, correlation dimension, and PoincarC analyses). The predictive value of PR, QRS, QTc and JTc intervals, QT dispersion (QTd), beat-to-beat QT and PR interval variability indices (QTVI and PRVI) and 12- lead high frequency QRS ECG (150-250 Hz) were also studied. FD patients and controls (C) differed (Pless than 0.0l) with respect to 20+ of the HRV indices (FD less than C) and with respect to QTVI and PRVI (FDBC) and HF QRS- related root mean squared voltages (FDBC) and reduced amplitude zone counts (FD less than C). They differed less with respect to PR intervals (FD less than C) and JTc intervals (FD greater than C) (P less than 0.05 for both) and did not differ at all with respect to QRS and QTc intervals and to QTd. Within 12 months after study, 2 of the 14 patients succumbed to sudden cardiac arrest. The best predictor of sudden death was the degree of diminution in HRV vagal-cardiac (parasympathetic) parameters such as RMSSD, the SDl of Poincare plots, and HF spectral power. Excluding the two FD patients who had resting tachycardia (HR greater than 100, which confounds traditional HRV analyses), the following criteria were independently 100% sensitive and 100% specific for predicting sudden death in the remaining 12 FD patients during spontaneous breathing: RMSSD less than 13 ms and/or PoincarC SD1 less than 9 ms. In FD patients without supine tachycardia, the degree of diminution in parasympathetic HRV parameters (by high-fidelity ECG) predicts

  8. Depression and Risk of Sudden Cardiac Death and Coronary Heart Disease in Women: Results from the Nurses’ Health Study

    PubMed Central

    Whang, William; Kubzansky, Laura D.; Kawachi, Ichiro; Rexrode, Kathryn M.; Kroenke, Candyce H.; Glynn, Robert J.; Garan, Hasan; Albert, Christine M.

    2008-01-01

    Objectives We assessed the association between depression and sudden cardiac death (SCD) and cardiac events among individuals without baseline coronary heart disease (CHD). Background Depression is a risk factor for cardiac events and mortality among those with CHD, possibly from arrhythmia. Methods We studied depressive symptoms, and a proxy variable for clinical depression consisting of severe symptoms and/or antidepressant medication use, and their relationship to cardiac events in the Nurses’ Health Study. Questionnaires in 1992, 1996, and 2000 assessed symptoms with the Mental Health Index (MHI-5), and antidepressant use was assessed in 1996 and 2000. Primary endpoints included SCD, fatal CHD, and non-fatal myocardial infarction (MI). Results Among 63,469 women without prior CHD/stroke in 1992, 7.9% had MHI-5 scores (<53) previously found to predict clinical depression. Depressive symptoms were associated with CHD events, and the relationship was strongest for fatal CHD, where the association remained significant even after controlling for CHD risk factors (HR=1.49; 95% CI 1.11–2.00 for MHI-5 score<53). In models from 1996 onward, our proxy variable for clinical depression was most associated with SCD in multivariable models (HR=2.33, 95% CI 1.47–3.70), and this risk was primarily due to a specific relationship between antidepressant use and SCD (HR=3.34, 95% CI 2.03–5.50). Conclusions In this cohort of women without baseline CHD, depressive symptoms were associated with fatal CHD, and a measure of clinical depression including antidepressant use was specifically associated with SCD. Although antidepressant use may be a marker of worse depression, its specific association with SCD merits further study. CONDENSED ABSTRACT We prospectively analyzed the association between depression and cardiac events in the Nurses’ Health Study. Symptoms of depression as measured by Mental Health Index (MHI-5) score were directly associated with risk of CHD events

  9. Abortion - medical

    MedlinePlus

    Therapeutic medical abortion; Elective medical abortion; Induced abortion; Nonsurgical abortion ... The pregnancy is harmful to the woman's health (therapeutic abortion). The pregnancy resulted after a traumatic event ...

  10. Syncope as a Warning Symptom of Sudden Cardiac Death in Athletes.

    PubMed

    Vettor, Giulia; Zorzi, Alessandro; Basso, Cristina; Thiene, Gaetano; Corrado, Domenico

    2015-08-01

    Clinical evaluation of syncope in the athlete remains a challenge. Although benign mechanisms predominate, syncope may be arrhythmic and precede SCD. Exercise-induced syncope should be regarded as an important alarming symptom of an underlying cardiac disease predisposing to arrhythmic cardiac arrest. All athletes with syncope require a focused and detailed workup for underlying cardiac causes, either structural or electrical. Major aim is to identify athletes at risk and to protect them from SCD. Athletes with potentially life-threatening etiologies of syncope should be restricted from competitive sports. PMID:26115828

  11. Preparticipation Screening for Sudden Cardiac Death in High School and College Athletes.

    ERIC Educational Resources Information Center

    Braden, David S.; Strong, William B.

    1988-01-01

    A properly performed screening history and cardiovascular examination can identify most young athletes at risk for sudden death from heart abnormalities. Warning signs and examiner response are discussed as well as appropriate use of echocardiography. Included is a sample preparticipation examination form recommended by the American Academy of…

  12. Brugada syndrome and right ventricle morphofunctional abnormalities on echocardiography in young male with family anamnesis of sudden cardiac death.

    PubMed

    Steiner, Robert; Makarovic, Sandra; Makarovic, Zorin; Bilic-Curcic, Ines

    2014-03-01

    First presented by Brugada and Brugada in 1992, Brugada Syndrome (BrS) is a primary electrical disease of the heart that causes sudden cardiac death or life-threatening ventricular arrhythmias. This disease is hereditary autosomic dominant transmitted and genetically determined. The syndrome has been linked to mutations in SCN5A, the gene encoding for the a-subunit of the sodium channel. Electrocardiogram (ECG) abnormalities indicating Brugada syndrome, include repolarization and depolarization abnormalities in the absence of identifiable structural cardiac abnormalities or other conditions or agents known to lead to ST-segment elevation in the right precordial leads (V1-V3). Intravenous administration of sodium channel blocking drugs may modify the ECG pattern. Ajmaline, flecainide, procainamide and propafenone exaggerate the ST-segment elevation or unmask it when it is initially absent. An implantable cardioverter-defibrillator (ICD) is the only proven effective device treatment for the disease. Although BrS is primary electrical disease, some authors have suggested the presence of morphological and functional abnormalities mainly located in the right ventricle (RV), notably in the outflow tract (RVOT). In this short report we will present a young male, with predisposition and positive family history of sudden cardiac death, with complete diagnostic procedure including propafenon testing unmasking Brugada syndrome. An echosonography revealed dilated apical right ventricle, suggesting BrS is not only electrical disorder, but may include morphofunctional abnormalities, described in previous reports. In addition, we reviewed the possible connection between Brugada syndrome and morphological abnormalities in RV. PMID:24851643

  13. Nonischemic Left Ventricular Scar as a Substrate of Life-Threatening Ventricular Arrhythmias and Sudden Cardiac Death in Competitive Athletes

    PubMed Central

    Zorzi, Alessandro; Perazzolo Marra, Martina; Rigato, Ilaria; De Lazzari, Manuel; Susana, Angela; Niero, Alice; Pilichou, Kalliopi; Migliore, Federico; Rizzo, Stefania; Giorgi, Benedetta; De Conti, Giorgio; Sarto, Patrizio; Serratosa, Luis; Patrizi, Giampiero; De Maria, Elia; Pelliccia, Antonio; Basso, Cristina; Schiavon, Maurizio; Bauce, Barbara; Iliceto, Sabino; Thiene, Gaetano

    2016-01-01

    Background— The clinical profile and arrhythmic outcome of competitive athletes with isolated nonischemic left ventricular (LV) scar as evidenced by contrast-enhanced cardiac magnetic resonance remain to be elucidated. Methods and Results— We compared 35 athletes (80% men, age: 14–48 years) with ventricular arrhythmias and isolated LV subepicardial/midmyocardial late gadolinium enhancement (LGE) on contrast-enhanced cardiac magnetic resonance (group A) with 38 athletes with ventricular arrhythmias and no LGE (group B) and 40 healthy control athletes (group C). A stria LGE pattern with subepicardial/midmyocardial distribution, mostly involving the lateral LV wall, was found in 27 (77%) of group A versus 0 controls (group C; P<0.001), whereas a spotty pattern of LGE localized at the junction of the right ventricle to the septum was respectively observed in 11 (31%) versus 10 (25%; P=0.52). All athletes with stria pattern showed ventricular arrhythmias with a predominant right bundle branch block morphology, 13 of 27 (48%) showed ECG repolarization abnormalities, and 5 of 27 (19%) showed echocardiographic hypokinesis of the lateral LV wall. The majority of athletes with no or spotty LGE pattern had ventricular arrhythmias with a predominant left bundle branch block morphology and no ECG or echocardiographic abnormalities. During a follow-up of 38±25 months, 6 of 27 (22%) athletes with stria pattern experienced malignant arrhythmic events such as appropriate implantable cardiac defibrillator shock (n=4), sustained ventricular tachycardia (n=1), or sudden death (n=1), compared with none of athletes with no or LGE spotty pattern and controls. Conclusions— Isolated nonischemic LV LGE with a stria pattern may be associated with life-threatening arrhythmias and sudden death in the athlete. Because of its subepicardial/midmyocardial location, LV scar is often not detected by echocardiography. PMID:27390211

  14. Post-mortem whole-exome sequencing (WES) with a focus on cardiac disease-associated genes in five young sudden unexplained death (SUD) cases.

    PubMed

    Neubauer, Jacqueline; Haas, Cordula; Bartsch, Christine; Medeiros-Domingo, Argelia; Berger, Wolfgang

    2016-07-01

    Sudden death of healthy young adults in the absence of any medical reason is generally categorised as autopsy-negative sudden unexplained death (SUD). Approximately 30 % of all SUD cases can be explained by lethal sequence variants in cardiac genes causing disturbed ion channel functions (channelopathies) or minimal structural heart abnormalities (cardiomyopathies). The aim of this study was to perform whole-exome sequencing (WES) in five young SUD cases in order to identify potentially disease-causing mutations with a focus on 184 genes associated with cardiac diseases or sudden death. WES analysis enabled the identification of damaging-predicted cardiac sequence alterations in three out of five SUD cases. Two SUD victims carried disease-causing variants in long QT syndrome (LQTS)-associated genes (KCNH2, SCN5A). In a third case, WES identified variants in two genes involved in mitral valve prolapse and thoracic aortic aneurism (DCHS1, TGFβ2). The genome of a fourth case carried several minor variants involved in arrhythmia pointing to a multigene influence that might have contributed to sudden death. Our results confirm that post-mortem genetic testing in SUD cases in addition to the conventional autopsy can help to identify familial cardiac diseases and can contribute to the identification of genetic risk factors for sudden death. PMID:26846766

  15. Decreased mRNA levels of cardiac Cx43 and ZO1 in sudden cardiac death related to coronary atherosclerosis: a pilot study.

    PubMed

    Xue, Ye; Zhao, Rui; Du, Si-Hao; Zhao, Dong; Li, Dong-Ri; Xu, Jing-Tao; Xie, Xiao-Li; Wang, Qi

    2016-07-01

    Sudden cardiac death (SCD) is the most frequent cause of sudden unexplained death in forensic practice. The most common cause of SCD is coronary artery disease related to coronary atherosclerosis. Previous study suggested the possible application of connexin 43 (Cx43) and zonula occludens-1 (ZO1) immunostaining in the early diagnosis of myocardial ischemia. However, there appears to be insufficient data with regard to their mRNA levels. The present study investigated the cardiac mRNA levels of Cx43 and ZO1, using forensic autopsy materials consisting of 41 control cases without any disease or structural abnormality of the heart (group 1), 32 deaths due to acute ischemic heart disease related to coronary atherosclerosis without apparent myocardial necrosis (group 2), and 29 traumatic deaths with coronary atherosclerosis (group 3). Ten candidate reference genes were evaluated in the left ventricles of 10 forensic autopsy cases. EEF1A1, PPIA, TPT1, and RPL13A were identified as the most stable reference genes. Using these validated reference genes, mRNA levels of Cx43 and ZO1 were examined in the bilateral ventricles and atria of the heart. Relative mRNA quantification demonstrated decreased calibrated normalized relative quantity (CNRQ) values of Cx43 and ZO1 in bilateral ventricles of group 2. When using one conventional reference gene (GAPDH or ACTB) for normalization, nearly no difference was detected among the three groups. These findings indicate that ventricular gap junction remodeling may be a key contributor to rhythm disturbances. Analysis of cardiac Cx43 and ZO1 using real-time PCR is useful in diagnosis of SCD, and validation of reference genes is crucial. PMID:26972693

  16. Geophysical variables and behavior: CIII. Days with sudden infant deaths and cardiac arrhythmias in adults share a factor with PC1 geomagnetic pulsations: implications for pursuing mechanism.

    PubMed

    Persinger, M A; O'Connor, R P

    2001-06-01

    If geomagnetic-mediated stimuli trigger many sudden infant deaths, then the days in which they and hospital admissions for cardiac arrhythmias for adults occur should share a similar source of variance. Factor analyses of the days in which a sudden infant death occurred in Ontario or adults were admitted for one of eight categories of cardiac crisis in the Sudbury (Ontario) Region for the year 1984 supported the hypothesis. This factor, with which infant deaths and adult cardiac arrhythmias each shared about 40% of their variance, also shared about 40% of the variance with a factor with which about 35% of the variance in daily occurrence of geomagnetic pulsations (0.2 Hz to 5 Hz) was associated. These results are consistent with the important role of geomagnetic variables in the occurrence of transient electrical anomalies in brain function rather than cardiac blood flow. PMID:11453188

  17. QT prolongation and sudden cardiac death in patients with alcoholic liver disease

    SciTech Connect

    Day, C.P.; James, O.F.W. . Dept. of Medicine); Butler, T.J. . Dept. of Medical Statistics); Campbell, R.W.F. . Dept. of Academic Cardiology)

    1993-06-05

    Cardiovascular death is the most important cause of mortality in alcoholics, yet alcohol may protect against ischemic heart disease. This could be explained if deaths were a consequence of alcohol-related arrhythmias rather than of coronary atheroma. In many conditions, abnormalities of the QT interval are markers of arrhythmia and for risk of sudden death. The authors examined the relation between QT intervals and mortality in patients with alcoholic liver disease.

  18. Electrocardiographic Screening for Prolonged QT Interval to Reduce Sudden Cardiac Death in Psychiatric Patients: A Cost-Effectiveness Analysis

    PubMed Central

    Blondon, Marc; Gex-Fabry, Marianne; Combescure, Christophe; Shah, Dipen; Schwartz, Peter J.; Besson, Marie; Girardin, François R.

    2015-01-01

    Importance Sudden cardiac death is a leading cause of mortality in psychiatric patients. Long QT (LQT) is common in this population and predisposes to Torsades-de-Pointes (TdP) and subsequent mortality. Objective To estimate the cost-effectiveness of electrocardiographic screening to detect LQT in psychiatric inpatients. Design, Setting, and Participants We built a decision analytic model based on a decision tree to evaluate the cost-effectiveness and utility of LQT screening from a health care perspective. LQT proportion parameters were derived from an in-hospital cross-sectional study. We performed experts' elicitation to estimate the risk of TdP, given extent of QT prolongation. A TdP reduction of 65% after LQT detection was based on positive drug dechallenge rate and through adequate treatment and electrolyte adjustments. The base-case model uncertainty was assessed with one-way and probabilistic sensitivity analyses. Finally, the TdP related mortality and TdP avoidance parameters were varied in a two-way sensitivity analysis to assess their effect on the Incremental Cost-Effectiveness Ratio (ICER). Main Outcomes and Measures Costs, Quality Ajusted Life Year (QALY), ICER, and probability of cost effectiveness thresholds ($ 10 000, $25 000, and $50 000 per QALY). Results In the base-case scenario, the numbers of patients needed to screen were 1128 and 2817 to avoid one TdP and one death, respectively. The ICER of systematic ECG screening was $8644 (95%CI, 3144-82 498) per QALY. The probability of cost-effectiveness was 96% at a willingness-to-pay of $50 000 for one QALY. In sensitivity analyses, results were sensitive to the case-fatality of TdP episodes and to the TdP reduction following the diagnosis of LQT. Conclusion and Relevance In psychiatric hospitals, performing systematic ECG screening at admission help reduce the number of sudden cardiac deaths in a cost-effective fashion. PMID:26070071

  19. The School Nurse Role in Preparing for Sudden Cardiac Arrest in the School Setting

    ERIC Educational Resources Information Center

    Evans, Warna K.; Ficca, Michelle

    2012-01-01

    Automated external defibrillators (AEDs) were introduced for first responders in 1992 to manage adult cardiac arrest and are now common in many public places. Today AEDs are capable of shocking children under 8 years of age, or less than 55 pounds. This presents a challenge for school nurses, particularly as the prevalence of chronic medical…

  20. Etiology of Sudden Cardiac Arrest in Patients with Epilepsy: Experience of Tertiary Referral Hospital in Sapporo City, Japan.

    PubMed

    Miyata, Kei; Ochi, Satoko; Enatsu, Rei; Wanibuchi, Masahiko; Mikuni, Nobuhiro; Inoue, Hiroyuki; Uemura, Shuji; Tanno, Katsuhiko; Narimatsu, Eichi; Maekawa, Kunihiko; Usui, Keiko; Mizobuchi, Masahiro

    2016-05-15

    It has been reported that epilepsy patients had higher risk of sudden death than that of the general population. However, in Japan, there is very little literature on the observational research conducted on sudden fatal events in epilepsy. We performed a single-center, retrospective study on all the out-of-hospital cardiac arrest (OHCA) patients treated in our emergency department between 2007 and 2013. Among the OHCA patients, we extracted those with a history of epilepsy and then analyzed the characteristics of the fatal events and the background of epilepsy. From 1,823 OHCA patients, a total of 10 cases were enrolled in our study. The median age was 34 years at the time of the incident [9-52 years; interquartile range (IQR), 24-45]. We determined that half of our cases resulted from external causes of death such as drowning and suffocation and the other half were classified as sudden unexpected death in epilepsy (SUDEP). In addition, asphyxia was implicated as the cause in eight cases. Only the two near-drowning patients were immediately resuscitated, but the remaining eight patients died. The median age of first onset of epilepsy was 12 years (0.5-30; IQR, 3-21), and the median disease duration was 25 years (4-38; IQR, 6-32). Patients with active epilepsy accounted for half of our series and they were undergoing poly anti-epileptic drug therapy. The fatal events related to epilepsy tended to occur in the younger adult by external causes. An appropriate therapeutic intervention and a thorough observation were needed for its prevention. PMID:26948699

  1. Etiology of Sudden Cardiac Arrest in Patients with Epilepsy: Experience of Tertiary Referral Hospital in Sapporo City, Japan

    PubMed Central

    MIYATA, Kei; OCHI, Satoko; ENATSU, Rei; WANIBUCHI, Masahiko; MIKUNI, Nobuhiro; INOUE, Hiroyuki; UEMURA, Shuji; TANNO, Katsuhiko; NARIMATSU, Eichi; MAEKAWA, Kunihiko; USUI, Keiko; MIZOBUCHI, Masahiro

    2016-01-01

    It has been reported that epilepsy patients had higher risk of sudden death than that of the general population. However, in Japan, there is very little literature on the observational research conducted on sudden fatal events in epilepsy. We performed a single-center, retrospective study on all the out-of-hospital cardiac arrest (OHCA) patients treated in our emergency department between 2007 and 2013. Among the OHCA patients, we extracted those with a history of epilepsy and then analyzed the characteristics of the fatal events and the background of epilepsy. From 1,823 OHCA patients, a total of 10 cases were enrolled in our study. The median age was 34 years at the time of the incident [9–52 years; interquartile range (IQR), 24–45]. We determined that half of our cases resulted from external causes of death such as drowning and suffocation and the other half were classified as sudden unexpected death in epilepsy (SUDEP). In addition, asphyxia was implicated as the cause in eight cases. Only the two near-drowning patients were immediately resuscitated, but the remaining eight patients died. The median age of first onset of epilepsy was 12 years (0.5–30; IQR, 3–21), and the median disease duration was 25 years (4–38; IQR, 6–32). Patients with active epilepsy accounted for half of our series and they were undergoing poly anti-epileptic drug therapy. The fatal events related to epilepsy tended to occur in the younger adult by external causes. An appropriate therapeutic intervention and a thorough observation were needed for its prevention. PMID:26948699

  2. Usefulness of cardiac meta-iodobenzylguanidine imaging to identify patients with chronic heart failure and left ventricular ejection fraction <35% at low risk for sudden cardiac death.

    PubMed

    Kawai, Tsutomu; Yamada, Takahisa; Tamaki, Shunsuke; Morita, Takashi; Furukawa, Yoshio; Iwasaki, Yusuke; Kawasaki, Masato; Kikuchi, Atsushi; Kondo, Takumi; Takahashi, Satoshi; Ishimi, Masashi; Hakui, Hideyuki; Ozaki, Tatsuhisa; Sato, Yoshihiro; Seo, Masahiro; Sakata, Yasushi; Fukunami, Masatake

    2015-06-01

    Patients with chronic heart failure (CHF) at risk of sudden cardiac death (SCD) are often treated with implantable cardiac defibrillators (ICDs). However, current criteria for device use that is based largely on left ventricular ejection fraction (LVEF) lead to many patients receiving ICDs that never deliver therapy. It is of clinical significance to identify patients who do not require ICDs. Although cardiac I-123 meta-iodobenzylguanidine (MIBG) imaging provides prognostic information about CHF, whether it can identify patients with CHF who do not require an ICD remains unclear. We studied 81 patients with CHF and LVEF <35%, assessed by cardiac MIBG imaging at enrollment. The heart-to-mediastinal ratio (H/M) in delayed images and washout rates were divided into 6 grades from 0 to 5, according to the degree of deviation from control values. The study patients were classified into 3 groups: low (1 to 4), intermediate (5 to 7), and high (8 to 10), according to the MIBG scores defined as the sum of the H/M and washout rate scores. Sixteen patients died of SCD during a follow-up period. Patients with low MIBG score had a significantly lower risk of SCD than those with intermediate and high scores (low [n = 19], 0%; intermediate [n = 37], 19%; high [n = 25], 36%; p = 0.001). The positive predictive value of low MIBG score for identifying patients without SCD was 100%. In conclusion, the MIBG score can identify patients with CHF and LVEF <35% who have low risk of developing SCD. PMID:25851796

  3. Targeted next generation sequencing application in cardiac channelopathies: Analysis of a cohort of autopsy-negative sudden unexplained deaths.

    PubMed

    Farrugia, A; Keyser, C; Hollard, C; Raul, J S; Muller, J; Ludes, B

    2015-09-01

    Genetic testing for cardiac channelopathies in sudden unexplained death (SUD) has developed substantially over the last years. The Next Generation Sequencing (NGS) technology provides an unprecedented opportunity to screen for genetic variations underlying arrhythmogenic genes in a short period of time at a low cost. The present study aimed to perform genetic testing with NGS technologies on the Ion Torrent Personal Genome Machine™ (Ion PGM™) sequencer, in targeting a total of 23 genes reported to be associated with inherited cardiac channelopathies in order to identify the possible cause of death in a cohort of post-mortem cases. The molecular analyses focused on 16 cases of SUD, aged less than 35 years old. In all cases, the cause of death could not be determined after a rigorous autopsy associated with histopathological and toxicological analyses according to the guidelines of the Association for European Cardiovascular Pathology. DNA was extracted from fresh frozen tissue. An average of 200 variants was identified per case. However, after the prioritization process using a new scoring program (VaRank) and after the conjunction of clinical data and molecular findings, four "likely pathogenic" variants (including two undescribed variants), were identified in three cases (18.75%) of our cohort in the genes KCNH2, ANK2, SCN5A and RYR2. One case, who died during psychiatric hospitalization after administration of a QT prolonging drug, showed a double "likely pathogenic" variant in Long QT genes (ANK2 and SCN5A) which may have predisposed to drug-induced cardiac arrhythmias. Our study illustrates that the NGS approach based on AmpliSeq™ libraries and Ion Torrent PGM™ sequencing may be an efficient approach, integrated to post-mortem examination. Given the massive amount of information generated by NGS, a rigorous filtration strategy of variants coupled with multidisciplinary collaboration is crucial to determine the potential pathogenic role of identified

  4. Abortion - surgical

    MedlinePlus

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... problem. Your pregnancy is harmful to your health (therapeutic abortion). The pregnancy resulted after a traumatic event ...

  5. Can the direct cardiac effects of the electric pulses generated by the TASER X26 cause immediate or delayed sudden cardiac arrest in normal adults?

    PubMed

    Ideker, Raymond E; Dosdall, Derek J

    2007-09-01

    There is only a small amount of experimental data about whether the TASER X26, a nonlethal weapon that delivers a series of brief electrical pulses to cause involuntary muscular contraction to temporarily incapacitate an individual, can initiate ventricular fibrillation to cause sudden cardiac arrest either immediately or sometime after its use. Therefore, this paper uses the fundamental law of electrostimulation and experimental data from the literature to estimate the likelihood of such events. Because of the short duration of the TASER pulses, the large duration of the cardiac cell membrane time constant, the small fraction of current from electrodes on the body surface that passes through the heart, and the resultant high pacing threshold from the body surface, the fundamental law of electrostimulation predicts that the TASER pulses will not stimulate an ectopic beat in the large majority of normal adults. Since the immediate initiation of ventricular fibrillation in a normal heart requires a very premature stimulated ectopic beat and the threshold for such premature beats is higher than less premature beats, it is unlikely that TASER pulses can immediately initiate ventricular fibrillation in such individuals through the direct effect of the electric field generated through the heart by the TASER. In the absence of preexisting heart disease, the delayed development of ventricular fibrillation requires the electrical stimuli to cause electroporation or myocardial necrosis. However, the electrical thresholds for electroporation and necrosis are many times higher than that required to stimulate an ectopic beat. Therefore, it is highly unlikely that the TASER X26 can cause ventricular fibrillation minutes to hours after its use through direct cardiac effects of the electric field generated by the TASER. PMID:17721165

  6. Fibromuscular Dysplasia Leading to Spontaneous Coronary Artery Dissection with Sudden Cardiac Arrest

    PubMed Central

    Bajwa, Ata; Bhatnagar, Udit; Sharma, Amit; El-Halawany, Hani; Thompson, Randall C.

    2015-01-01

    A 30-year-old previously healthy female, who was six-week postpartum, experienced sudden collapse and tonic-clonic seizure. Emergency medicine services arrived at the scene and the patient was found to be in ventricular fibrillation. Advanced cardiovascular life support (ACLS) was initiated with return of spontaneous circulation. Afterwards, her initial EKG showed atrial fibrillation with rapid ventricular rate, ST elevation in leads II, III, and aVF, and ST depression in V2–V4. She was transferred to a tertiary care hospital where emergent angiogram was performed revealing obstruction of blood flow in the proximal and mid right coronary artery (RCA). A hazy and irregularly contoured appearance of the RCA was consistent with diagnosis of fibromuscular dysplasia. Subsequently, intravascular ultrasonogram (IVUS) was performed which confirmed the diagnosis of RCA dissection. Successful revascularization of the RCA was performed using two bare mental stents. After a complicated course in hospital, she was discharged in stable condition and did very well overall. PMID:26146572

  7. Genome-Wide Association Study Identifies GPC5 as a Novel Genetic Locus Protective against Sudden Cardiac Arrest

    PubMed Central

    Post, Wendy; Jui, Jonathan; Hilton, Gina; O'Connor, Ashley; Prineas, Ronald J.; Boerwinkle, Eric; Psaty, Bruce M.; Tomaselli, Gordon F.; Rea, Thomas; Sotoodehnia, Nona; Siscovick, David S.; Burke, Gregory L.; Marban, Eduardo; Spooner, Peter M.

    2010-01-01

    Background Existing studies indicate a significant genetic component for sudden cardiac arrest (SCA) and genome-wide association studies (GWAS) provide an unbiased approach for identification of novel genes. We performed a GWAS to identify genetic determinants of SCA. Methodology/Principal Findings We used a case-control design within the ongoing Oregon Sudden Unexpected Death Study (Oregon-SUDS). Cases (n = 424) were SCAs with coronary artery disease (CAD) among residents of Portland, OR (2002–07, population ∼1,000,000) and controls (n = 226) were residents with CAD, but no history of SCA. All subjects were of White-European ancestry and GWAS was performed using Affymetrix 500K/5.0 and 6.0 arrays. High signal markers were genotyped in SCA cases (n = 521) identified from the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS) (combined n = 19,611). No SNPs reached genome-wide significance (p<5×10−8). SNPs at 6 loci were prioritized for follow-up primarily based on significance of p<10−4 and proximity to a known gene (CSMD2, GPR37L1, LIN9, B4GALNT3, GPC5, and ZNF592). The minor allele of GPC5 (GLYPICAN 5, rs3864180) was associated with a lower risk of SCA in Oregon-SUDS, an effect that was also observed in ARIC/CHS whites (p<0.05) and blacks (p<0.04). In a combined Cox proportional hazards model analysis that adjusted for race, the minor allele exhibited a hazard ratio of 0.85 (95% CI 0.74 to 0.98; p<0.01). Conclusions/Significance A novel genetic locus for SCA, GPC5, was identified from Oregon-SUDS and successfully validated in the ARIC and CHS cohorts. Three other members of the Glypican family have been previously implicated in human disease, including cardiac conditions. The mechanism of this specific association requires further study. PMID:20360844

  8. ECG risk markers for atrial fibrillation and sudden cardiac death in minimally symptomatic obstructive sleep apnoea: the MOSAIC randomised trial

    PubMed Central

    Schlatzer, Christian; Bratton, Daniel J; Craig, Sonja E; Kohler, Malcolm; Stradling, John R

    2016-01-01

    Objective Obstructive sleep apnoea (OSA), atrial fibrillation (AF) and sudden cardiac death (SCD) may occur concomitantly, and are of considerable epidemiological interest, potentially leading to morbidity and mortality. Effective treatment of OSA with continuous positive airway pressure (CPAP) could prevent progression and/or recurrence of AF and factors leading to SCD. Recently, a randomised controlled trial showed a statistically and clinically significant prolongation of measures of cardiac repolarisation after CPAP withdrawal in symptomatic patients with moderate to severe OSA. Whether or not CPAP therapy improves ECG risk markers of AF and SCD in patients with minimally symptomatic OSA as well, is unknown. Methods 3 centres taking part in the MOSAIC (Multicentre Obstructive Sleep Apnoea Interventional Cardiovascular) trial randomisd 303 patients with minimally symptomatic OSA to receive either CPAP or standard care for 6 months. Treatment effects of CPAP on P-wave duration, P-wave dispersion, QT interval, QT dispersion, Tpeak-to-Tend (TpTe) and TpTe/QT ratio were analysed. Results Participants were primarily men (83%). Mean age was 57.8 (7.2) and mean ODI (Oxygen Desaturation Index) at baseline was 13.1/h (12.3). Full 12-lead ECG data was available in 250 patients. Mean (SD) baseline intervals of P-wave duration, P-wave dispersion, QTc interval, QT dispersion, TpTe and TpTe/QT ratio in ms were 87.4 (8.3), 42.3 (11.9), 397.8 (22.7), 43.1 (16.7), 73.5 (13.7) and 0.19 (0.0), respectively. No treatment effect of CPAP on risk markers for AF and SCD was found. Conclusions There seems to be no effect of CPAP on ECG measures of arrhythmia risk in patients with minimally symptomatic OSA. Trial registration number ISRCTN34164388; Post-results. PMID:26983946

  9. Fatalities after taking ibogaine in addiction treatment could be related to sudden cardiac death caused by autonomic dysfunction.

    PubMed

    Maas, U; Strubelt, S

    2006-01-01

    Ibogaine is the most important alkaloid of the Central African Iboga-shrub. It is the central drug in Gabonian initiation ceremonies in which it is used to cause a near-death experience. In Western countries it is used in private clinics to treat addiction. However, in the United States and most European countries it is classified as an illegal drug because at least eight persons have died after having taken Ibogaine. These fatalities occurred in most cases several days after ingestion or following the intake of very small doses. There is no conclusive explanation at the present time for these deaths. We hypothesize, that these deaths may be a result of cardiac arrhythmias, caused by a dysregulation of the autonomic nervous system. Ibogaine affects the autonomic nervous system by influencing several neurotransmitter-systems and the fastigial nucleus. The cerebellar nucleus responds to small doses with a stimulation of the sympathetic system, leading to a fight or flight reaction. High doses, however, lead to a vagal dominance: a "feigned death". The risk of cardiac arrhythmias is increased in situations of sympathetic stimulation or coincidence of a high parasympathetic tonus and a left-sided sympathetic stimulation. This could occur under influence of small doses of ibogaine and also at times of exhaustion with a high vagal tonus, when sudden fear reactions could cause a critical left-sided sympathetic stimulation. Gabonian healers prevent these risks by isolating their patients from normal life and by inducing a trance-state with right-hemispheric and vagal dominance for several days. PMID:16698188

  10. Incidence of sudden cardiac death in Germany: results from an emergency medical service registry in Lower Saxony

    PubMed Central

    Martens, Eimo; Sinner, Moritz F.; Siebermair, Johannes; Raufhake, Carsten; Beckmann, Britt M.; Veith, Stefan; Düvel, Dieter; Steinbeck, Gerhard; Kääb, Stefan

    2014-01-01

    Aims Sudden cardiac death (SCD) is among the most common causes of death in western countries including Germany. Whereas risk stratification and primary prevention is still insufficient, we also lack accurate incidence estimates. Current estimates vary widely (18.6–128/100 000/year), but data on SCD incidence in Germany are missing. Depending on SCD definitions, death needs to occur between 1 and 24 h after the onset of symptoms. Methods and results In the district of Aurich (190 000 inhabitants, Lower Saxony, Germany), emergency medical service (EMS) is provided by a district government operated single carrier and two hospitals. To evaluate all EMS calls in this district from 2002 to 2009, we obtained EMS protocols, medical records, and death certificates for data analysis and adjudication of SCD. We defined SCD according to the definition of the World Health Organization, considering patients with cardiac arrest within ≤1 h after the onset of symptoms. We also required cardiopulmonary resuscitation being performed by EMS personnel. The overall mortality rate in the district of Aurich (1060/100 000/year) corresponded well with the average mortality rate in Germany (1030/100 000/year). During the observation period, we adjudicated 1212 SCD cases, equivalent to an annual rate of 151 SCD cases (81 cases/100 000/year). Rates remained remarkably stable over time, and affected a considerable number of individuals of working age (32/100 000/year). Conclusion Consistent with prior reports, the SCD incidence in a district of Germany is substantial. Despite an elaborate EMS system and advanced medical care, SCD rates remain stable and necessitate improved, individualized risk stratification. PMID:25061228

  11. Functional characterization of CaVα2δ mutations associated with sudden cardiac death.

    PubMed

    Bourdin, Benoîte; Shakeri, Behzad; Tétreault, Marie-Philippe; Sauvé, Rémy; Lesage, Sylvie; Parent, Lucie

    2015-01-30

    L-type Ca(2+) channels play a critical role in cardiac rhythmicity. These ion channels are oligomeric complexes formed by the pore-forming CaVα1 with the auxiliary CaVβ and CaVα2δ subunits. CaVα2δ increases the peak current density and improves the voltage-dependent activation gating of CaV1.2 channels without increasing the surface expression of the CaVα1 subunit. The functional impact of genetic variants of CACNA2D1 (the gene encoding for CaVα2δ), associated with shorter repolarization QT intervals (the time interval between the Q and the T waves on the cardiac electrocardiogram), was investigated after recombinant expression of the full complement of L-type CaV1.2 subunits in human embryonic kidney 293 cells. By performing side-by-side high resolution flow cytometry assays and whole-cell patch clamp recordings, we revealed that the surface density of the CaVα2δ wild-type protein correlates with the peak current density. Furthermore, the cell surface density of CaVα2δ mutants S755T, Q917H, and S956T was not significantly different from the cell surface density of the CaVα2δ wild-type protein expressed under the same conditions. In contrast, the cell surface expression of CaVα2δ D550Y, CaVα2δ S709N, and the double mutant D550Y/Q917H was reduced, respectively, by ≈30-33% for the single mutants and by 60% for the latter. The cell surface density of D550Y/Q917H was more significantly impaired than protein stability, suggesting that surface trafficking of CaVα2δ was disrupted by the double mutation. Co-expression with D550Y/Q917H significantly decreased CaV1.2 currents as compared with results obtained with CaVα2δ wild type. It is concluded that D550Y/Q917H reduced inward Ca(2+) currents through a defect in the cell surface trafficking of CaVα2δ. Altogether, our results provide novel insight in the molecular mechanism underlying the modulation of CaV1.2 currents by CaVα2δ. PMID:25527503

  12. Outcomes After Implantable Cardioverter-Defibrillator Generator Replacement for Primary Prevention of Sudden Cardiac Death

    PubMed Central

    Madhavan, Malini; Waks, Jonathan W.; Friedman, Paul A.; Kramer, Daniel B.; Buxton, Alfred E.; Noseworthy, Peter A.; Mehta, Ramila A.; Hodge, David O.; Higgins, Angela Y.; Webster, Tracy L.; Witt, Chance M.; Cha, Yong-Mei; Gersh, Bernard J.

    2016-01-01

    Background The effectiveness of implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden death in patients with an ejection fraction (EF) ≤35% and clinical heart failure is well established. However, outcomes after replacement of the ICD generator in patients with recovery of EF to >35% and no previous therapies are not well characterized. Methods and Results Between 2001 and 2011, generator replacement was performed at 2 tertiary medical centers in 253 patients (mean age, 68.3±12.7 years; 82% men) who had previously undergone ICD placement for primary prevention but subsequently never received appropriate ICD therapy. EF had recovered to >35% in 72 of 253 (28%) patients at generator replacement. During median (quartiles) follow-up of 3.3 (1.8–5.3) years after generator replacement, 68 of 253 (27%) experienced appropriate ICD therapy. Patients with EF ≤35% were more likely to experience ICD therapy compared with those with EF >35% (12% versus 5% per year; hazard ratio, 3.57; P=0.001). On multivariable analysis, low EF predicted appropriate ICD therapy after generator replacement (hazard ratio, 1.96 [1.35–2.87] per 10% decrement; P=0.001). Death occurred in 25% of patients 5 years after generator replacement. Mortality was similar in patients with EF ≤35% and >35% (7% versus 5% per year; hazard ratio, 1.10; P=0.68). Atrial fibrillation (3.24 [1.63–6.43]; P<0.001) and higher blood urea nitrogen (1.28 [1.14–1.45] per increase of 10 mg/dL; P<0.001) were associated with mortality. Conclusions Although approximately one fourth of patients with a primary prevention ICD and no previous therapy have EF >35% at the time of generator replacement, these patients continue to be at significant risk for appropriate ICD therapy (5% per year). These data may inform decisions on ICD replacement. PMID:26921377

  13. Abortion - medical

    MedlinePlus

    Therapeutic medical abortion; Elective medical abortion; Induced abortion; Nonsurgical abortion ... A medical, or nonsurgical, abortion can be done within 7 weeks from the first day of the woman's last ...

  14. Under-Utilization of Implantable Cardioverter Defibrillators in Patients with Heart Failure - The Current State of Sudden Cardiac Death Prophylaxis

    PubMed Central

    Pillarisetti, Jayasree; Emert, Martin; Biria, Mazda; Chotia, Rashaad; Guda, Rajeshwer; Bommana, Sudharani; Pimentel, Rhea; Vacek, James; Dendi, Raghuveer; Berenbom, Loren; Dawn, Buddhadeb; Lakkireddy, Dhanunjaya

    2016-01-01

    Background Despite ACC/AHA guidelines indicating implantable cardioverter defibrillator (ICD) as class I therapy for primary prevention of sudden cardiac death in patients with EF≤35%, ICD utilization rates in real world practice have been low. Objective To determine the rate of ICD implantation at a tertiary care academic center and to assess the reasons for under-utilization of the same. Methods Review of a prospectively collected database which included all patients diagnosed with an EF≤35% was performed to assess the rate of ICD implantation and mortality. Reasons for non-implantation of ICD were then assessed from detailed chart review. Results A total of 707 patients (age 69.4 ± 14.1 years) with mean EF of 26±7% were analyzed. Only 28% (200/707) of patients had ICDs implanted. Mortality was lower in the group with ICD (25% vs 37%, p=0.004). When patients who either died or were lost to follow-up prior to 2005 were excluded, ICD utilization rate was still low at 37.6%. The most common reason for non-implantation of ICD was physicians not discussing this option with their patients. Patient refusal was the second most common reason. Conclusions ICD Implantation rates for primary prevention of SCD in patients with EF≤35% is low. Physician and patient education should be addressed to improve the utilization rates. PMID:25852239

  15. Ryanodine receptors/calcium release channels in heart failure and sudden cardiac death.

    PubMed

    Marks, A R

    2001-04-01

    Calcium (Ca2+) ions are second messengers in signaling pathways in all types of cells. They regulate muscle contraction, electrical signals which determine the cardiac rhythm and cell growth pathways in the heart. In the past decade cDNA cloning has provided clues as to the molecular structure of the intracellular Ca2+ release channels (ryanodine receptors, RyR, and inositol 1,4,5-trisphosphate receptors, IP3R) on the sarcoplasmic and endoplasmic reticulum (SR/ER) and an understanding of how these molecules regulate Ca2+ homeostasis in the heart is beginning to emerge. The intracellular Ca2+ release channels form a distinct class of ion channels distinguished by their structure, size, and function. Both RyRs and IP3Rs have gigantic cytoplasmic domains that serve as scaffolds for modulatory proteins that regulate the channel pore located in the carboxy terminal 10% of the channel sequence. The channels are tetramers comprised of four RyR or IP3R subunits. RyR2 is required for excitation-contraction (EC) coupling in the heart. Using co-sedimentation and co-immunoprecipitation we have defined a macromolecular complex comprised of RyR2, FKBP12.6, PKA, the protein phosphatases PP1 and PP2A, and an anchoring protein mAKAP. We have shown that protein kinase A (PKA) phosphorylation of RyR2 dissociates FKBP12.6 and regulates the channel open probability (P(o)). In failing human hearts RyR2 is PKA hyperphosphorylated resulting in defective channel function due to increased sensitivity to Ca2+-induced activation. PMID:11273716

  16. Blinded Evaluation of Combination Drug Therapy for Prolonged Ventricular Fibrillation Using a Swine Model of Sudden Cardiac Arrest.

    PubMed

    Mader, Timothy J; Coute, Ryan A; Kellogg, Adam R; Nathanson, Brian H

    2016-01-01

    Despite experimental evidence supporting the use of resuscitation drugs in the treatment of sudden cardiac arrest (CA), there are no good human clinical data to support the decades-old practice of giving these medications during out-of-hospital CA resuscitation. We hypothesized that the lack of efficacy in clinical practice in ventricular fibrillation (VF) is the failure-based manner in which resuscitation drugs have historically been administered (one at a time interspersed with chest compressions and a defibrillation attempt, giving the next only if the previous one was ineffective). The aim of this study was to determine if giving and circulating a combination of commonly available, historically used resuscitation drugs together, prior to the first defibrillation attempt after prolonged VF, might improve short-term outcomes compared with the failure-based serial drug approach used in the past. We used a well-established swine model of sudden prolonged untreated VF. Animals were randomized to receive epinephrine (0.01 mg/kg), vasopressin (0.5 U/kg), amiodarone (4 mg/kg), and sodium bicarbonate (1.0 mEq/kg) in series (SERIES group [n = 53]) or a combination of epinephrine (0.01 mg/kg), vasopressin (0.5 U/kg), amiodarone (4 mg/kg), sodium bicarbonate (1.0 mEq/kg), and metoprolol (0.2 mg/kg) (COCKTAIL group) delivered in rapid succession at the beginning of the attempted resuscitation (n = 27). Data were analyzed descriptively. Baseline characteristics and chemistries between the two groups were the same. Termination of VF was statistically similar in the two groups: 88.7% (47/53) versus 85.2% (23/27) p = 0.66, with an adjusted relative risk ratio (RRR) of 0.94 (0.37, 1.15). However, ROSC was higher in the SERIES group (56.6% [30/53] versus 22.2% [6/27], adjusted RRR = 2.83; [1.16, 3.84] p = 0.029) as was 20-minute survival (52.8% [28/53] versus 18.5% [5/27], adjusted RRR = 3.15 [1.14, 4.54] p = 0.032). The combination of drugs studied, at these dosages

  17. Perceptions of an implantable cardioverter-defibrillator: A qualitative study of families with a history of sudden life-threatening cardiac events and recommendations to improve care

    PubMed Central

    Linder, Jarrett; Hidayatallah, Nadia; Stolerman, Marina; McDonald, Thomas V.; Marion, Robert; Walsh, Christine; Dolan, Siobhan

    2014-01-01

    Objective To identify major concerns associated with implantable cardioverter-defibrillators (ICDs) and to provide recommendations to adult and pediatric physicians involved in the care of patients with ICDs. Background Cardiac ion channelopathies are a well-recognized cause of sudden cardiac death in infants, children, adolescents, and young adults. ICDs are effective in preventing sudden death from fatal arrhythmias in patients with known cardiac channelopathies. There is a paucity of research on the effect of ICDs on quality of life in patients with cardiac channelopathy diagnoses, especially young patients. Methods A qualitative study interviewing patients and families affected by inherited arrhythmias was conducted. Fifty participants with personal or family histories of cardiac events or sudden death were interviewed individually or in focus groups by clinical psychologists. All interviews were transcribed verbatim and then analyzed and coded based on current qualitative research theory to identify themes related to the research question. Twenty-four participants discussed ICDs in their interviews. Results Participants reported concerns about ICDs, and these concerns were categorized into six themes: (1) comprehension and physician-patient communication; (2) anxiety; (3) restrictions and fallacies; (4) complications; (5) utility; and (6) alternative therapy. Participants noted communication breakdowns between providers and their colleagues, and between providers and their patients. Participants and their families experienced many different forms of anxiety, including worry about the aesthetics of the ICDs and fears of being shocked. Multiple restrictions, fallacies, and complications were also cited. Conclusion Interview themes were used to formulate recommendations for counseling and educating patients with ICDs. PMID:25383067

  18. Body Mass Index as a Predictor of Sudden Cardiac Death and Usefulness of the Electrocardiogram for Risk Stratification.

    PubMed

    Eranti, Antti; Aro, Aapo L; Kerola, Tuomas; Tikkanen, Jani T; Rissanen, Harri A; Anttonen, Olli; Junttila, M Juhani; Knekt, Paul; Huikuri, Heikki V

    2016-02-01

    Evidence of the role of body mass index (BMI) as a risk factor for sudden cardiac death (SCD) is conflicting, and how electrocardiographic (ECG) SCD risk markers perform in subjects with different BMIs is not known. In this study, a general population cohort consisting of 10,543 middle-aged subjects (mean age 44 years, 52.7% men) was divided into groups of lean (BMI <20, n = 374), normal weight (BMI 20.0 to 24.9, n = 4,334), overweight (BMI 25.0 to 29.9, n = 4,390), and obese (BMI >30, n = 1,445) subjects. Cox proportional hazards models adjusted for confounders were used to assess the risk for SCD associated with BMI and the risk for SCD associated with ECG abnormalities in subjects with different BMIs. The overweight and obese subjects were at increased risk for SCD (hazard ratios [95% CIs] were 1.33 [1.13 to 1.56], p = 0.001 and 1.79 [1.44 to 2.23], p <0.001 for overweight and obese subjects, respectively). The risk of non-SCD had a similar relation with BMI as SCD. Hazard ratios associated with ECG abnormalities were 3.03, 1.75, 1.74, and 1.34 in groups of lean, normal weight, overweight, and obese subjects, respectively, but no statistical significance was reached in the obese. ECG abnormalities improved integrated discrimination indexes and continuous net reclassification indexes statistically significantly only in the normal weight group. In conclusion, the overweight and obese are at increased risk for SCD but also for non-SCD, and ECG abnormalities are associated with increased risk of SCD also in normal weight subjects presenting with less traditional cardiovascular risk factors. PMID:26723105

  19. Effect of Left Ventricular Dysfunction and Viral Load on Risk of Sudden Cardiac Death In Patients with Human Immunodeficiency Virus

    PubMed Central

    Moyers, Brian S.; Secemsky, Eric A.; Vittinghoff, Eric; Wong, Joseph K.; Havlir, Diane V.; Hsue, Priscilla Y.; Tseng, Zian H.

    2014-01-01

    Human Immunodeficiency Virus-infected patients are disproportionately affected by cardiovascular disease and sudden cardiac death (SCD). Whether left ventricular (LV) dysfunction predicts SCD in those with human immunodeficiency virus (HIV) is unknown. We sought to determine the impact of LV on SCD in patients with HIV. We previously characterized all SCDs and AIDS deaths in 2860 consecutive patients in a public HIV clinic between 2000 and 2009. Transthoracic echocardiograms (TTEs) performed during the study period were identified. The effect of ejection fraction (EF), diastolic dysfunction, pulmonary artery pressure, and LV mass on SCD and acquired immune deficiency syndrome (AIDS) death were evaluated: 423 patients had at least one TTE; 13 SCDs and 55 AIDS deaths had at least one TTE. In the propensity-adjusted analysis, EF 30–39% and EF <30% predicted SCD (HR 9.5, 95% CI 1.7–53.3, p=0.01 and HR 38.5, 95% CI 7.6–195.0, p<0.001, respectively) but not AIDS death. Diastolic dysfunction also predicted SCD (HR 14.8, 95% CI 4.0–55.4, p<0.001) but not AIDS death, even after adjusting for EF. The association between EF<40% and SCD was greater in subjects with detectable vs. undetectable HIV-RNA (adjusted HR 11.7, 95% CI 2.9–47.2, p=0.001 vs. HR 2.7, 95% CI 0.3–27.6, p=0.41; p=0.07 for interaction). In conclusion, LV systolic and diastolic dysfunction predict SCD but not AIDS death in a large HIV cohort, with greater effect in those with detectable HIV RNA. Further investigation is needed to thoroughly evaluate the effect of low EF and HIV factors on SCD incidence and the potential benefit of implantable cardioverter-defibrillator therapy in this high-risk population. PMID:24521717

  20. Effect of left ventricular dysfunction and viral load on risk of sudden cardiac death in patients with human immunodeficiency virus.

    PubMed

    Moyers, Brian S; Secemsky, Eric A; Vittinghoff, Eric; Wong, Joseph K; Havlir, Diane V; Hsue, Priscilla Y; Tseng, Zian H

    2014-04-01

    Human immunodeficiency virus (HIV)-infected patients are disproportionately affected by cardiovascular disease and sudden cardiac death (SCD). Whether left ventricular (LV) dysfunction predicts SCD in those with HIV is unknown. We sought to determine the impact of LV dysfunction on SCD in patients with HIV. We previously characterized all SCDs and acquired immunodeficiency syndrome (AIDS) deaths in 2,860 consecutive patients in a public HIV clinic from 2000 to 2009. Transthoracic echocardiograms (TTEs) performed during the study period were identified. The effect of ejection fraction (EF), diastolic dysfunction, pulmonary artery pressure, and LV mass on SCD and AIDS death were evaluated: 423 patients had at least 1 TTE; 13 SCDs and 55 AIDS deaths had at least 1 TTE. In the propensity-adjusted analysis, EF 30% to 39% and EF<30% predicted SCD (hazard ratio [HR] 9.5, 95% confidence interval [CI] 1.7 to 53.3, p=0.01 and HR 38.5, 95% CI 7.6 to 195.0, p<0.001, respectively) but not AIDS death. Diastolic dysfunction also predicted SCD (HR 14.8, 95% CI 4.0 to 55.4, p<0.001) but not AIDS death, even after adjusting for EF. The association between EF<40% and SCD was greater in subjects with detectable versus undetectable HIV RNA (adjusted HR 11.7, 95% CI 2.9 to 47.2, p=0.001 vs HR 2.7, 95% CI 0.3 to 27.6, p=0.41; p=0.07 for interaction). In conclusion, LV systolic dysfunction and diastolic dysfunction predict SCD but not AIDS death in a large HIV cohort, with greater effect in those with detectable HIV RNA. Further investigation is needed to thoroughly evaluate the effect of low EF and HIV factors on SCD incidence and the potential benefit of implantable cardioverter-defibrillator therapy in this high-risk population. PMID:24521717

  1. Sudden cardiac arrest in sports - need for uniform registration: A Position Paper from the Sport Cardiology Section of the European Association for Cardiovascular Prevention and Rehabilitation.

    PubMed

    Solberg, E E; Borjesson, M; Sharma, S; Papadakis, M; Wilhelm, M; Drezner, J A; Harmon, K G; Alonso, J M; Heidbuchel, H; Dugmore, D; Panhuyzen-Goedkoop, N M; Mellwig, K-P; Carre, F; Rasmusen, H; Niebauer, J; Behr, E R; Thiene, G; Sheppard, M N; Basso, C; Corrado, D

    2016-04-01

    There are large variations in the incidence, registration methods and reported causes of sudden cardiac arrest/sudden cardiac death (SCA/SCD) in competitive and recreational athletes. A crucial question is to which degree these variations are genuine or partly due to methodological incongruities. This paper discusses the uncertainties about available data and provides comprehensive suggestions for standard definitions and a guide for uniform registration parameters of SCA/SCD. The parameters include a definition of what constitutes an 'athlete', incidence calculations, enrolment of cases, the importance of gender, ethnicity and age of the athlete, as well as the type and level of sporting activity. A precise instruction for autopsy practice in the case of a SCD of athletes is given, including the role of molecular samples and evaluation of possible doping. Rational decisions about cardiac preparticipation screening and cardiac safety at sport facilities requires increased data quality concerning incidence, aetiology and management of SCA/SCD in sports. Uniform standard registration of SCA/SCD in athletes and leisure sportsmen would be a first step towards this goal. PMID:26285770

  2. Sudden Cardiac Death Associated with Anomalous Origin of the Left Main Coronary Artery from the Right Sinus, with an Intramural Course

    PubMed Central

    Chang, Huai-Ren; Hsieh, Jen-Che; Chao, Shen-Feng; Wang, Ji-Hung

    2015-01-01

    Anomalous origin of the left main coronary artery from the right sinus of Valsalva is extremely rare and can lead to sudden cardiac death. We report a case in which an 18-year-old college student collapsed immediately after a long-distance run of 10 km. After cardiopulmonary resuscitation and electrical shock for ventricular fibrillation, she experienced a return of spontaneous circulation. Cardiac catheterization and cardiac computed tomographic angiography revealed an unusually long intramural course of the left main coronary artery from the right sinus of Valsalva. The young woman underwent a successful unroofing operation for coronary artery correction. She remained asymptomatic upon exercise during 2.5 years of follow-up. PMID:26664310

  3. Abortion - surgical

    MedlinePlus

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  4. Sudden Cardiac Arrest (SCA)

    MedlinePlus

    ... Search: Education & Meetings Scientific Sessions Certified Education Courses & Online Learning Heart Rhythm On Demand Co-Sponsored & Endorsed Events ... Education & Meetings less Scientific Sessions Certified Education Courses & Online Learning Heart Rhythm On Demand Co-Sponsored & Endorsed Events ...

  5. Involvement of neuroleptic drugs in selenium deficiency and sudden death of cardiac origin: study and human post-mortem examination.

    PubMed

    Hamdan, Lamia; Bost, Muriel; Chazot, Guy; Bui-Xuan, Bernard; Vaillant, Fanny; Dehina, Leila; Descotes, Jacques; Tabib, Alain; Mamou, Zahida; Timour, Quadiri

    2012-06-01

    The involvement of psychotropic drugs in sudden deaths has been highlighted. The objective of this work was to establish a link between selenium levels in heart tissue, psychotropic treatment and sudden death. Selenium levels were measured by electrothermal atomic absorption spectroscopy post-mortem in heart, brain and liver. Histological examination evidenced dilated cardiomyopathy in 45% of cases, left ventricular hypertrophy in 36%, and ischemic coronaropathy in 18%. A significant reduction of myocardial selenium levels compared to controls was seen in patients treated with neuroleptic drugs or meprobamate. No changes in brain or liver selenium levels were seen. These results suggest that selenium deficiency can facilitate sudden death in patients on psychotropic drugs. The reduced activity of glutathione peroxidase due to selenium deficiency can result in augmented oxidative stress in myocardial cells and myocardiopathy leading to sudden death. PMID:22664334

  6. How are European patients at risk of malignant arrhythmias or sudden cardiac death identified and informed about their risk profile: results of the European Heart Rhythm Association survey.

    PubMed

    Proclemer, Alessandro; Bongiorni, Maria Grazia; Dagres, Nikolaos; Sciaraffia, Elena; Todd, Derick; Blomstrom-Lundqvist, Carina

    2015-06-01

    The purpose of this EP wire is to examine clinical practice in the field of screening of patients of risk of ventricular arrhythmias and/or sudden cardiac death (SCD) in European countries. A systematic screening programme existed in the majority of centres and was organized by a multidisciplinary dedicated team or by an activity programme of implantable cardioverter-defibrillator (ICD) or heart failure clinics. In particular, high-risk subgroups of patients with ischaemic and non-ischaemic cardiomyopathy ICD implantation are considered strongly indicated within 90 days of myocardial revascularization or initial diagnosis. Cardiac magnetic resonance imaging appears as an important tool to better characterize the left ventricular arrhythmogenic substrate in patients at risk of SCD. PMID:26023178

  7. Implantable cardioverter-defibrillator therapy in a 34-year-old patient with eating disorders and after the third sudden cardiac arrest.

    PubMed

    Piotrowicz, Ewa; Orzechowski, Piotr; Bilinska, Maria; Przybylski, Andrzej; Szumowski, Lukasz; Piotrowicz, Ryszard

    2015-03-01

    Eating disorders (ED) such as anorexia nervosa and bulimia are psychiatric diseases associated with the highest mortality rate of any other psychiatric disorders. More recently, long-term outcome studies with follow-up of over 20 years report a mortality of between 15% and 18% (Casiero and Frishman, Cardiol Rev 14(5), 227, 2006). The sudden death secondary to arrhythmias is often the cause of death in these patients (Casiero and Frishman, Cardiol Rev 14(5), 227, 2006). A case of life-threatening ventricular arrhythmia (VA) in a patient with ED is presented. Clinical records (cardiologic, psychiatric), electrocardiograms, echocardiogram, coronary angiogram, cardiac magnetic resonance, and endocrine diagnostics were performed. Finally a cardioverter-defibrillator (ICD) was implanted in the patient after her third cardiac arrest. An optimal approach to antiarrhythmic therapy in such patients is a real challenge for a cardiologist. PMID:24535846

  8. Postmortem mRNA Expression Patterns in Left Ventricular Myocardial Tissues and Their Implications for Forensic Diagnosis of Sudden Cardiac Death

    PubMed Central

    Son, Gi Hoon; Park, Seong Hwan; Kim, Yunmi; Kim, Ji Yeon; Kim, Jin Wook; Chung, Sooyoung; Kim, Yu-Hoon; Kim, Hyun; Hwang, Juck-Joon; Seo, Joong-Seok

    2014-01-01

    Sudden cardiac death (SCD), which is primarily caused by lethal heart disorders resulting in structural and arrhythmogenic abnormalities, is one of the prevalent modes of death in most developed countries. Myocardial ischemia, mainly due to coronary artery disease, is the most common type of heart disease leading to SCD. However, postmortem diagnosis of SCD is frequently complicated by obscure histological evidence. Here, we show that certain mRNA species, namely those encoding hemoglobin A1/2 and B (Hba1/2 and Hbb, respectively) as well as pyruvate dehydrogenase kinase 4 (Pdk4), exhibit distinct postmortem expression patterns in the left ventricular free wall of SCD subjects when compared with their expression patterns in the corresponding tissues from control subjects with non-cardiac causes of death. Hba1/2 and Hbb mRNA expression levels were higher in ischemic SCD cases with acute myocardial infarction or ischemic heart disease without recent infarction, and even in cardiac death subjects without apparent pathological signs of heart injuries, than control subjects. By contrast, Pdk4 mRNA was expressed at lower levels in SCD subjects. In conclusion, we found that altered myocardial Hba1/2, Hbb, and Pdk4 mRNA expression patterns can be employed as molecular signatures of fatal cardiac dysfunction to forensically implicate SCD as the primary cause of death. PMID:24642708

  9. From Recurrent Syncope to Sudden Cardiac Death: Clinical Characteristics in a Chinese Patient Carrying a Plakophilin-2 Gene Mutation

    PubMed Central

    Liu, Wenling; Qiu, Xiaoliang; Liu, Wen; Hu, Dayi; Zhu, Tiangang; Wang, Chunling; Beer, Dominik; Zhang, Li

    2013-01-01

    We report a case of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) which illustrates the natural progression of disease in the absence of availability of an implanted cardiac defibrillator (ICD). Electrocardiograms and cardiac imaging show the progress of ARVC and these clinical milestones of disease are presented herein. PMID:24826278

  10. Sudden Cardiac Arrest at the Finish Line: In Coronary Ectopia, the Cause of Ischemia Is from Intramural Course, Not Ostial Location

    PubMed Central

    Joggerst, Steven; Monge, Jorge; Uribe, Carlo; Sherron, Scott; Angelini, Paolo

    2014-01-01

    A 26-year-old woman, a well-trained runner, had a sudden cardiac arrest just before crossing the finish line of a marathon. She was rapidly resuscitated and was later found to have an ectopic origin of the left coronary artery. This anomaly was surgically repaired by translocating the ostium from the right to the left sinus of Valsalva. Her difficult postoperative course prompted further coronary evaluation, which revealed severe stenosis of the neoostium. The patient underwent a second operation: this time, the stenosis was bypassed via a left internal mammary artery-to-left anterior descending coronary artery (LAD) graft. Hypoplasia of the LAD and spasm during manipulation caused the graft to fail, necessitating double-stent angioplasty of the left main ostium and the LAD 2 months later. At the patient's 6-month follow-up examination, she had no further evidence of functional ischemia, and she resumed jogging. Because the mode and mechanism of the patient's condition and events were documented in unusual detail, this case furthers our understanding of sudden cardiac arrest in athletes who have rare coronary anomalies. We conclude that ectopia of a coronary artery does not itself cause potentially fatal ischemia. Rather, these events are due to the ectopic artery's intramural proximal course within the aortic media, which might result in critical stenosis by means of hypoplasia or lateral compression of the artery. PMID:24808787

  11. Quantitative T-wave alternans analysis for sudden cardiac death risk assessment and guiding therapy: answered and unanswered questions: For: Proceedings of ICE2015 Comandatuba, Brazil, Sudden Death Symposium.

    PubMed

    Verrier, Richard L; Sroubek, Jakub

    2016-01-01

    This review addresses current questions regarding use of T-wave alternans to stratify risk for sudden cardiac death. Both of the currently available commercial methodologies, namely, the frequency-domain spectral method and the time-domain modified moving average (MMA) method, are supported by guideline statements, cleared by the US FDA, and covered by the US Center for Medicare and Medicaid services. Similar numbers of patients have been enrolled in predictive studies; odds ratios generated by the two methods are similar including in a head-to-head study. However, in two prospective studies, prediction by TWA with the spectral method was negative, likely due to withdrawal of beta-blockade before the test with later resumption, while all studies with MMA have achieved prediction when the commercial software was used appropriately. Questions currently undergoing investigation include TWA's potential to guide ICD implantation, to track changes in risk during cardiac disease progression, and to evaluate the adequacy of medical therapy. PMID:26987616

  12. Induced Abortion

    MedlinePlus

    ... Induced Abortion Patient Education FAQs Induced Abortion Patient Education Pamphlets - Spanish Induced Abortion FAQ043, May 2015 PDF Format Induced ... Your Practice Patient Safety & Quality Payment Reform (MACRA) Education & Events Annual ... Pamphlets Teen Health About ACOG About Us Leadership & ...

  13. Loss of the transcription factor Meis1 prevents sympathetic neurons target-field innervation and increases susceptibility to sudden cardiac death

    PubMed Central

    Bouilloux, Fabrice; Thireau, Jérôme; Ventéo, Stéphanie; Farah, Charlotte; Karam, Sarah; Dauvilliers, Yves; Valmier, Jean; Copeland, Neal G; Jenkins, Nancy A; Richard, Sylvain; Marmigère, Frédéric

    2016-01-01

    Although cardio-vascular incidents and sudden cardiac death (SCD) are among the leading causes of premature death in the general population, the origins remain unidentified in many cases. Genome-wide association studies have identified Meis1 as a risk factor for SCD. We report that Meis1 inactivation in the mouse neural crest leads to an altered sympatho-vagal regulation of cardiac rhythmicity in adults characterized by a chronotropic incompetence and cardiac conduction defects, thus increasing the susceptibility to SCD. We demonstrated that Meis1 is a major regulator of sympathetic target-field innervation and that Meis1 deficient sympathetic neurons die by apoptosis from early embryonic stages to perinatal stages. In addition, we showed that Meis1 regulates the transcription of key molecules necessary for the endosomal machinery. Accordingly, the traffic of Rab5+ endosomes is severely altered in Meis1-inactivated sympathetic neurons. These results suggest that Meis1 interacts with various trophic factors signaling pathways during postmitotic neurons differentiation. DOI: http://dx.doi.org/10.7554/eLife.11627.001 PMID:26857994

  14. Beta-blockers for the prevention of sudden cardiac death in heart failure patients: a meta-analysis of randomized controlled trials

    PubMed Central

    2013-01-01

    Background In many studies, beta-blockers have been shown to decrease sudden cardiac death (SCD) in heart failure patients; other studies reported mixed results. Recently, several large randomized control trials of beta blockers have been carried out. It became necessary to conduct a systematic review to provide an up-to-date synthesis of available data. Methods We conducted a meta-analysis of all randomized controlled trials examining the use of beta-blockers vs. placebo/control for the prevention of SCD in heart failure patients. We identified 30 trials, which randomized 24,779 patients to beta-blocker or placebo/control. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Eligible studies had to be randomized controlled trials and provide information on the incidence of sudden cardiac death in heart failure patients. Additional inclusion criteria included: treatment for >30 days and follow-up ≥ 3 months. Studies of patients <18 years, randomization to beta-blocker vs. an angiotensin converting enzyme (without placebo) and/or beta-blocker in both arms were excluded from the analysis. Pre-specified outcomes of interest included SCD, cardiovascular death (CVD), and all-cause mortality and were analyzed according to intention-to-treat. Results We found that beta-blockers are effective in the prevention of SCD [OR 0.69; 95% CI, 0.62–0.77, P < 0.00001], cardiovascular death (CVD) [OR 0.71; 95% CI, 0.64–0.79, P < 0.00001], and all-cause mortality [OR 0.67; 95% CI, 0.59–0.76, P < 0.00001]. Based on the study analysis, 43 patients must be treated with a beta-blocker to prevent one SCD, 26 patients to prevent one CVD and 21 patients to prevent all-cause mortality in one year. Conclusion Beta-blockers reduce the risk of sudden cardiac death (SCD) by 31%, cardiovascular death (CVD) by 29% and all-cause mortality by 33%. These results confirm the mortality benefits of these drugs and they should be recommended to all

  15. Sudden cardiac arrest during anesthesia in a 30-month-old boy with syndactyly: a case of genetically proven Timothy syndrome.

    PubMed

    An, Hyo Soon; Choi, Eun Young; Kwon, Bo Sang; Kim, Gi Beom; Bae, Eun Jung; Noh, Chung Il; Choi, Jung Yun; Park, Sung Sup

    2013-05-01

    Timothy syndrome, long QT syndrome type 8, is highly malignant with ventricular tachyarrhythmia. A 30-month-old boy had sudden cardiac arrest during anesthesia induction before plastic surgery for bilateral cutaneous syndactyly. After successful resuscitation, prolonged QT interval (QTc, 0.58-0.60 sec) and T-wave alternans were found in his electrocardiogram. Starting β-blocker to prevent further tachycardia and collapse event, then there were no more arrhythmic events. The genes KCNQ1, KCNH2, KCNE1 and 2, and SCN5A were negative for long QT syndrome. The mutation p.Gly406Arg was confirmed in CACNA1C, which maintains L-type calcium channel depolarization in the heart and other systems. PMID:23678275

  16. Sudden cardiac death associated with an extremely rare coronary anomaly of the left and right coronary arteries arising exclusively from the posterior (noncoronary) sinus of valsalva.

    PubMed

    Catanzaro, John N; Makaryus, Amgad N; Catanese, Charles

    2005-11-01

    Congenital anomalies of the coronary arteries are relatively uncommon conditions and have been associated with sudden cardiac death (SCD) in children. Although anomalous coronary artery distribution is widely reported in the literature, no articles to date address the origin of both the right (RCA) and left coronary arteries (LCA) from the posterior (noncoronary) sinus of Valsalva. This is a report of a 16-year-old black male in good health, who collapsed and was unable to be resuscitated after physical exertion while playing basketball. In this patient, postmortem evaluation revealed the LCA and RCA originating exclusively from the posterior (noncoronary) sinus with acute angle takeoff of the LCA which likely lead to ischemia, causing SCD. We discuss the incidence of coronary artery anomalies and the proposed mechanisms that led to SCD in these patients. PMID:16450799

  17. The Role of Genetic Testing in the Identification of Young Athletes with Inherited Primitive Cardiac Disorders at Risk of Exercise Sudden Death

    PubMed Central

    Tiziano, Francesco Danilo; Palmieri, Vincenzo; Genuardi, Maurizio; Zeppilli, Paolo

    2016-01-01

    Although relatively rare, inherited primitive cardiac disorders (IPCDs) in athletes have a deep social impact since they often present as sudden cardiac death (SCD) of young and otherwise healthy persons. The diagnosis of these conditions is likely underestimated due to the lack of shared clinical criteria and to the existence of several borderline clinical pictures. We will focus on the clinical and molecular diagnosis of the most common IPCDs, namely hypertrophic cardiomyopathies, long QT syndrome, arrhythmogenic right ventricular cardiomyopathy, and left ventricular non-compaction. Collectively, these conditions account for the majority of SCD episodes and/or cardiologic clinical problems in athletes. In addition to the clinical and instrumental tools for the diagnosis of IPCD, the viral technological advances in genetic testing have facilitated the molecular confirmation of these conditions. However, genetic testing presents several issues: the limited sensitivity (globally, around 50%), the low prognostic predictive value, the probability to find pathogenic variants in different genes in the same patient, and the risk of non-interpretable results. In this review, we will analyze the pros and cons of the different clinical approaches for the presymptomatic identification, the diagnosis and management of IPCD athletes, and we will discuss the indications to the genetic testing for patients and their relatives, particularly focusing on the most complex scenarios, such as presymptomatic tests, uncertain results, and unexpected findings. PMID:27617263

  18. The Role of Genetic Testing in the Identification of Young Athletes with Inherited Primitive Cardiac Disorders at Risk of Exercise Sudden Death.

    PubMed

    Tiziano, Francesco Danilo; Palmieri, Vincenzo; Genuardi, Maurizio; Zeppilli, Paolo

    2016-01-01

    Although relatively rare, inherited primitive cardiac disorders (IPCDs) in athletes have a deep social impact since they often present as sudden cardiac death (SCD) of young and otherwise healthy persons. The diagnosis of these conditions is likely underestimated due to the lack of shared clinical criteria and to the existence of several borderline clinical pictures. We will focus on the clinical and molecular diagnosis of the most common IPCDs, namely hypertrophic cardiomyopathies, long QT syndrome, arrhythmogenic right ventricular cardiomyopathy, and left ventricular non-compaction. Collectively, these conditions account for the majority of SCD episodes and/or cardiologic clinical problems in athletes. In addition to the clinical and instrumental tools for the diagnosis of IPCD, the viral technological advances in genetic testing have facilitated the molecular confirmation of these conditions. However, genetic testing presents several issues: the limited sensitivity (globally, around 50%), the low prognostic predictive value, the probability to find pathogenic variants in different genes in the same patient, and the risk of non-interpretable results. In this review, we will analyze the pros and cons of the different clinical approaches for the presymptomatic identification, the diagnosis and management of IPCD athletes, and we will discuss the indications to the genetic testing for patients and their relatives, particularly focusing on the most complex scenarios, such as presymptomatic tests, uncertain results, and unexpected findings. PMID:27617263

  19. Cardiac Channel Molecular Autopsy: Insights From 173 Consecutive Cases of Autopsy-Negative Sudden Unexplained Death Referred for Postmortem Genetic Testing

    PubMed Central

    Tester, David J.; Medeiros-Domingo, Argelia; Will, Melissa L.; Haglund, Carla M.; Ackerman, Michael J.

    2012-01-01

    Objective To perform long QT syndrome and catecholaminergic polymorphic ventricular tachycardia cardiac channel postmortem genetic testing (molecular autopsy) for a large cohort of cases of autopsy-negative sudden unexplained death (SUD). Methods From September 1, 1998, through October 31, 2010, 173 cases of SUD (106 males; mean ± SD age, 18.4±12.9 years; age range, 1-69 years; 89% white) were referred by medical examiners or coroners for a cardiac channel molecular autopsy. Using polymerase chain reaction, denaturing high-performance liquid chromatography, and DNA sequencing, a comprehensive mutational analysis of the long QT syndrome susceptibility genes (KCNQ1, KCNH2, SCN5A, KCNE1, and KCNE2) and a targeted analysis of the catecholaminergic polymorphic ventricular tachycardia type 1–associated gene (RYR2) were conducted. Results Overall, 45 putative pathogenic mutations absent in 400 to 700 controls were identified in 45 autopsy-negative SUD cases (26.0%). Females had a higher yield (26/67 [38.8%]) than males (19/106 [17.9%]; P<.005). Among SUD cases with exercise-induced death, the yield trended higher among the 1- to 10-year-olds (8/12 [66.7%]) compared with the 11- to 20-year-olds (4/27 [14.8%]; P=.002). In contrast, for those who died during a period of sleep, the 11- to 20-year-olds had a higher yield (9/25 [36.0%]) than the 1- to 10-year-olds (1/24 [4.2%]; P=.01). Conclusion Cardiac channel molecular autopsy should be considered in the evaluation of autopsy-negative SUD. Several interesting genotype-phenotype observations may provide insight into the expected yields of postmortem genetic testing for SUD and assist in selecting cases with the greatest potential for mutation discovery and directing genetic testing efforts. PMID:22677073

  20. Behavioral and cardiac responses to a sudden change in environmental stimuli: effect of forced shift in food intake.

    PubMed

    Steenbergen, J M; Koolhaas, J M; Strubbe, J H; Bohus, B

    1989-04-01

    In order to test the possibility of a change in stress susceptibility induced by a forced change in activity rhythm, during control weeks food availability was restricted to the dark period only (fa-D) and to the light period only during the test week (fa-L). Stress susceptibility was measured on the basis of the decrease in heart rate (bradycardia) and an increase in freezing behavior in response to a sudden reduction in background noise. A significant increase in bradycardia both in magnitude and duration was observed during fa-L conditions as compared to the control fa-D condition. Also the duration of freezing behavior was increased during the fa-L condition. These results support the hypothesis that forced changes in circadian activities affect stress susceptibility. The significance of this finding for the incidence of stress pathologies is discussed. PMID:2780841

  1. Abnormal interactions of calsequestrin with the ryanodine receptor calcium release channel complex linked to exercise-induced sudden cardiac death.

    PubMed

    Terentyev, Dmitry; Nori, Alessandra; Santoro, Massimo; Viatchenko-Karpinski, Serge; Kubalova, Zuzana; Gyorke, Inna; Terentyeva, Radmila; Vedamoorthyrao, Srikanth; Blom, Nico A; Valle, Giorgia; Napolitano, Carlo; Williams, Simon C; Volpe, Pompeo; Priori, Silvia G; Gyorke, Sandor

    2006-05-12

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a familial arrhythmogenic disorder associated with mutations in the cardiac ryanodine receptor (RyR2) and cardiac calsequestrin (CASQ2) genes. Previous in vitro studies suggested that RyR2 and CASQ2 interact as parts of a multimolecular Ca(2+)-signaling complex; however, direct evidence for such interactions and their potential significance to myocardial function remain to be determined. We identified a novel CASQ2 mutation in a young female with a structurally normal heart and unexplained syncopal episodes. This mutation results in the nonconservative substitution of glutamine for arginine at amino acid 33 of CASQ2 (R33Q). Adenoviral-mediated expression of CASQ2(R33Q) in adult rat myocytes led to an increase in excitation-contraction coupling gain and to more frequent occurrences of spontaneous propagating (Ca2+ waves) and local Ca2+ signals (sparks) with respect to control cells expressing wild-type CASQ2 (CASQ2WT). As revealed by a Ca2+ indicator entrapped inside the sarcoplasmic reticulum (SR) of permeabilized myocytes, the increased occurrence of spontaneous Ca2+ sparks and waves was associated with a dramatic decrease in intra-SR [Ca2+]. Recombinant CASQ2WT and CASQ2R33Q exhibited similar Ca(2+)-binding capacities in vitro; however, the mutant protein lacked the ability of its WT counterpart to inhibit RyR2 activity at low luminal [Ca2+] in planar lipid bilayers. We conclude that the R33Q mutation disrupts interactions of CASQ2 with the RyR2 channel complex and impairs regulation of RyR2 by luminal Ca2+. These results show that intracellular Ca2+ cycling in normal heart relies on an intricate interplay of CASQ2 with the proteins of the RyR2 channel complex and that disruption of these interactions can lead to cardiac arrhythmia. PMID:16601229

  2. Absence of triadin, a protein of the calcium release complex, is responsible for cardiac arrhythmia with sudden death in human

    PubMed Central

    Roux-Buisson, Nathalie; Cacheux, Marine; Fourest-Lieuvin, Anne; Fauconnier, Jeremy; Brocard, Julie; Denjoy, Isabelle; Durand, Philippe; Guicheney, Pascale; Kyndt, Florence; Leenhardt, Antoine; Le Marec, Hervé; Lucet, Vincent; Mabo, Philippe; Probst, Vincent; Monnier, Nicole; Ray, Pierre F.; Santoni, Elodie; Trémeaux, Pauline; Lacampagne, Alain; Fauré, Julien; Lunardi, Joël; Marty, Isabelle

    2012-01-01

    Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited arrhythmogenic disease so far related to mutations in the cardiac ryanodine receptor (RYR2) or the cardiac calsequestrin (CASQ2) genes. Because mutations in RYR2 or in CASQ2 are not retrieved in all CPVT cases, we searched for mutations in the physiological protein partners of RyR2 and CSQ2 in a large cohort of CPVT patients with no detected mutation in these two genes. Based on a candidate gene approach, we focused our investigations on triadin and junctin, two proteins that link RyR2 and CSQ2. Mutations in the triadin (TRDN) and in the junctin (ASPH) genes were searched in a cohort of 97 CPVT patients. We identified three mutations in triadin which cosegregated with the disease on a recessive mode of transmission in two families, but no mutation was found in junctin. Two TRDN mutations, a 4 bp deletion and a nonsense mutation, resulted in premature stop codons; the third mutation, a p.T59R missense mutation, was further studied. Expression of the p.T59R mutant in COS-7 cells resulted in intracellular retention and degradation of the mutant protein. This was confirmed after in vivo expression of the mutant triadin in triadin knock-out mice by viral transduction. In this work, we identified TRDN as a new gene responsible for an autosomal recessive form of CPVT. The mutations identified in the two families lead to the absence of the protein, thereby demonstrating the importance of triadin for the normal function of the cardiac calcium release complex in humans. PMID:22422768

  3. Underdiagnosis of Conditions Associated with Sudden Cardiac Death in Children - Is it the Absence of a Comprehensive Screening Program or a True Low Prevalence?

    PubMed Central

    Takiguchi, Marisa; Knight, Tristan; Nguyen, Tin Toan; Limm, Blair; Hayes, Donald; Reddy, Venu

    2016-01-01

    This study aimed to assess the prevalence of conditions associated with sudden cardiac death (SCD) among all children and children with sudden infant death syndrome (SIDS) in the State of Hawai‘i, where no comprehensive screening program is conducted for such conditions. A retrospective chart review was conducted from the single tertiary pediatric hospital in Hawai‘i, from offices of all pediatric cardiologists in Hawai‘i, and the Hawai‘i State Department of Health from 1/1/2000 to 12/31/2013. Children aged 0–18 years were included in the study. A subset of the study analyzed records of infants aged 0–12 months. SIDS rate was calculated and compared to national data. Prevalence was calculated for known conditions associated with SCD. The identified prevalence was compared to the established prevalence of conditions associated with SCD. In Hawai‘i, the infant SIDS rate (66.4/100,000) was similar to the national rate (54.4/100,000). Over 14 years, only 51 children were diagnosed with a condition associated with SCD; 28 with a cardiomyopathy and 21 with a channelopathy. A 14-year retrospective analysis in the State of Hawai‘i revealed that less than 1 in 30 children, who are expected to harbor a SCD-associated condition, had been appropriately diagnosed. The underdiagnosis of conditions associated with SCD reflects that in the absence of a comprehensive screening program, conditions without obvious signs and symptoms are difficult to diagnose. Many children with these conditions will remain at risk of SCD. PMID:26918207

  4. Kidney retrieval after sudden out of hospital refractory cardiac arrest: a cohort of uncontrolled non heart beating donors

    PubMed Central

    2009-01-01

    Introduction To counter the shortage of kidney grafts in France, a non heart beating donor (NHBD) program has recently been implemented. The aim of this study was to describe this pilot program for kidney retrieval from "uncontrolled" NHBD meaning those for whom attempts of resuscitation after a witnessed out-of-hospital cardiac arrest (CA) have failed (Maastricht 1 and 2), in a centre previously trained for retrieval from brain dead donors. Methods A prospective, monocentric, descriptive study concerning NHBD referred to our institution from February 2007 to June 2008. The protocol includes medical transport of refractory CA under mechanical ventilation and external cardiac massage, kidney protection by insertion of an intraaortic double-balloon catheter (DBC) with perfusion of a hypothermic solution, kidney retrieval and kidney preservation in a hypothermic pulsatile perfusion machine. Results 122 potential NHBD were referred to our institution after a mean resuscitation attempt of 35 minutes (20–95). Regarding the contraindications, 63 were finally accepted and 56 had the DBC inserted. Organ retrieval was performed in 27 patients (43%) and 31 kidneys out of the 54 procured (57%) have been transplanted. Kidney transplantation exclusion was related to family refusal (n = 15), past medical history, time constraints, viral serology, high vascular ex vivo resistance of the graft and macroscopic abnormalities. The 31 kidneys exhibited an expected high delayed graft function rate (92%). Despite these initial results transplanted kidney had good creatinine clearance at six months (66 ± 24 ml/min) with a 89% graft survival rate at six months. Conclusions This study shows the feasibility and efficacy of an organ procurement program targeting NHBD allowing a 10% increase in the kidney transplantation rate over 17 months. With a six months follow-up period, the results of transplanted kidney function were excellent. PMID:19715564

  5. [Discussing abortion].

    PubMed

    1997-01-01

    Discussions with several groups of low-income, middle-aged women in various countries of Latin America showed that most disapproved of abortion. In the course of group discussions about the motives of women who seek abortions and the psychological and sanitary conditions under which abortion occurs, however, their disapproval became less categorical. They began to accept the need to decriminalize abortion in order to protect women. The majority, strongly influenced by the Catholic Church, believed that human life begins at conception. Others disapproved of abortion because they feared it would be used as a birth control method and would encourage promiscuity. Most disapproved of abortion for single women attempting to escape family or social censure of unmarried motherhood. Fear of health effects or death from abortion and fear of divine punishment were also mentioned. Recognition of the anguish and pain suffered by women deciding to seek abortion and the difficulty of providing for the material and other needs of many children were factors that led to reconsideration of the wholesale condemnation of abortion. The women realized that such condemnations never take the woman's circumstances into account. Some of the women felt that aborting an unwanted pregnancy would be preferable to abandoning or neglecting an unwanted child. Many of the women came to feel that abortion should be legalized at least under some circumstances. PMID:12348503

  6. Mutual information analysis reveals bigeminy patterns in Andersen-Tawil syndrome and in subjects with a history of sudden cardiac death

    NASA Astrophysics Data System (ADS)

    Núñez-Acosta, Elisa; Lerma, Claudia; Márquez, Manlio F.; José, Marco V.

    2012-02-01

    Herein we introduce the Mutual Information Function (MIF) as a mathematical method to analyze ventricular bigeminy in certain pathological conditions of the heart known to be associated with frequent ventricular arrhythmias. In particular, we show that the MIF is sensitive enough to detect the bigeminy pattern in symbolic series from patients with Andersen-Tawil syndrome as well as in a group of patients from the Sudden Cardiac Death Holter Databases. The results confirm that MIF is an adequate method to detect the autocorrelation between the appearance of sinus and ventricular premature beats resulting in a bigeminy pattern. It is also shown that MIF reflects the bigeminy patterns as a function of the percentage of ventricular premature beats present in the symbolic series and also as a function of the percentage of bigeminy. The MIF was also useful to establish a consistent difference in the bigeminy pattern related to the diurnal and nocturnal periods presumably associated to the circadian rhythm of the heart. Understanding of the ventricular bigeminy patterns throughout 24-hours could provide some insights into the pathogenesis of ventricular tachyarrhythmias in these pathological conditions.

  7. Identification of a Sudden Cardiac Death Susceptibility Locus at 2q24.2 through Genome-Wide Association in European Ancestry Individuals

    PubMed Central

    Reinier, Kyndaron; Teodorescu, Carmen; Uy-Evanado, Audrey; Carter-Monroe, Naima; Kaikkonen, Kari S.; Kortelainen, Marja-Leena; Boucher, Gabrielle; Lagacé, Caroline; Moes, Anna; Zhao, XiaoQing; Kolodgie, Frank; Rivadeneira, Fernando; Hofman, Albert; Witteman, Jacqueline C. M.; Uitterlinden, André G.; Marsman, Roos F.; Pazoki, Raha; Bardai, Abdennasser; Koster, Rudolph W.; Dehghan, Abbas; Hwang, Shih-Jen; Bhatnagar, Pallav; Post, Wendy; Hilton, Gina; Prineas, Ronald J.; Li, Man; Köttgen, Anna; Ehret, Georg; Boerwinkle, Eric; Coresh, Josef; Kao, W. H. Linda; Psaty, Bruce M.; Tomaselli, Gordon F.; Sotoodehnia, Nona; Siscovick, David S.; Burke, Greg L.; Marbán, Eduardo; Spooner, Peter M.; Cupples, L. Adrienne; Jui, Jonathan; Gunson, Karen; Kesäniemi, Y. Antero; Wilde, Arthur A. M.; Tardif, Jean-Claude; O'Donnell, Christopher J.; Bezzina, Connie R.; Virmani, Renu; Stricker, Bruno H. C. h.; Tan, Hanno L.; Albert, Christine M.; Chakravarti, Aravinda; Rioux, John D.; Huikuri, Heikki V.; Chugh, Sumeet S.

    2011-01-01

    Sudden cardiac death (SCD) continues to be one of the leading causes of mortality worldwide, with an annual incidence estimated at 250,000–300,000 in the United States and with the vast majority occurring in the setting of coronary disease. We performed a genome-wide association meta-analysis in 1,283 SCD cases and >20,000 control individuals of European ancestry from 5 studies, with follow-up genotyping in up to 3,119 SCD cases and 11,146 controls from 11 European ancestry studies, and identify the BAZ2B locus as associated with SCD (P = 1.8×10−10). The risk allele, while ancestral, has a frequency of ∼1.4%, suggesting strong negative selection and increases risk for SCD by 1.92–fold per allele (95% CI 1.57–2.34). We also tested the role of 49 SNPs previously implicated in modulating electrocardiographic traits (QRS, QT, and RR intervals). Consistent with epidemiological studies showing increased risk of SCD with prolonged QRS/QT intervals, the interval-prolonging alleles are in aggregate associated with increased risk for SCD (P = 0.006). PMID:21738491

  8. Patient barriers to implantable cardioverter defibrillator implantation for the primary prevention of sudden cardiac death in patients with heart failure and reduced ejection fraction

    PubMed Central

    Chan, Laura Lihua; Lim, Choon Pin; Aung, Soe Tin; Quetua, Paul; Ho, Kah Leng; Chong, Daniel; Teo, Wee Siong; Sim, David; Ching, Chi Keong

    2016-01-01

    INTRODUCTION Device therapy is efficacious in preventing sudden cardiac death (SCD) in patients with reduced ejection fraction. However, few who need the device eventually opt to undergo implantation and even fewer reconsider their decisions after deliberation. This is due to many factors, including unresolved patient barriers. This study identified the factors that influenced patients’ decision to decline implantable cardioverter defibrillator (ICD) implantation, and those that influenced patients who initially declined an implant to reconsider having one. METHODS A single-centre survey was conducted among 240 patients who had heart failure with reduced ejection fraction and met the ICD implantation criteria, but had declined ICD implantation. RESULTS Participants who refused ICD implantation were mostly male (84%), Chinese (71%), married (72%), currently employed (54%), and had up to primary or secondary education (78%) and monthly income of < SGD 3,000 (51%). Those who were more likely to reconsider their decision were aware that SCD was a consequence of heart failure with reduced ejection fraction, knowledgeable of the preventive role of ICDs, currently employed and aware that their doctor strongly recommended the implant. Based on multivariate analysis, knowledge of the role of ICDs for primary prophylaxis was the most important factor influencing patient decision. CONCLUSION This study identified the demographic and social factors of patients who refused ICD therapy. Knowledge of the role of ICDs in preventing SCD was found to be the strongest marker for reconsidering ICD implantation. Measures to address this information gap may lead to higher rates of ICD implantation. PMID:27075476

  9. Association of Holter-Based Measures Including T-wave Alternans with Risk of Sudden Cardiac Death in the Community-Dwelling Elderly: The Cardiovascular Health Study

    PubMed Central

    Stein, Phyllis K.; Sanghavi, Devang; Sotoodehnia, Nona; Siscovick, David S; Gottdiener, John

    2010-01-01

    Background Sudden cardiac death (SCD) can be the first manifestation of cardiovascular disease. Development of screening methods for higher / lower risk is critical. Methods The Cardiovascular Healthy Study (CHS) is a population-based study of risk factors for coronary heart disease and stroke those ≥65 years. N=49 (of 1649) with usable Holters and in normal sinus rhythm, suffered SCD during follow up and were matched with 2 controls, alive at the time of death of the case and not suffering SCD on follow up. Univariate and multivariate conditional logistic regression determined the association of Holter-based information and SCD. Results In univariate models, the upper half of VPC counts, abnormal heart rate turbulence, decreased normalized low frequency power, increased T-wave alternans (TWA) and decreased DFA1 (short-term fractal scaling exponent) were associated with SCD, but time domain HRV was not. In multivariate models, the upper half of VPC counts (OR=6.6) and having TWA ≥37µV on Ch2 (OR=4.8) were independently associated with SCD. Also, the upper half of VPC counts (OR=6.9) and having DFA1 <1.05 (OR=5.0) were independently associated with SCD. When additive effects were explored: having both higher VPCs and higher TWA was associated with an OR of 8.2 for SCD compared to 2.6 for having either. Also, having both higher VPCs and lower DFA1 was associated with an OR of 9.6 for SCD compared to 3.1 for having either. Conclusions Results support a potential role for 24-hour Holter recordings to identify older adults at increased or lower risk of SCD. PMID:20096853

  10. Antipsychotic Drugs and the Risk of Ventricular Arrhythmia and/or Sudden Cardiac Death: A Nation‐wide Case‐Crossover Study

    PubMed Central

    Wu, Chi‐Shin; Tsai, Yu‐Ting; Tsai, Hui‐Ju

    2015-01-01

    Background Antipsychotics have been linked to prolongation of the QT interval. However, little is known about the risk of ventricular arrhythmia (VA) and/or sudden cardiac death (SCD) associated with individual antipsychotic drug use. This study was designed to investigate the association between specific antipsychotic drugs and the risk of VA and/or SCD. Methods and Results We conducted a case‐crossover study using a nation‐wide population‐based sample obtained from Taiwan's National Health Insurance Research Database. A total of 17 718 patients with incident VA and/or SCD were enrolled. Conditional logistic regression models were applied to examine the effects of antipsychotic drug use on the risk of VA/SCD during various case and control time windows of 7, 14, and 28 days. The effect of the potency of a human ether‐à‐go‐go‐related gene (hERG) potassium channel blockade was also assessed. Antipsychotic drug use was associated with a 1.53‐fold increased risk of VA and/or SCD. Antipsychotic drugs with increased risk included clothiapine, haloperidol, prochlorperazine, thioridazine, olanzapine, quetiapine, risperidone, and sulpiride. The association was significantly higher among those with short‐term use. Antipsychotics with a high potency of the hERG potassium channel blockade had the highest risk of VA and/or SCD. Conclusion Use of antipsychotic drugs is associated with an increased risk of VA and/or SCD. Careful evaluations of the risks and benefits of antipsychotic treatment are highly recommended. PMID:25713294

  11. Treatment of Elderly Hypertensive Patients with Epithelial Sodium Channel Inhibitors Combined with a Thiazide Diuretic Reduces Coronary Mortality and Sudden Cardiac Death

    PubMed Central

    Hebert, Patricia R.; Coffey, Christopher S.; Byrne, Daniel W.; Scott, Theresa A.; Fagard, Robert H.; Rottman, Jeffrey N.; Murray, Katherine T.; Oates, John A.

    2008-01-01

    Background No reduction in either coronary mortality or sudden cardiac death (SCD) has been demonstrated in overviews of randomized trials of treatment of hypertension with diuretics. Methods An overview was conducted of coronary mortality and SCD in randomized controlled antihypertensive trials in which an epithelial sodium channel (ENaC) inhibitor/ hydrochlorthiazide (HCTZ) combination was used. Secondarily, an analogous overview in which thiazide diuretic was used alone was performed. Randomized trials that used an ENaC inhibitor/ HCTZ combination (or, alternatively, thiazide diuretic alone) were identified from previous meta-analyses, searches of PubMed, search of the Cochrane Clinical Trials database, and review of publications that addressed the consequences of treating hypertension. Trials in which participants were randomized to either an ENaC inhibitor combined with a thiazide diuretic (or to a thiazide diuretic alone) or to control treatment for at least one year and in which coronary mortality was reported were included. Numbers of events in individual trials were abstracted independently by 2 authors. Results Significant reductions in both coronary mortality and SCD were observed in the overview of trials in which elderly patients received an ENaC inhibitor/ HCTZ combination. The odds ratio (OR) for coronary mortality was 0.59 (95% confidence interval [CI] 0.44, 0.78) and for SCD was 0.60 (95% CI 0.38, 0.94). In contrast, an overview of the trials using thiazide diuretics alone showed no significant reductions of either coronary mortality (OR 0.94; 95% CI 0.81, 1.09) or SCD (OR 1.27; 95% CI 0.93, 1.75). Conclusions Use of an ENaC inhibitor combined with HCTZ for treatment of hypertension in the elderly results in favorable effects on coronary mortality and SCD. PMID:19727429

  12. Electrocardiographic Predictors of Coronary Heart Disease and Sudden Cardiac Deaths in Men and Women Free From Cardiovascular Disease in the Atherosclerosis Risk in Communities Study

    PubMed Central

    Rautaharju, Pentti M.; Zhang, Zhu‐Ming; Warren, James; Gregg, Richard E.; Haisty, Wesley K.; Kucharska‐Newton, Anna M.; Rosamond, Wayne D.; Soliman, Elsayed Z.

    2013-01-01

    Background We evaluated predictors of coronary heart disease (CHD) death and sudden cardiac death (SCD) in the Atherosclerosis Risk in Communities (ARIC) study. Methods and Results The study population included 13 621 men and women 45 to 65 years of age free from manifest cardiovascular disease at entry. Hazard ratios from Cox regression with 95% confidence intervals were computed for 18 dichotomized repolarization‐related ECG variables. The average follow‐up was 14 years. Independent predictors of CHD death in men were TaVR‐ and rate‐adjusted QTend (QTea), with a 2‐fold increased risk for both, and spatial angles between mean QRS and T vectors and between Tpeak (Tp) and normal R reference vectors [θ(Rm|Tm) and θ(Tp|Tref), respectively], with a >1.5‐fold increased risk for both. In women, independent predictors of the risk of CHD death were θ(Rm|Tm), with a 2‐fold increased risk for θ(Rm|Tm), and θ(Tp|Tref), with a 1.7‐fold increased risk. Independent predictors of SCD in men were θ(Tp|Tref) and QTea, with a 2‐fold increased risk, and θ(Tinit|Tterm), with a 1.6‐fold increased risk. In women, θ(Tinit|Tterm) was an independent predictor of SCD, with a >3‐fold increased risk, and θ(Rm|Tm) and TV1 were >2‐fold for both. Conclusions θ(Rm|Tm) and θ(Tp|Tref), reflecting different aspects of ventricular repolarization, were independent predictors of CHD death and SCD, and TaVR and TV1 were also independent predictors. The risk levels for independent predictors for both CHD death and SCD were stronger in women than in men, and QTea was a significant predictor in men but not in women. PMID:23723252

  13. Trends in sudden cardiac death and its risk factors in Japan from 1981 to 2005: the Circulatory Risk in Communities Study (CIRCS)

    PubMed Central

    Maruyama, Minako; Ohira, Tetsuya; Imano, Hironori; Kitamura, Akihiko; Kiyama, Masahiko; Okada, Takeo; Maeda, Kenji; Yamagishi, Kazumasa; Noda, Hiroyuki; Ishikawa, Yoshinori; Shimamoto, Takashi

    2012-01-01

    Objective There is little evidence whether sudden cardiac death (SCD) is increasing in Asia, although the incidence of coronary heart disease among urban middle-aged Japanese men has increased recently. We examined trends in the incidence of SCD and its risk factors in the Circulatory Risk in Communities Study. Design and setting This was a population-based longitudinal study. Surveillance of men and women for SCD incidence and risk factors was conducted from 1981 to 2005. Subjects The surveyed population was all men and women aged 30–84 years who lived in three rural communities and one urban community in Japan. Main outcome measures Trends in SCD incidence and its risk factors. Results Age-adjusted and sex-adjusted incidence of SCD decreased from 1981–1985 to 1991–1995, and plateaued thereafter. The annual incidence per 100 000 person-years was 76.0 in 1981–1985, 57.9 in 1986–1990, 39.3 in 1991–1995, 31.6 in 1996–2000 and 36.8 in 2001–2005. The prevalence of hypertension decreased from 1981–1985 to 1991–1995, and plateaued thereafter for men and women. The age-adjusted prevalence of current smoking for men decreased while that of diabetes mellitus increased for both sexes from 1981–1985 to 2001–2005. Conclusions The incidence of SCD decreased from 1981 to 1995 but was unchanged from 1996 to 2005. Continuous surveillance is necessary to clarify future trends in SCD in Japan because of an increasing incidence of diabetes mellitus. PMID:22446988

  14. Validation of the 2014 European Society of Cardiology Sudden Cardiac Death Risk Prediction Model in Hypertrophic Cardiomyopathy in a Reference Center in South America.

    PubMed

    Fernández, Adrián; Quiroga, Alejandro; Ochoa, Juan Pablo; Mysuta, Mauricio; Casabé, José Horacio; Biagetti, Marcelo; Guevara, Eduardo; Favaloro, Liliana E; Fava, Agostina M; Galizio, Néstor

    2016-07-01

    Sudden cardiac death (SCD) is a common cause of death in hypertrophic cardiomyopathy (HC). Our aim was to conduct an external and independent validation in South America of the 2014 European Society of Cardiology (ESC) SCD risk prediction model to identify patients requiring an implantable cardioverter defibrillator. This study included 502 consecutive patients with HC followed from March, 1993 to December, 2014. A combined end point of SCD or appropriate implantable cardioverter defibrillator therapy was assessed. For the quantitative estimation of individual 5-year SCD risk, we used the formula: 1 - 0.998(exp(Prognostic index)). Our database also included the abnormal blood pressure response to exercise as a risk marker. We analyzed the 3 categories of 5-year risk proposed by the ESC: low risk (LR) <4%; intermediate risk (IR) ≥4% to <6%, and high risk (HR) ≥6%. The LR group included 387 patients (77%); the IR group 39 (8%); and the HR group 76 (15%). Fourteen patients (3%) had SCD/appropriate implantable cardioverter defibrillator therapy (LR: 0%; IR: 2 of 39 [5%]; and HR: 12 of 76 [16%]). In a receiver-operating characteristic curve, the new model proved to be an excellent predictor because the area under the curve for the estimated risk is 0.925 (statistical C: 0.925; 95% CI 0.8884 to 0.9539, p <0.0001). In conclusion, the SCD risk prediction model in HC proposed by the 2014 ESC guidelines was validated in our population and represents an improvement compared with previous approaches. A larger multicenter, independent and external validation of the model with long-term follow-up would be advisable. PMID:27189816

  15. Notes from the field: update on Lyme carditis, groups at high risk, and frequency of associated sudden cardiac death--United States.

    PubMed

    Forrester, Joseph D; Meiman, Jonathan; Mullins, Jocelyn; Nelson, Randall; Ertel, Starr-Hope; Cartter, Matt; Brown, Catherine M; Lijewski, Virginia; Schiffman, Elizabeth; Neitzel, David; Daly, Elizabeth R; Mathewson, Abigail A; Howe, Whitney; Lowe, Lindsay A; Kratz, Natalie R; Semple, Shereen; Backenson, P Bryon; White, Jennifer L; Kurpiel, Phillip M; Rockwell, Russell; Waller, Kirsten; Johnson, Diep Hoang; Steward, Christopher; Batten, Brigid; Blau, Dianna; DeLeon-Carnes, Marlene; Drew, Clifton; Muehlenbachs, Atis; Ritter, Jana; Sanders, Jeanine; Zaki, Sherif R; Molins, Claudia; Schriefer, Martin; Perea, Anna; Kugeler, Kiersten; Nelson, Christina; Hinckley, Alison; Mead, Paul

    2014-10-31

    On December 13, 2013, MMWR published a report describing three cases of sudden cardiac death associated with Lyme carditis. State public health departments and CDC conducted a follow-up investigation to determine 1) whether carditis was disproportionately common among certain demographic groups of patients diagnosed with Lyme disease, 2) the frequency of death among patients diagnosed with Lyme disease and Lyme carditis, and 3) whether any additional deaths potentially attributable to Lyme carditis could be identified. Lyme disease cases are reported to CDC through the Nationally Notifiable Disease Surveillance System; reporting of clinical features, including Lyme carditis, is optional. For surveillance purposes, Lyme carditis is defined as acute second-degree or third-degree atrioventricular conduction block accompanying a diagnosis of Lyme disease. During 2001-2010, a total of 256,373 Lyme disease case reports were submitted to CDC, of which 174,385 (68%) included clinical information. Among these, 1,876 (1.1%) were identified as cases of Lyme carditis. Median age of patients with Lyme carditis was 43 years (range = 1-99 years); 1,209 (65%) of the patients were male, which is disproportionately larger than the male proportion among patients with other clinical manifestations (p<0.001). Of cases with this information available, 69% were diagnosed during the months of June-August, and 42% patients had an accompanying erythema migrans, a characteristic rash. Relative to patients aged 55-59 years, carditis was more common among men aged 20-39 years, women aged 25-29 years, and persons aged ≥75 years. PMID:25356607

  16. Electrocardiographic screening for hypertrophic cardiomyopathy and long QT syndrome: the drivers of cost-effectiveness for the prevention of sudden cardiac death.

    PubMed

    Anderson, Brett R; McElligott, Sean; Polsky, Daniel; Vetter, Victoria L

    2014-02-01

    It is universally recognized that the prevention of sudden cardiac death (SCD) in youth is an important public health initiative. The best approach remains uncertain. Many European and Asian countries support the use of electrocardiograms (ECGs). In the United States, this is highly controversial. Many debate its cost-effectiveness. We designed a comprehensive economic model of two of the most prevalent causes of SCD identifiable by ECG, hypertrophic cardiomyopathy (HCM) and long QT syndrome (LQTS), to determine the drivers of uncertainty in the estimate of cost-effectiveness. We compared the cost-effectiveness of screening with history and physical examination (H&P) plus ECG to the current United States standard, H&P alone, for the detection and treatment of HCM and LQTS. We used a Markov model on a theoretical cohort of healthy 12-year-olds over a 70-year time horizon from a societal perspective, employing extensive univariable and probabilistic sensitivity analyses, to determine drivers of costs and effectiveness. The incremental cost-effectiveness of adding ECGs to H&Ps was $41,400/life-year saved. The model was highly sensitive to the effect of identification and treatment of previously undiagnosed individuals with HCM; however, it was insensitive to many variables commonly assumed to be significant, including the costs of ECGs, echocardiograms, and genetic testing, as well as the sensitivity and specificity of ECGs. No LQTS-related parameters were significant. This study suggests that the key to determining the cost-effectiveness of ECG screening in the United States lies in developing a better understanding of disease progression in the previously undiagnosed HCM population. PMID:24005901

  17. What Is Sudden Cardiac Arrest?

    MedlinePlus

    ... Clinical Trials Links Related Topics Arrhythmia Automated External Defibrillator Coronary Heart Disease Heart Failure Long QT Syndrome ... within minutes. Rapid treatment of SCA with a defibrillator can be lifesaving. A defibrillator is a device ...

  18. What Causes Sudden Cardiac Arrest?

    MedlinePlus

    ... a few minutes. Other problems with the heart's electrical system also can cause SCA. For example, SCA can occur if the rate of the heart's electrical signals becomes very slow and stops. SCA also ...

  19. Sudden Heart Death More Common in Male Minority Athletes

    MedlinePlus

    ... medlineplus.gov/news/fullstory_159606.html Sudden Heart Death More Common in Male Minority Athletes Inherited condition ... found that about one-third of sudden cardiac deaths were caused by the heart condition hypertrophic cardiomyopathy. ...

  20. Sudden Heart Death More Common in Male Minority Athletes

    MedlinePlus

    ... gov/medlineplus/news/fullstory_159606.html Sudden Heart Death More Common in Male Minority Athletes Inherited condition ... found that about one-third of sudden cardiac deaths were caused by the heart condition hypertrophic cardiomyopathy. ...

  1. Primary prevention of sudden cardiac death of the young athlete: the controversy about the screening electrocardiogram and its innovative artificial intelligence solution.

    PubMed

    Chang, Anthony C

    2012-03-01

    The preparticipation screening for athlete participation in sports typically entails a comprehensive medical and family history and a complete physical examination. A 12-lead electrocardiogram (ECG) can increase the likelihood of detecting cardiac diagnoses such as hypertrophic cardiomyopathy, but this diagnostic test as part of the screening process has engendered considerable controversy. The pro position is supported by argument that international screening protocols support its use, positive diagnosis has multiple benefits, history and physical examination are inadequate, primary prevention is essential, and the cost effectiveness is justified. Although the aforementioned myriad of justifications for routine ECG screening of young athletes can be persuasive, several valid contentions oppose supporting such a policy, namely, that the sudden death incidence is very (too) low, the ECG screening will be too costly, the false-positive rate is too high, resources will be allocated away from other diseases, and manpower is insufficient for its execution. Clinicians, including pediatric cardiologists, have an understandable proclivity for avoiding this prodigious national endeavor. The controversy, however, should not be focused on whether an inexpensive, noninvasive test such as an ECG should be mandated but should instead be directed at just how these tests for young athletes can be performed in the clinical imbroglio of these disease states (with variable genetic penetrance and phenotypic expression) with concomitant fiscal accountability and logistical expediency in this era of economic restraint. This monumental endeavor in any city or region requires two crucial elements well known to business scholars: implementation and execution. The eventual solution for the screening ECG dilemma requires a truly innovative and systematic approach that will liberate us from inadequate conventional solutions. Artificial intelligence, specifically the process termed "machine

  2. Implantable Cardioverter Defibrillators for Primary Prevention of Sudden Cardiac Death in CKD: A Meta-analysis of Patient-Level Data from 3 Randomized Trials

    PubMed Central

    Pun, Patrick H.; Al-Khatib, Sana M.; Han, Joo Yoon; Edwards, Rex; Bardy, Gust H.; Bigger, J. Thomas; Buxton, Alfred E.; Moss, Arthur J.; Lee, Kerry L.; Steinman, Richard; Dorian, Paul; Hallstrom, Al; Cappato, Riccardo; Kadish, Alan H.; Kudenchuk, Peter J.; Mark, Daniel B.; Hess, Paul L.; Inoue, Lurdes Y. T.; Sanders, Gillian D.

    2014-01-01

    Background The benefit of a primary prevention implantable cardioverter defibrillator (ICD) among patients with chronic kidney disease (CKD) is uncertain. Study Design Meta-analysis of patient-level data from randomized controlled trials. Setting & Population Patients with symptomatic heart failure and left ventricular ejection fraction of <35%. Selection Criteria for Studies From 7 available randomized control studies with patient level data, we selected studies with available data on important covariates. Studies without patient-level data on baseline eGFR were excluded. Intervention Primary prevention ICD versus usual care Outcomes Mortality, re-hospitalizations, and effect modification by estimated GFR (eGFR) Results We included data from the Multicenter Automatic Defibrillator Implantation Trial I (MADIT-I), MADIT-II, and the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). 2,867 patients were included; 36.3% had at least stage 3 CKD (eGFR<60). The Kaplan-Meier estimate of the probability of death during follow-up was 43.3% among 1,334 patients receiving usual care and 35.8% among 1,533 ICD recipients. After adjustment for baseline differences, there was evidence that the survival benefit of ICDs in comparison to usual care depends on eGFR (posterior probability for null interaction p <0.001). The ICD was associated with survival benefit among patients with an eGFR ≥ 60 (adjusted HR (aHR)=0.49 [95% posterior credible interval (PCI) 0.24-0.95]) but not among patients with eGFR <60 (aHR = 0.80 [95% PCI 0.40-1.53]). eGFR did not modify the association between the ICD and re-hospitalizations. Limitations Few patients with eGFR <30 were available. Differences in trial-to-trial measurement techniques may lead to residual confounding. Conclusions Reductions in baseline eGFR decrease the survival benefit associated with the ICD. These findings should be confirmed by additional studies specifically targeting patients with varying levels of eGFR. PMID:24518128

  3. Common variants at SCN5A-SCN10A and HEY2 are associated with Brugada syndrome, a rare disease with high risk of sudden cardiac death

    PubMed Central

    Bezzina, Connie R.; Barc, Julien; Mizusawa, Yuka; Remme, Carol Ann; Gourraud, Jean-Baptiste; Simonet, Floriane; Verkerk, Arie O.; Schwartz, Peter J.; Crotti, Lia; Dagradi, Federica; Guicheney, Pascale; Fressart, Véronique; Leenhardt, Antoine; Antzelevitch, Charles; Bartkowiak, Susan; Schulze-Bahr, Eric; Zumhagen, Sven; Behr, Elijah R.; Bastiaenen, Rachel; Tfelt-Hansen, Jacob; Olesen, Morten Salling; Kääb, Stefan; Beckmann, Britt M.; Weeke, Peter; Watanabe, Hiroshi; Endo, Naoto; Minamino, Tohru; Horie, Minoru; Ohno, Seiko; Hasegawa, Kanae; Makita, Naomasa; Nogami, Akihiko; Shimizu, Wataru; Aiba, Takeshi; Froguel, Philippe; Balkau, Beverley; Lantieri, Olivier; Torchio, Margherita; Wiese, Cornelia; Weber, David; Wolswinkel, Rianne; Coronel, Ruben; Boukens, Bas J.; Bézieau, Stéphane; Charpentier, Eric; Chatel, Stéphanie; Despres, Aurore; Gros, Françoise; Kyndt, Florence; Lecointe, Simon; Lindenbaum, Pierre; Portero, Vincent; Violleau, Jade; Gessler, Manfred; Tan, Hanno L.; Roden, Dan M.; Christoffels, Vincent M.; Le Marec, Hervé; Wilde, Arthur A; Probst, Vincent; Schott, Jean-Jacques; Dina, Christian; Redon, Richard

    2013-01-01

    Brugada syndrome is a rare cardiac arrhythmia disorder, causally related to SCN5A mutations in around 20% of cases1–3. Through a genome-wide association study of 312 individuals with Brugada syndrome and 1,115 controls, we detected 2 significant association signals at the SCN10A locus (rs10428132) and near the HEY2 gene (rs9388451). Independent replication confirmed both signals (meta-analyses: rs10428132, P = 1.0 × 10−68; rs9388451, P = 5.1 × 10−17) and identified one additional signal in SCN5A (at 3p21; rs11708996, P = 1.0 × 10−14). The cumulative effect of the three loci on disease susceptibility was unexpectedly large (Ptrend = 6.1 × 10−81). The association signals at SCN5A-SCN10A demonstrate that genetic polymorphisms modulating cardiac conduction4–7 can also influence susceptibility to cardiac arrhythmia. The implication of association with HEY2, supported by new evidence that Hey2 regulates cardiac electrical activity, shows that Brugada syndrome may originate from altered transcriptional programming during cardiac development8. Altogether, our findings indicate that common genetic variation can have a strong impact on the predisposition to rare diseases. PMID:23872634

  4. Sudden death in eating disorders

    PubMed Central

    Jáuregui-Garrido, Beatriz; Jáuregui-Lobera, Ignacio

    2012-01-01

    Eating disorders are usually associated with an increased risk of premature death with a wide range of rates and causes of mortality. “Sudden death” has been defined as the abrupt and unexpected occurrence of fatality for which no satisfactory explanation of the cause can be ascertained. In many cases of sudden death, autopsies do not clarify the main cause. Cardiovascular complications are usually involved in these deaths. The purpose of this review was to report an update of the existing literature data on the main findings with respect to sudden death in eating disorders by means of a search conducted in PubMed. The most relevant conclusion of this review seems to be that the main causes of sudden death in eating disorders are those related to cardiovascular complications. The predictive value of the increased QT interval dispersion as a marker of sudden acute ventricular arrhythmia and death has been demonstrated. Eating disorder patients with severe cardiovascular symptoms should be hospitalized. In general, with respect to sudden death in eating disorders, some findings (eg, long-term eating disorders, chronic hypokalemia, chronically low plasma albumin, and QT intervals >600 milliseconds) must be taken into account, and it must be highlighted that during refeeding, the adverse effects of hypophosphatemia include cardiac failure. Monitoring vital signs and performing electrocardiograms and serial measurements of plasma potassium are relevant during the treatment of eating disorder patients. PMID:22393299

  5. [Sudden death. Role of the electrophysiologic study].

    PubMed

    Colín Lizalde, Luis

    2002-01-01

    At present, sudden death is considered a major health problem, DeBoer in 1935, recognized the clinical importance of ventricular fibrillation as the cause of sudden cardiac death. Sudden death due to cardiovascular problems has been established as one of the main causes of death in the developed countries and in developing countries as ours, where the deaths caused by cardiovascular diseases represent 15% of the total, exceeding other causes of death. The frequency of sudden death in our country is unknown, but more frequently we hear about cases of patients that have been reanimated for cardiac arrest; in the United States of America the frequency has been estimated between 400,000 at 500,000 per year although, recently, 250,000 at 300,000 events are being mentioned. It is convenient to comment that the causal arrhythmias are diverse and may vary depending on the underlying disease, although, generally, it can be pointed out that 80% of them are due to tachyarrhythmias. It's important to point out that there is a strong relationship between left ventricular dysfunction, the frequency of ventricular arrhythmias, and fatal cardiac events due to cardiac rhythm disturbances. The recommendations for electrophysiological studies are: 1) patients surviving cardiac arrest, occurring without evidence of an acute Q-wave myocardial infarction and 2) patients surviving cardiac arrest occurring more than 48 hours after the acute phase of myocardial infarction in the absence of a recurrent ischemic event. PMID:12001869

  6. Imaging of cardiac sarcoidosis.

    PubMed

    Erthal, Fernanda; Juneau, Daniel; Lim, Siok P; Dwivedi, Girish; Nery, Pablo B; Birnie, David; Beanlands, Rob S

    2016-09-01

    Sarcoidosis is a multisystem inflammatory disease. Cardiac involvement is described in up to 50% of the cases. The disease spectrum is wide and cardiac manifestations ranges from being asymptomatic to heart failure, arrhythmias and sudden cardiac death. The diagnosis of cardiac sarcoidosis can be challenging due to its non-specific nature and the focal involvement of the heart. In this review, we discuss the utility of a stepwise approach with multimodality cardiac imaging in the diagnosis and management of CS. PMID:27225318

  7. Sudden death in hemodialysis: an update.

    PubMed

    Kanbay, Mehmet; Afsar, Baris; Goldsmith, David; Covic, Adrian

    2010-01-01

    Cardiovascular disease including sudden death, myocardial infarction, cardiac arrest, malignant arrhythmias and other cardiac causes is the major cause of death accounting for 43% of all-cause mortality among hemodialysis patients. In addition to increased traditional risk factors, hemodialysis patients also have a number of nontraditional cardiovascular risk factors, which may play a prominent role in the development of sudden death such as left ventricular hypertrophy, coronary artery disease, rapid electrolyte shifts, QT dispersion, sympathetic overactivity, calcium-phosphate deposition. The purpose of the present review was to critically review the current literature to summarize the following aspects: (1) the pathophysiological mechanism responsible for sudden death in hemodialysis patients, and (2) the prevention and management of sudden death in hemodialysis patients. PMID:20798493

  8. Space Shuttle ascent aborts

    NASA Astrophysics Data System (ADS)

    Schmidgall, Richard A.

    1989-09-01

    Specific guidance functions and trajectory design of return to launch site (RTLS) and transoceanic abort landing (TAL) intact abort profiles, as well as the increasing emphasis on contingency aborts, are presented. Various systems failures including Space Shuttle main engine failures and detailed technical analyses, including the design of powered flight abort trajectories, are considered. The most critical of flight abort situations is the RTLS, while TAL is the preferred abort when uphill capability is no longer available. It is concluded that one principle must remain to ensure continuing success of Space Shuttle flights: namely that intact and contingency aborts necessitate development to ensure safe return of the vehicle, payload, and crew whenever possible.

  9. Should abortion be legalized?

    PubMed

    Sodhy, L S

    1968-01-01

    Abortion is an important means of family planning, especially when contraception is unavailable or when it fails. Morbidity associated with legal abortion is low, though illegal abortion is a common cause of maternal mortality. The Union of Soviet Socialist Republic, Hungary, Yugoslavia, Czechoslovakia, Romania, Poland, and the German Demogratic Republic all have laws legalizing abortion. Legalized abortion is the surest method of population control and should be promoted if the moral and religious objections can be overcome. PMID:12255647

  10. Incidence of sudden cardiac death associated with coronary artery occlusion in dogs with hypertension and left ventricular hypertrophy is reduced by chronic beta-adrenergic blockade.

    PubMed

    Dellsperger, K C; Martins, J B; Clothier, J L; Marcus, M L

    1990-09-01

    Because beta-adrenergic blockade has as one of its many effects altered electrophysiological abnormalities after dogs with left ventricular hypertrophy have been subjected to coronary occlusion, we tested the hypothesis that metoprolol (200-400 mg/day) would reduce mortality rates in dogs with one-kidney, one clip left ventricular hypertrophy while a similar reduction in arterial pressure with enalapril (20-40 mg/day) would not. Dogs with left ventricular hypertrophy were given metoprolol or enalapril for 5-7 days before a 3-hour coronary occlusion. Infarct size and risk area were measured with triphenyltetrazolium chloride stain and barium angiography, respectively. For control (n = 15), left ventricular hypertrophy (n = 17), left ventricular hypertrophy plus metoprolol (n = 12), and left ventricular hypertrophy plus enalapril (n = 15) groups, mean arterial pressure, ratio of infarct size to risk area, and dogs experiencing sudden death were 110 +/- 4, 142 +/- 4, 121 +/- 7, and 120 +/- 3 mm Hg; 44 +/- 5%, 65 +/- 5%, 44 +/- 7%, and 30 +/- 4%; and 27%, 65%, 17%, and 53%, respectively. Thus, the excessive increase in early mortality occurring when dogs with hypertension and left ventricular hypertrophy undergo coronary occlusion is interrupted with beta-blockade, possibly via electrophysiological effects rather than by changes in arterial pressure or infarct size. PMID:1975521

  11. [Abortion and rights. Legal thinking about abortion].

    PubMed

    Perez Duarte, A E

    1991-01-01

    Analysis of abortion in Mexico from a juridical perspective requires recognition that Mexico as a national community participates in a double system of values. Politically it is defined as a liberal, democratic, and secular state, but culturally the Judeo-Christian ideology is dominant in all social strata. This duality complicates all juridical-penal decisions regarding abortion. Public opinion on abortion is influenced on the 1 hand by extremely conservative groups who condemn abortion as homicide, and on the other hand by groups who demand legislative reform in congruence with characteristics that define the state: an attitude of tolerance toward the different ideological-moral positions that coexist in the country. The discussion concerns the rights of women to voluntary maternity, protection of health, and to making their own decisions regarding their bodies vs. the rights of the fetus to life. The type of analysis is not objective, and conclusions depend on the ideology of the analyst. Other elements must be examined for an objective consideration of the social problem of abortion. For example, aspects related to maternal morbidity and mortality and the demographic, economic, and physical and mental health of the population would all seem to support the democratic juridical doctrine that sees the clandestine nature of abortion as the principal problem. It is also observed that the illegality of abortion does not guarantee its elimination. Desperate women will seek abortion under any circumstances. The illegality of abortion also impedes health and educational policies that would lower abortion mortality. There are various problems from a strictly juridical perspective. A correct definition of the term abortion is needed that would coincide with the medical definition. The discussion must be clearly centered on the protected juridical right and the definition of reproductive and health rights and rights to their own bodies of women. The experiences of other

  12. Abortion Before & After Roe

    PubMed Central

    Joyce, Ted; Tan, Ruoding; Zhang, Yuxiu

    2013-01-01

    We use unique data on abortions performed in New York State from 1971–1975 to demonstrate that women travelled hundreds of miles for a legal abortion before Roe. A100- mile increase in distance for women who live approximately 183 miles from New York was associated with a decline in abortion rates of 12.2 percent whereas the same change for women who lived 830 miles from New York lowered abortion rates by 3.3 percent. The abortion rates of nonwhites were more sensitive to distance than those of whites. We found a positive and robust association between distance to the nearest abortion provider and teen birth rates but less consistent estimates for other ages. Our results suggest that even if some states lost all abortion providers due to legislative policies, the impact on population measures of birth and abortion rates would be small as most women would travel to states with abortion services. PMID:23811233

  13. Low Heart Rate Variability in a 2-Minute Electrocardiogram Recording Is Associated with an Increased Risk of Sudden Cardiac Death in the General Population: The Atherosclerosis Risk in Communities Study

    PubMed Central

    Maheshwari, Ankit; Norby, Faye L.; Soliman, Elsayed Z.; Adabag, Selcuk; Whitsel, Eric A.; Alonso, Alvaro; Chen, Lin Y.

    2016-01-01

    Low heart rate variability (HRV) has been linked to increased total mortality in the general population; however, the relationship between low HRV and sudden cardiac death (SCD) is less well-characterized. The goal of this study was to evaluate the relationship between low HRV and SCD in a community-based cohort. Our cohort consisted of 12,543 participants from the Atherosclerosis Risk in Communities (ARIC) study. HRV measures were derived from 2-minute electrocardiogram recordings obtained during the baseline exam (1987–89). Time domain measurements included the standard deviation of all normal RR intervals (SDNN) and the root mean squared successive difference (r-MSSD). Frequency domain measurements included low frequency power (LF) and high frequency (HF) power. During a median follow-up of 13 years, 215 SCDs were identified from physician adjudication of all coronary heart disease deaths through 2001. In multivariable adjusted Cox proportional hazards models, each standard deviation decrement in SDNN, LF, and HF were associated with 24%, 27% and 16% increase in SCD risk, respectively. Low HRV is independently associated with increased risk of SCD in the general population. PMID:27551828

  14. Low Heart Rate Variability in a 2-Minute Electrocardiogram Recording Is Associated with an Increased Risk of Sudden Cardiac Death in the General Population: The Atherosclerosis Risk in Communities Study.

    PubMed

    Maheshwari, Ankit; Norby, Faye L; Soliman, Elsayed Z; Adabag, Selcuk; Whitsel, Eric A; Alonso, Alvaro; Chen, Lin Y

    2016-01-01

    Low heart rate variability (HRV) has been linked to increased total mortality in the general population; however, the relationship between low HRV and sudden cardiac death (SCD) is less well-characterized. The goal of this study was to evaluate the relationship between low HRV and SCD in a community-based cohort. Our cohort consisted of 12,543 participants from the Atherosclerosis Risk in Communities (ARIC) study. HRV measures were derived from 2-minute electrocardiogram recordings obtained during the baseline exam (1987-89). Time domain measurements included the standard deviation of all normal RR intervals (SDNN) and the root mean squared successive difference (r-MSSD). Frequency domain measurements included low frequency power (LF) and high frequency (HF) power. During a median follow-up of 13 years, 215 SCDs were identified from physician adjudication of all coronary heart disease deaths through 2001. In multivariable adjusted Cox proportional hazards models, each standard deviation decrement in SDNN, LF, and HF were associated with 24%, 27% and 16% increase in SCD risk, respectively. Low HRV is independently associated with increased risk of SCD in the general population. PMID:27551828

  15. Abortion and psychiatric practice.

    PubMed

    Stotland, Nada L

    2003-03-01

    The subject of abortion is fraught with politics, emotions, and misinformation. A widespread practice reaching far back in history, abortion is again in the news. Psychiatry sits at the intersection of the religious, ethical, psychological, sociological, medical, and legal facets of the abortion issue. Although the religions that forbid abortion are more prominent in the media, many religions have more liberal approaches. While the basic right to abortion has been upheld by the U.S. Supreme Court, several limitations have been permitted, including parental notification or consent (with the possibility of judicial bypass) for minors, waiting periods, and mandatory provision of certain, sometimes biased, information. Before the Roe v. Wade decision legalizing abortion in 1973, many women were maimed or killed by illegal abortions, and psychiatrists were sometimes asked to certify that abortions were justified on psychiatric grounds. Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. This assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae. The psychiatric outcome of abortion is best when patients are able to make autonomous, supported decisions. Psychiatrists need to know the medical and psychiatric facts about abortion. Psychiatrists can then help patients prevent unwanted pregnancies, make informed decisions consonant with their own values and circumstances when they become pregnant, and find appropriate social and medical resources whatever their decisions may be. PMID:15985924

  16. Legalized abortion in Czechoslovakia.

    PubMed

    Zidovsky, J; Zwinger, A

    1972-01-01

    A law legalizing abortion was passed nearly 20 years ago in Czechosl ovakia. The law aimed to give women the freedom to decide for themselves whether they want to be pregnant and to decrease the dangers of illegal abortion. The law resulted in a decreased number of abortions and of complications and deaths associated with abortion. Fertility in the country also declined. In 1968 there were more abortions than live births in the country. Since 1957, the law has been modified. The law still aims to prevent the birth of defective children and to protect the life and health of mothers. Each application for abortion is now examined on its own merits. Favorable economic circumstances, prolife social policies adopted by the government, and the new stricter interpretation of the abortion law have resulted in a r ising birthrate since 1969. Contraception is still stressed as preferab le to abortion. PMID:12256872

  17. Abortion - surgical - aftercare

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  18. Sudden unexpected death in epilepsy genetics: Molecular diagnostics and prevention.

    PubMed

    Goldman, Alica M; Behr, Elijah R; Semsarian, Christopher; Bagnall, Richard D; Sisodiya, Sanjay; Cooper, Paul N

    2016-01-01

    Epidemiologic studies clearly document the public health burden of sudden unexpected death in epilepsy (SUDEP). Clinical and experimental studies have uncovered dynamic cardiorespiratory dysfunction, both interictally and at the time of sudden death due to epilepsy. Genetic analyses in humans and in model systems have facilitated our current molecular understanding of SUDEP. Many discoveries have been informed by progress in the field of sudden cardiac death and sudden infant death syndrome. It is becoming apparent that SUDEP genomic complexity parallels that of sudden cardiac death, and that there is a pauci1ty of analytically useful postmortem material. Because many challenges remain, future progress in SUDEP research, molecular diagnostics, and prevention rests in international, collaborative, and transdisciplinary dialogue in human and experimental translational research of sudden death. PMID:26749013

  19. Late-term abortion.

    PubMed

    Epner, J E; Jonas, H S; Seckinger, D L

    1998-08-26

    Recent proposed federal legislation banning certain abortion procedures, particularly intact dilatation and extraction, would modify the US Criminal Code such that physicians performing these procedures would be liable for monetary and statutory damages. Clarification of medical procedures is important because some of the procedures used to induce abortion prior to viability are identical or similar to postviability procedures. This article reviews the scientific and medical information on late-term abortion and late-term abortion techniques and includes data on the prevalence of late-term abortion, abortion-related mortality and morbidity rates, and legal issues regarding fetal viability and the balance of maternal and fetal interests. According to enacted American Medical Association (AMA) policy, the use of appropriate medical terminology is critical in defining late-term abortion procedures, particularly intact dilatation and extraction, which is a variant of but distinct from dilatation and evacuation. The AMA recommends that the intact dilatation and extraction procedure not be used unless alternative procedures pose materially greater risk to the woman and that abortions not be performed in the third trimester except in cases of serious fetal anomalies incompatible with life. Major medical societies are urged to collaborate on clinical guidelines on late-term abortion techniques and circumstances that conform to standards of good medical practice. More research on the advantages and disadvantages of specific abortion procedures would help physicians make informed choices about specific abortion procedures. Expanded ongoing data surveillance systems estimating the prevalence of abortion are also needed. PMID:9728645

  20. Abortion among Adolescents.

    ERIC Educational Resources Information Center

    Adler, Nancy E.; Ozer, Emily J.; Tschann, Jeanne

    2003-01-01

    Reviews the current status of abortion laws pertaining to adolescents worldwide, examining questions raised by parental consent laws in the United States and by the relevant psychological research (risk of harm from abortion, informed consent, consequences of parental involvement in the abortion decision, and current debate). Discusses issues…

  1. Vision Loss, Sudden

    MedlinePlus

    ... of age-related macular degeneration. Spotlight on Aging: Vision Loss in Older People Most commonly, vision loss ... Some Causes and Features of Sudden Loss of Vision Cause Common Features* Tests Sudden loss of vision ...

  2. Sudden Infant Death Syndrome

    MedlinePlus

    Sudden infant death syndrome (SIDS) is the sudden, unexplained death of an infant younger than one year old. Some people call ... boys, African Americans, and American Indian/Alaska Native infants have a higher risk of SIDS. Although health ...

  3. Sudden Infant Death Syndrome

    MedlinePlus

    Sudden infant death syndrome (SIDS) is the sudden, unexplained death of an infant younger than one year old. Some people call SIDS "crib death" because many babies who die of SIDS are found in their ...

  4. Abortion in Ireland.

    PubMed

    Francome, C

    1992-08-22

    Substantial legal barriers to abortion persist in both the Irish Republic and Northern Ireland, despite growing popular support for abortion under certain conditions. A 1983 amendment to the republic's constitution guarantees the fetus the same right to life s the mother and bans the provision of information on abortion. Although a recent well publicized case of a pregnant, suicidal 14-year-old who travelled to England for an abortion resulted in an Irish Supreme Court ruling that abortion was acceptable in cases of "real and substantial risk" to a woman's life, uncertainty still surrounds the right to travel to England for the procedure. In Northern Ireland, the 1967 Abortion Act does not apply and abortions are denied even in cases of rape and incest. A total of 1766 women from Northern Ireland and 4158 from the republic travelled to England for abortions in 1991. Public opinion seems to have shifted toward support for less restrictive abortion laws, however. Whereas 80% of those surveyed in a 1980 Irish poll supported to ban on abortion in all cases, this statistic had dropped to 30% by 1990. Similarly, a 1991 poll taken in Northern Ireland found 80% of respondents to be a favor of abortion in cases where the procedure is necessary to maintain a woman's physical or mental health. PMID:1392954

  5. Preventing Sudden Death: Cardiovascular Screening of Young Athletes.

    ERIC Educational Resources Information Center

    Ades, Philip A.

    1992-01-01

    Efficiently and inexpensively identifying athletes at risk for exercise-related sudden death is difficult. The article discusses types of cardiac disorders and outlines a practical screening method that features a cardiac history questionnaire designed to identify symptomatic athletes and those with a family history of congenital heart disease.…

  6. Abortion ruling in Quebec.

    PubMed

    Brahams, D

    1989-08-01

    Brahams summarizes a 1989 Quebec Court of Appeal decision in an abortion case and places the ruling in the context of worldwide trends in abortion regulation. In Tremblay v. Daigle (1989 Jul 26), the Quebec court upheld a lower court injunction banning a woman from having an abortion. The injunction had been obtained by the woman's former boyfriend, the putative father. Brahams discusses the current legal status of abortion in Canada, the Daigle court's reasoning, and how the British approach to the legal status of fathers and fetuses in abortion disputes differs from the Canadian. She also briefly summarizes recent abortion-related judicial and regulatory developments in the United States, Ireland, and France. PMID:2569146

  7. Sudden Death in a Patient with Carney's Complex.

    PubMed

    Rothschild, James Adam; Kreso, Melissa; Slodzinski, Martin

    2013-01-01

    Carney's complex is a rare autosomal dominantly inherited multiple endocrine neoplasia syndrome that involves spotty skin pigmentations, recurrent cardiac myxomas, endocrine hyperactivity, pituitary adenomas, peripheral nerve tumors, testicular tumors, and ovarian lesions. We present a case of sudden cardiac death in a 40 year old female with a history of Carney's complex with recurrent cardiac myxomas presenting for exploratory laparotomy and enblock adnexal resection of a slowly enlarging right sided ovarian mass. This case highlights the risk for sudden death in these patients as well as the preoperative assessment that should be undertaken by the anesthesiologist as it relates to Carney's complex. PMID:24223358

  8. How Is Sudden Cardiac Arrest Treated?

    MedlinePlus

    ... passes, the chances of surviving SCA drop rapidly. Police, emergency medical technicians, and other first responders usually ... defibrillation can be done. People who are at risk for SCA may want to consider having an ...

  9. How Is Sudden Cardiac Arrest Diagnosed?

    MedlinePlus

    ... factors that put people at risk for SCA. EKG (Electrocardiogram) An EKG is a simple, painless test that detects and ... beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical ...

  10. Signaling prodromes of sudden cardiac death

    PubMed Central

    Vranic, Ivana I.

    2013-01-01

    The new criteria in detection of ARVC/D produced more subtle noninvasive parameters that raised sensitivity in diagnosis. Since heart rate dynamics have prognostic significance for the progression of a disease and for mortality, the main objective was to explore its value in disclosing risk for serious arrhythmias. Out of 100 ARVC/D patients, 35 with normal ECG Holter recordings (PVC

  11. [Bioethics and abortion. Debate].

    PubMed

    Diniz, D; Gonzalez Velez, A C

    1998-06-01

    Although abortion has been the most debated of all issues analyzed in bioethics, no moral consensus has been achieved. The problem of abortion exemplifies the difficulty of establishing social dialogue in the face of distinct moral positions, and of creating an independent academic discussion based on writings that are passionately argumentative. The greatest difficulty posed by the abortion literature is to identify consistent philosophical and scientific arguments amid the rhetorical manipulation. A few illustrative texts were selected to characterize the contemporary debate. The terms used to describe abortion are full of moral meaning and must be analyzed for their underlying assumptions. Of the four main types of abortion, only 'eugenic abortion', as exemplified by the Nazis, does not consider the wishes of the woman or couple--a fundamental difference for most bioethicists. The terms 'selective abortion' and 'therapeutic abortion' are often confused, and selective abortion is often called eugenic abortion by opponents. The terms used to describe abortion practitioners, abortion opponents, and the 'product' are also of interest in determining the style of the article. The video entitled "The Silent Scream" was a classic example of violent and seductive rhetoric. Its type of discourse, freely mixing scientific arguments and moral beliefs, hinders analysis. Within writings about abortion three extreme positions may be identified: heteronomy (the belief that life is a gift that does not belong to one) versus reproductive autonomy; sanctity of life versus tangibility of life; and abortion as a crime versus abortion as morally neutral. Most individuals show an inconsistent array of beliefs, and few groups or individuals identify with the extreme positions. The principal argument of proponents of legalization is respect for the reproductive autonomy of the woman or couple based on the principle of individual liberty, while heteronomy is the main principle of

  12. [Abortion law in Italy].

    PubMed

    Havránek, F

    1979-04-01

    On May 28, 1978, the Italian senate passed a law legalizing abortions. The law, passed against the will of the Christian Democrat party and the Vatican, is the most liberal in Western Europe. Any woman 18 or older is free to seek an abortion at a private or public institution during the first 90 days of pregnancy. Abortions can be sought on health, economic, social, family, or psychological grounds. A woman requests an abortion at a hospital or clinic, or from a physician. If termination is deemed urgent, the procedure may be performed immediately. If a request is denied, a woman may make another request 7 days later. Second trimester abortions are permitted only if grave danger to the woman or deformation of the fetus is suspected. Women under 18 meed the permission of their parents or legal guardians; a court may also grant permission. Passage of the law has facilitated open debate on the legal and medical aspects of abortion. It has also guaranteed women access to abortions. Physicians, who on grounds of conscience feel they can't perform abortions, may register to be exempt from having to perform them. They may not, however, deny a woman care before and after her abortion, and if they perform the procedure even once, their name is removed from the exempt register. Additionally, all physicians are bound to attempt to preserve the life of all women as well as any fetus which shows life outside the womb. PMID:445601

  13. Beat‐to‐Beat Spatiotemporal Variability in the T Vector Is Associated With Sudden Cardiac Death in Participants Without Left Ventricular Hypertrophy: The Atherosclerosis Risk in Communities (ARIC) Study

    PubMed Central

    Waks, Jonathan W.; Soliman, Elsayed Z.; Henrikson, Charles A.; Sotoodehnia, Nona; Han, Lichy; Agarwal, Sunil K.; Arking, Dan E.; Siscovick, David S.; Solomon, Scott D.; Post, Wendy S.; Josephson, Mark E.; Coresh, Josef; Tereshchenko, Larisa G.

    2015-01-01

    Background Despite advances in prevention and treatment of cardiovascular disease, sudden cardiac death (SCD) remains a clinical challenge. Risk stratification in the general population is needed. Methods and Results Beat‐to‐beat spatiotemporal variability in the T vector was measured as the mean angle between consecutive T‐wave vectors (mean TT′ angle) on standard 12‐lead ECGs in 14 024 participants in the Atherosclerosis Risk in Communities (ARIC) study. Subjects with left ventricular hypertrophy, atrial arrhythmias, frequent ectopy, ventricular pacing, or QRS duration ≥120 ms were excluded. The mean spatial TT′ angle was 5.21±3.55°. During a median of 14 years of follow‐up, 235 SCDs occurred (1.24 per 1000 person‐years). After adjustment for demographics, coronary heart disease risk factors, and known ECG markers for SCD, mean TT′ angle was independently associated with SCD (hazard ratio 1.089; 95% CI 1.044 to 1.137; P<0.0001). A mean TT′ angle >90th percentile (>9.57°) was associated with a 2‐fold increase in the hazard for SCD (hazard ratio 2.01; 95% CI 1.28 to 3.16; P=0.002). In a subgroup of patients with T‐vector amplitude ≥0.2 mV, the association with SCD was almost twice as strong (hazard ratio 3.92; 95% CI 1.91 to 8.05; P<0.0001). A significant interaction between mean TT′ angle and age was found: TT′ angle was associated with SCD in participants aged <55 years (hazard ratio 1.096; 95% CI 0.043 to 1.152; P<0.0001) but not in participants aged ≥55 years (Pinteraction=0.009). Conclusions In a large, prospective, community‐based cohort of left ventricular hypertrophy–free participants, increased beat‐to‐beat spatiotemporal variability in the T vector, as assessed by increasing TT′ angle, was associated with SCD. PMID:25600143

  14. Impact of Aldosterone Antagonists on Sudden Cardiac Death Prevention in Heart Failure and Post-Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Le, Hai-Ha; El-Khatib, Chadia; Mombled, Margaux; Guitarian, Frédéric; Al-Gobari, Muaamar; Fall, Mor; Janiaud, Perrine; Marchant, Ivanny; Cucherat, Michel; Bejan-Angoulvant, Théodora; Gueyffier, François

    2016-01-01

    Background and Objectives Sudden cardiac death (SCD) is a severe burden of modern medicine. Aldosterone antagonist is publicized as effective in reducing mortality in patients with heart failure (HF) or post myocardial infarction (MI). Our study aimed to assess the efficacy of AAs on mortality including SCD, hospitalization admission and several common adverse effects. Methods We searched Embase, PubMed, Web of Science, Cochrane library and clinicaltrial.gov for randomized controlled trials (RCTs) assigning AAs in patients with HF or post MI through May 2015. The comparator included standard medication or placebo, or both. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Event rates were compared using a random effects model. Prospective RCTs of AAs with durations of at least 8 weeks were selected if they included at least one of the following outcomes: SCD, all-cause/cardiovascular mortality, all-cause/cardiovascular hospitalization and common side effects (hyperkalemia, renal function degradation and gynecomastia). Results Data from 19,333 patients enrolled in 25 trials were included. In patients with HF, this treatment significantly reduced the risk of SCD by 19% (RR 0.81; 95% CI, 0.67–0.98; p = 0.03); all-cause mortality by 19% (RR 0.81; 95% CI, 0.74–0.88, p<0.00001) and cardiovascular death by 21% (RR 0.79; 95% CI, 0.70–0.89, p<0.00001). In patients with post-MI, the matching reduced risks were 20% (RR 0.80; 95% CI, 0.66–0.98; p = 0.03), 15% (RR 0.85; 95% CI, 0.76–0.95, p = 0.003) and 17% (RR 0.83; 95% CI, 0.74–0.94, p = 0.003), respectively. Concerning both subgroups, the relative risks respectively decreased by 19% (RR 0.81; 95% CI, 0.71–0.92; p = 0.002) for SCD, 18% (RR 0.82; 95% CI, 0.77–0.88, p < 0.0001) for all-cause mortality and 20% (RR 0.80; 95% CI, 0.74–0.87, p < 0.0001) for cardiovascular mortality in patients treated with AAs. As well, hospitalizations were significantly reduced

  15. [Prevention of abortion].

    PubMed

    Alberti, N; Nègre-Garnier, C

    1994-03-01

    Psychologists and marriage counselors conducting preabortion interviews in a French clinic note that women have emotions concerning abortion apart from the reasons they give for choosing to end their pregnancies. Their experience demonstrates that a pregnancy never occurs by chance, but always at a given moment of existence. An abortion becomes an event in the significant and particular history of each woman undergoing one. Particular circumstances of unemployment, illness, or other adversity become linked in the woman's later recollections of the abortion. Abortions often signify psychic problems of separation or loss, as demonstrated by the considerable number of immigrant women who undergo abortions after having been obliged to leave their native lands, or those who undergo abortions after the death of a child. Women choosing abortion experience anguish and guilt. Fantasies of the aborted child represent the period of mourning that must be surmounted. The psychic labor of the grief process allows a progressive detachment to be achieved. The belief that expanded knowledge and use of contraception would lead to a significant decline in abortion has been belied by experience; the number of abortions has been stable over the years despite ever increasing use of contraceptives of all types. The objective of contraception, a harmonious sexual relationship in which pregnancy does not occur, is itself complex. Choices related to a more or less distant future are made by individuals who are to a greater or lesser extent engaged in the relationship using more or less inconvenient techniques. Statements made by couples themselves perfectly reflect the paradoxes. Objections and resistances to contraceptive use are also prompted by societal norms of sex and reproduction. The couple are influenced in their abortion decision by their own level of maturity and by their family backgrounds. PMID:8009399

  16. Sudden Infant Death Syndrome.

    ERIC Educational Resources Information Center

    Barnett, Henry L.; And Others

    There is a growing body of evidence that Sudden Infant Death Syndrome (SIDS) victims are not completely normal and healthy, as was once believed. A variety of new information from several disciplines strongly suggests that the infant who dies suddenly and unexpectedly may do so because of subtle developmental, neurologic, cardiorespiratory, and…

  17. Sudden Unexpected Postnatal Collapse of the Newborn.

    PubMed

    Ferrarello, Debi; Carmichael, Tanya

    2016-01-01

    Sudden unexpected postnatal collapse is a rare but devastating neonatal event. A well-appearing, full-term newborn with Agpar scores of eight or more suddenly crashes, often with full respiratory and cardiac arrest. Up to half of newborns with sudden unexpected postnatal collapse die, with many survivors suffering serious neurological damage. The first 2 hours of life are the hours of greatest risk, coinciding with the time frame when nurses encourage breastfeeding and uninterrupted skin-to-skin contact between women and newborns. Nursing assessments and measures to promote neonates' optimal transition to extrauterine life through skin-to-skin contact and early breastfeeding while decreasing the risk of this catastrophic event are described. Nursing surveillance to promote optimal transition in a safe environment is essential, and birth facilities should allocate staffing resources accordingly. PMID:27287353

  18. Abortion: the new debate.

    PubMed

    Callahan, D

    1986-06-01

    The course of the debate on abortion following the 1973 Supreme Court decision legalizing abortion has been marked by a variety of medical and scientific developments. Many of these new developments have important legal, psychologic, social, moral, and political implications. The cumulative impact of all these developments may pose a significant challenge to the social and legal foundations of Roe v. Wade. PMID:3523563

  19. Psychosocial aspects of abortion

    PubMed Central

    Illsley, Raymond; Hall, Marion H.

    1976-01-01

    The literature on psychosocial aspects of abortion is confusing. Individual publications must be interpreted in the context of cultural, religious, and legal constraints obtaining in a particular society at a given time, with due attention to the status and availability of alternatives to abortion that might be chosen by a woman with an “unwanted” pregnancy. A review of the literature shows that, where careful pre- and post-abortion assessments are made, the evidence is that psychological benefit commonly results, and serious adverse emotional sequelae are rare. The outcome of refused abortion seems less satisfactory, with regrets and distress frequently occurring. Research on the administration of abortion services suggests that counselling is often of value, that distress is frequently caused by delays in deciding upon and in carrying out abortions, and by unsympathetic attitudes of service providers. The phenomenon of repeated abortion seeking should be seen in the context of the availability and cost of contraception and sterilization. The place of sterilization with abortion requires careful study. A recommendation is made for observational descriptive research on populations of women with potentially unwanted pregnancies in different cultures, with comparisons of management systems and an evaluation of their impact on service users. PMID:1085671

  20. Abortion in Adolescence.

    ERIC Educational Resources Information Center

    Campbell, Nancy B.; And Others

    1988-01-01

    Explored differences between 35 women who had abortions as teenagers and 36 women who had abortions as adults. Respondents reported on their premorbid psychiatric histories, the decision-making process itself, and postabortion distress symptoms. Antisocial and paranoid personality disorders, drug abuse, and psychotic delusions were significantly…

  1. Access to legal abortion.

    PubMed

    1993-10-01

    Countries are grouped by the nature and extent of access to legal abortion. The categories include abortion on demand, for social reasons, for health reasons, for rape or incest or to save a mother's life, and only to save a mother's life. Abortion on demand is available for about 40% of the world's population and may have restrictions, such as parental consent or approval of state committees or physicians. There are 22 countries in Europe, 12 in the former Soviet Union, four in Asia, four in the Americas, one in the Middle East (Turkey), and one in Africa (Tunisia) which provide access to early abortion on demand. Abortion for social and economic reasons is available to 21% of the world's population in five countries in Asia, three in Europe (Great Britain, Finland, and Hungary), and one in Africa (Zambia). Abortion for health reasons is available to 16% of the world's population located in 21 countries in Africa, eight in the Americas, seven in Asia, five in Europe, and four in the Middle East. Laws governing about 5% of the world's population permit abortion only in the case of rape, incest, or when a mother's life is in danger (Brazil, Mexico, and Sudan). 18% of the world's population is covered by laws which permit an abortion only when a mother's life is in danger; this includes 19 countries in Africa, 11 in the Americas, nine in Asia, seven in the Middle East, and one in Europe (Ireland). PMID:12287145

  2. "Conservative" views of abortion.

    PubMed

    Devine, P E

    1997-01-01

    The introduction to this essay, which presents and defends the "conservative" position on abortion, explains that this position holds that 1) abortion is wrong because it destroys the fetus; 2) the fetus has full personhood from conception (or very near conception); 3) abortion is only justified under special circumstances, such as when the pregnancy poses a threat to the woman's life; and 4) these conclusions should be reflected in law and public policy. Part 2 sets forth the moral foundations for this position. The third part considers the status of the fetus and reviews the various arguments that have been forwarded to resolve the question, such as the species principle, the potentiality principle, the sentience principle, and the conventionalist principle. Part 4 applies the conservative position to problems posed by hard cases, determines that abortion is a form of homicide from two weeks after fertilization (at the latest), reviews circumstances in which various legal definitions of homicide are applicable, argues for the denial of abortion funding by the state, and notes that violent militancy is not the appropriate response to a belief that abortion should be illegal. Section 5 refutes objections to the conservative position based on the fact that some opponents of abortion also oppose contraception, based on feminist ideals, and based on calls for religious freedom in a pluralistic society. In conclusion, the labels applied to the abortion debate are examined, and it is suggested that "communitarian" is the best term for the conservative position. PMID:12348327

  3. Induced abortion: epidemiological aspects.

    PubMed Central

    Baird, D

    1975-01-01

    Sir Dugald Baird sketches the history of abortion legislation in Great Britain from the beginning of the century. In his views the 1967 Abortion Act has been one of the most important and beneficial pieces of social legislation enacted in Britain in the last 100 years. It has, however, brought problems both of administration in the hospitals and to individual doctors and nurses, particularly when the patients are young single women and even schoolgirls. One of the consequences of the Abortion Act has been a fall in maternal mortality and perinatal mortality rates. Abortion does not seem to be followed by serious emotional sequelae. Nevertheless recent changes in sexual mores have introduced new and serious social problems which are discussed in relation to the role of the doctor in his relationship with patients seeking abortion. PMID:765461

  4. Abortion: a history.

    PubMed

    Hovey, G

    1985-01-01

    This review of abortion history considers sacred and secular practice and traces abortion in the US, the legacy of the 19th century, and the change that occurred in the 20th century. Abortion has been practiced since ancient times, but its legality and availability have been threatened continuously by forces that would denigrate women's fundamental rights. Currently, while efforts to decrease the need for abortion through contraception and education continue, access to abortion remains crucial for the well-being of millions of women. That access will never be secure until profound changes occur in the whole society. Laws that prohibit absolutely the practice of abortion are a relatively recent development. In the early Roman Catholic church, abortion was permitted for male fetuses in the first 40 days of pregnancy and for female fetuses in the first 80-90 days. Not until 1588 did Pope Sixtus V declare all abortion murder, with excommunication as the punishment. Only 3 years later a new pope found the absolute sanction unworkable and again allowed early abortions. 300 years would pass before the Catholic church under Pius IX again declared all abortion murder. This standard, declared in 1869, remains the official position of the church, reaffirmed by the current pope. In 1920 the Soviet Union became the 1st modern state formally to legalize abortion. In the early period after the 1917 revolution, abortion was readily available in state operated facilities. These facilities were closed and abortion made illegal when it became clear that the Soviet Union would have to defend itself against Nazi Germany. After World War II women were encouraged to enter the labor force, and abortion once again became legal. The cases of the Catholic church and the Soviet Union illustrate the same point. Abortion legislation has never been in the hands of women. In the 20th century, state policy has been determined by the rhythms of economic and military expansion, the desire for cheap

  5. Abortion in adolescence.

    PubMed

    Greydanus, D E; Railsback, L D

    1985-09-01

    This article reviews the difficult but complex subject of abortion in adolescents. Methods of abortion are outlined and additional aspects are presented: psychological effects, counseling issues, and legal parameters. It is our conclusion that intense efforts should be aimed at education of youth about sexuality and prevention of pregnancy, utilizing appropriate contraceptive services. When confronted with a youth having an unwanted pregnancy, all legal options need to be carefully explored: delivery, adoption, or abortion. The decision belongs to the youth and important individuals in her environment. Understanding developmental aspects of adolescence will help the clinician deal with the pregnant teenagers. If abortion is selected, a first trimester procedure is best. Finally, physicians are urged to be aware of the specific, ever changing legal dynamics concerning this subject which are present in their states. Abortion is a phenomenon which has become an emotional but undeniably important aspect of adolescent sexuality and adolescent health care, in this country and around the world. PMID:3916607

  6. [Sudden death in young athletes].

    PubMed

    Gojanovic, B; Feihl, F; Gremion, G; Waeber, B

    2007-02-01

    Sudden cardiac death in a young athlete is a tragic and marking event, even though the media attention it gets is more important than its incidence (1-2/100000 per year). The main etiology is hypertrophic cardiomyopathy, followed by coronary artery anomalies. Sometimes signs of myocarditis are found at autopsy. The pre-participation examination recommandations ask for oriented history and physical examination, routine EKG being controversial. A systematic screening program in Italy has reduced the occurrence of such deaths, which statistics are non-existant in Switzerland. It would be appropriate to implement a standardized pre-participation examination, as well as to make sure that the trainers, teachers and athletes themselves are able to recognize the frequent warning symptoms. PMID:17330410

  7. Unusual sudden death.

    PubMed Central

    Warren, J. V.

    1985-01-01

    In contrast to usual sudden death seen in the course of coronary artery disease, individuals dying suddenly from other causes form a complex array of situations. In some the causes are readily identifiable. No simple pattern is available to identify the potential candidate, but on review of the many causes some moves by the physician may be helpful. For example, a more complete physical evaluation of young individuals participating in competitive athletics is in order. This is particularly true if the athlete reports an episode of unexplained syncope. This may well be the warning of a propensity towards sudden death under physical and emotional stress. Knowledge of the specific problems in underwater swimming and diving, in high altitude exposure and in various circumstances such as certain weight reduction diets and industrial exposures may lead to control of some types of unusual sudden death. Clearly, more studies are needed to give answers in so called crib death. As the incidence of usual sudden death falls, these unusual forms of sudden death will represent a more important fraction of sudden death in general. PMID:6537674

  8. Legalized Abortion in Japan

    PubMed Central

    Hart, Thomas M.

    1967-01-01

    The enactment of the Eugenic Protection Act in Japan was followed by many changes. The population explosion was stemmed, the birth rate was halved, and while the marriage rate remained steady the divorce rate declined. The annual total of abortions increased until 1955 and then slowly declined. The highest incidence of abortions in families is in the 30 to 34 age group when there are four children in the family. As elsewhere abortion in advanced stages of pregnancy is associated with high morbidity and mortality. There is little consensus as to the number of criminal abortions. Reasons for criminal abortions can be found in the legal restrictions concerning abortion: Licensing of the abortionist, certification of hospitals, taxation of operations and the requirement that abortion be reported. Other factors are price competition and the patient's desire for secrecy. Contraception is relatively ineffective as a birth control method in Japan. Oral contraceptives are not yet government approved. In 1958 alone 1.1 per cent of married women were sterilized and the incidence of sterilization was increasing. PMID:6062283

  9. Undue burden of abortion.

    PubMed

    Charo, A

    1992-07-01

    In Planned Parenthood vs. Casey, the US Supreme Court upheld all but 1 provision of Pennsylvania law that further restricts access to abortion. The law has a 24-hour waiting period, parental consent for minors with a judicial bypass, husband notification, and the circumstances of each abortion are to be reported to the state for statistical purposes. The Court overturned the husband notification provision even though it had a bypass procedure. The most important aspect of the decision was the change from the strict scrutiny in which abortion was to be left alone unless the state could show a compelling need to regulate it to an undue burden test in which the state is allowed to regulate abortion so long as it does not place an undue burden on women trying to seek abortion services. The 24-hour waiting period was upheld; however, it was also acknowledged that since 83% of women live in counties without abortion services, this may turn out to be an undue burden and it is open to review at later date when statistical evidence is available. The Opinion was written by Justices O'Connor, Kennedy, and Souter. Chief Justice Rehnquist and Justices Scalia, White, and Thomas dissented saying that the undue burden standard was unprecedented in constitutional law and undefinable in practice. It is likely now that the Court will begin writing abortion policy as it clarifies each specific point of the law rather than ruling on fundamental legal principles. PMID:1351612

  10. Legalized abortion in Japan.

    PubMed

    Hart, T M

    1967-10-01

    The enactment of the Eugenic Protection Act in Japan was followed by many changes. The population explosion was stemmed, the birth rate was halved, and while the marriage rate remained steady the divorce rate declined. The annual total of abortions increased until 1955 and then slowly declined. The highest incidence of abortions in families is in the 30 to 34 age group when there are four children in the family. As elsewhere abortion in advanced stages of pregnancy is associated with high morbidity and mortality. There is little consensus as to the number of criminal abortions. Reasons for criminal abortions can be found in the legal restrictions concerning abortion: Licensing of the abortionist, certification of hospitals, taxation of operations and the requirement that abortion be reported. Other factors are price competition and the patient's desire for secrecy. Contraception is relatively ineffective as a birth control method in Japan. Oral contraceptives are not yet government approved. In 1958 alone 1.1 per cent of married women were sterilized and the incidence of sterilization was increasing. PMID:6062283

  11. Abortion: the hidden plague.

    PubMed

    Tuckwell, S

    1974-05-01

    Abortion is called the invisible plague of all countries and cultures in the twentieth century. It is by far the most important method of birth control in the world today. For every 200 babies born there are at least 100 abortions. In the rich world, a woman who wants to end her pregnancy goes to an abortionist, but for millions of poor women, abortion happens spontaneously in their own homes induced by poor nutrition, sheer physical weakness, and too many pregnancies too close together. In countries where abortion is illegal, millions of women die each year as a result of severe illness or the botched handiwork of backyard operators. The most common complications are massive hemorrhaging, perforation of the uterus, laceration, sepsis, and renal failure. The experience of a great many countries shows that simply legalizing abortion can lead to a dramatic drop in death and illness. Relaxation of abortion laws can save lives, money, and misery for mothers and children. Illegal abortion has become a major problem in Africa there are 3 main types of women who enter hospitals with complications after abortions: 1) the teenager who is away from home; 2) the young woman, often educated, working, and with financial responsibilities, who is ambitious for herself, her husband, or her family; and 3) the woman in her thirties, illiterate, a rural worker, married most of her reproductive life, and pregnant most years. The third type of woman may abort because her system is utterly depleted. Such women must be shown that there is a good chance of survival for her children so that she will not have so many. PMID:12307249

  12. Demand for abortion and post abortion care in Ibadan, Nigeria

    PubMed Central

    2014-01-01

    Background While induced abortion is considered to be illegal and socially unacceptable in Nigeria, it is still practiced by many women in the country. Poor family planning and unsafe abortion practices have daunting effects on maternal health. For instance, Nigeria is on the verge of not meeting the Millennium development goals on maternal health due to high maternal mortality ratio, estimated to be about 630 maternal deaths per 100,000 live births. Recent evidences have shown that a major factor in this trend is the high incidence of abortion in the country. The objective of this paper is, therefore, to investigate the factors determining the demand for abortion and post-abortion care in Ibadan city of Nigeria. Methods The study employed data from a hospital-based/exploratory survey carried out between March to September 2010. Closed ended questionnaires were administered to a sample of 384 women of reproductive age from three hospitals within the Ibadan metropolis in South West Nigeria. However, only 308 valid responses were received and analysed. A probit model was fitted to determine the socioeconomic factors that influence demand for abortion and post-abortion care. Results The results showed that 62% of respondents demanded for abortion while 52.3% of those that demanded for abortion received post-abortion care. The findings again showed that income was a significant determinant of abortion and post-abortion care demand. Women with higher income were more likely to demand abortion and post-abortion care. Married women were found to be less likely to demand for abortion and post-abortion care. Older women were significantly less likely to demand for abortion and post-abortion care. Mothers’ education was only statistically significant in determining abortion demand but not post-abortion care demand. Conclusion The findings suggest that while abortion is illegal in Nigeria, some women in the Ibadan city do abort unwanted pregnancies. The consequence of this

  13. Abortion in Ghana.

    PubMed

    Sedgh, Gilda

    2010-07-01

    Maternal mortality is the second most common cause of death among women in Ghana, and more than one in 10 maternal deaths (11%) are the result of unsafe induced abortions.1 In addition, a substantial proportion of women who survive an unsafe abortion experience complications from the procedure. This suffering is all the more tragic because it is unnecessary: Many women likely turn to unsafe providers or do not obtain adequate postabortion care when it is needed because they are unaware that abortion is legal on fairly broad grounds in Ghana. PMID:20653094

  14. [Interregional project concerning abortion].

    PubMed

    Jourdain, A; Pierotti, D; Vinclair, M

    1979-01-01

    The law legalizing abortion in France was passed in 1975. To group information of a social and medical nature and to publish reports on their activities, a questionnaire was designed to be filled by physicians and nurses working in centers and hospitals performing abortion. There were 19,000 abortions performed in 1976, and 30,000 are expected to be performed in 1979. The questionnaire contains 80 questions gathering information on socieconomic data, on medical history, on the procedure of the intervention, and on the follow-up visit. A study done on 5700 questionnaires filled between 1976 and 1977 show that most abortion seekers belong to the middle class, and that pregnancy was due in 20% of cases to pill failure, and in 34% of cases to failure of behavioral methods, or to lack of contraception. 88% of patients declared themselves satisfied with the procedure. PMID:12309432

  15. Induced abortion in Indonesia.

    PubMed

    Hull, T H; Sarwono, S W; Widyantoro, N

    1993-01-01

    Induced abortion is one of the most difficult sociomedical problems facing the Indonesian government. While well-known in traditional society, the practice was discouraged by all Indonesian religious groups, and forbidden by the Dutch colonial authorities. Although abortion was technically illegal under the criminal code, a judicial interpretation in the early 1970s permitted medical professionals to offer the procedure so long as they were discreet and careful. The numbers of medical abortions carried out in Indonesia rose dramatically, and there was evidence of matching declines in the incidence of morbidity and mortality caused by dangerous illegal procedures. Medical and community groups campaigned for a more liberal abortion law to protect legal practitioners and stamp out illegal traditional practices. Their efforts appeared to bear fruit in the draft Health Law, but when the law was passed by the legislature in late 1992, the issue was again clouded by contradictions and inconsistencies. PMID:8212094

  16. Botswana: abortion "debate" dynamics.

    PubMed

    Mogwe, A

    1992-01-01

    The Penal Code (Amendment) Bill or the abortion bill has the objective of liberalizing the current law on the regulation of abortion. Abortion had been strictly prohibited and carried stiff penalties. Anyone who attempted to assists a woman to procure an abortion could be liable to 7 years' imprisonment. However, medical abortions were distinguished as being medically determined to save the health of the mother. Demands for a reevaluation of the law came from the medical profession, and in response the Minister for Presidential Affairs submitted a bill to Parliament in November, 1990. The expressed government rationale for these proposed amendments was concern about the health of women. In Botswana about 200 women die yearly because of pregnancy. According to the proposed law: an abortion could be carried out within the first 16 weeks of pregnancy if: 1) the pregnancy were a result of rape, incest, or defilement (the impregnation of a girl aged 16 or less, the impregnation of imbeciles or idiots), 2) the physical or mental health of the woman were at risk because of the pregnancy, 3) the child would be born with a serious physical or mental abnormality. The abortion could be carried out only if 2 medical doctors approved it. The amendments fall far short of increasing women's control over their bodies. The Botswana Christian Council issued a statement early in the public debate. While it did not oppose the bill in its entirety, clear concern was expressed concerning the apparent right of determining who lives and who dies depending on the handicap of the child. This rather liberal position was challenged by the Roman Catholic Church which interpreted abortion as the murder of God-given life. The bill was nevertheless passed by Parliament in September 1991, and the President signed it on October 11, 1991. PMID:12288837

  17. Sudden maternal deaths in Malaysia: a case report.

    PubMed

    Jegasothy, Ravindran

    2002-08-01

    We report on a retrospective study of maternal deaths in Malaysia that occurred within 24 hours of delivery, abortion or operative termination of the pregnancy (defined as sudden deaths) in the years 1995-1996. There were 131 sudden maternal deaths (20.6% of all maternal deaths); postpartum hemorrhage, obstetric embolisms, trauma and hypertensive disorders of pregnancy were the main causes. There was a disproportionately increased risk of sudden maternal deaths in the Chinese and the 'other bumiputra' racial groups. The proportion of mothers who had no obstetric risk factors in the pregnancy that led to death was 16.8%. Fourteen mothers died in transit Twenty mothers died after a cesarean section. The findings of this review emphasize the fact that caregivers in obstetrics need to be forever vigilant. All maternity staff need to be well trained in emergency care and there needs to be quick referral to centers that can provide expertise in handling these emergencies. PMID:12452259

  18. Current technology for abortion.

    PubMed

    Stubblefield, P G

    1978-12-01

    This discussion focuses on the presently available technology of abortion induction techniques, which, though recent scientific interest has been in abortifacient agents, still primarily consists of some variation on the ancient technique of forcible cervical dilatation and pregnancy extraction in the first trimester. With the advent of legal abortions in the United States, technology and expertise that will lower the already low rate of abortion-associated complications are of paramount importance. That abortion may be preferable to contraception as a fertility control measure is argued from the following 3 drawbacks of present means of contraception: 1) they are preventitive and must be used in advance of need; 2) they fail more frequently than is usually thought (e.g., 4% for birth control pills, 5% for IUDs, and from 17-21% for more conventional methods); and 3) they are associated, though rarely, with potentially fatal side effects such as heart attack, stroke, or infection (some also raise the incidence of pathological pregnancies). The article devotes itself to an overview of complications of induced abortions (the mortality for legal abortions is 1/100,000 vs. maternal mortality of 10/100,000 in the United States), and to discussions of appropriate evacuation procedures per gestational age. Instruments and techniques for menstrual regulation (uterine aspiration during first trimester), are discussed. Procedures and instrumentation required for standard vacuum aspiration are covered. Use of analgesics and anesthetics during abortion procedures comprises one topic, with especial focus on the use of curettage for midtrimester terminations. Midtrimester terminations by amnioinfusions of abortifacients (saline, urea, and prostaglandins, e.g.) are analyzed. And, in addition to discussing sequelae for each particular abortion type, a section is devoted to the sequelae of induced abortion for subsequent pregnancy. Though 100% effectiveness has not been achieved yet

  19. Sudden Death Syndrome

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Sudden death syndrome (SDS) is an important disease of soybean in North and South America. SDS first occurred in South America in the early 1990s. In the U.S.A., SDS was first detected in AK in 1971. Now SDS occurs in most soybean production areas of the U.S. The SDS pathogen is a soil-borne fungu...

  20. The Response of Abortion Demand to Changes in Abortion Costs

    ERIC Educational Resources Information Center

    Medoff, Marshall H.

    2008-01-01

    This study uses pooled cross-section time-series data, over the years 1982, 1992 and 2000, to estimate the impact of various restrictive abortion laws on the demand for abortion. This study complements and extends prior research by explicitly including the price of obtaining an abortion in the estimation. The empirical results show that the real…

  1. Unsafe abortion and abortion care in Khartoum, Sudan.

    PubMed

    Kinaro, Joyce; Ali, Tag Elsir Mohamed; Schlangen, Rhonda; Mack, Jessica

    2009-11-01

    Unsafe abortion in Sudan results in significant morbidity and mortality. This study of treatment for complications of unsafe abortion in five hospitals in Khartoum, Sudan, included a review of hospital records and a survey of 726 patients seeking abortion-related care from 27 October 2007 to 31 January 2008, an interview of a provider of post-abortion care and focus group discussions with community leaders. Findings demonstrate enormous unmet need for safe abortion services. Abortion is legally restricted in Sudan to circumstances where the woman's life is at risk or in cases of rape. Post-abortion care is not easily accessible. In a country struggling with poverty, internal displacement, rural dwelling, and a dearth of trained doctors, mid-level providers are not allowed to provide post-abortion care or prescribe contraception. The vast majority of the 726 abortion patients in the five hospitals were treated with dilatation and curettage (D&C), and only 12.3% were discharged with a contraceptive method. Some women waited long hours before treatment was provided; 14.5% of them had to wait for 5-8 hours and 7.3% for 9-12 hours. Mid-level providers should be trained in safe abortion care and post-abortion care to make these services accessible to a wider community in Sudan. Guidelines should be developed on quality of care and should mandate the use of manual vacuum aspiration or misoprostol for medical abortion instead of D&C. PMID:19962640

  2. A compromise on abortion?

    PubMed

    Rhoden, N K

    1989-01-01

    Rhoden's article is one of three on "Abortion: searching for common ground" in this issue of the Hastings Center Report. Her article, together with those by M. Mahowald and M. Glendon, was prompted by the expectation that the impending U.S. Supreme Court decision in Webster v. Reproductive Health Services (3 July 1989) would overturn or restrict Roe v. Wade (1973). Rhoden, an advocate for the pro-choice position, asks whether a compromise leading to an acceptable regulatory policy is possible or desirable among those on opposite sides of the abortion issue. She identifies several reasons why the Roe decision is vulnerable to review, but argues that effective education about sexuality and comprehensive social support of women are better approaches to abortion than restrictive legislation. PMID:2663778

  3. Abortion and human rights.

    PubMed

    Shaw, Dorothy

    2010-10-01

    Abortion has been a reality in women's lives since the beginning of recorded history, typically with a high risk of fatal consequences, until the last century when evolutions in the field of medicine, including techniques of safe abortion and effective methods of family planning, could have ended the need to seek unsafe abortion. The context of women's lives globally is an important but often ignored variable, increasingly recognised in evolving human rights especially related to gender and reproduction. International and regional human rights instruments are being invoked where national laws result in violations of human rights such as health and life. The individual right to conscientious objection must be respected and better understood, and is not absolute. Health professional organisations have a role to play in clarifying responsibilities consistent with national laws and respecting reproductive rights. Seeking common ground using evidence rather than polarised opinion can assist the future focus. PMID:20303830

  4. [Spontaneous abortion. Etiologic survey. Results].

    PubMed

    Baaklini, N; Anguenot, J L; Boulanger, J C; Vitse, M

    1990-12-01

    The definition of repeated spontaneous abortions is subject to caution. For some, it corresponds to at least three repeated spontaneous abortions with no normal previous pregnancy; for others, it comprises the repeated spontaneous abortions occurring after a normal pregnancy. It is a frequent problem, especially if one tries to give a wider definition. The authors studied the frequency of repeated spontaneous abortions in a continuous series of 14,857 pregnancies which took place between January 1982 and December 1988. In the study of the aetiology of the repeated spontaneous abortions in the various groups of women defined according to the number of previous pregnancies and abortions, they find the classical causes of repeated spontaneous abortions in all the categories: therefore, it seems legitimate to them that a wider definition be given for repeated spontaneous abortions. PMID:2291048

  5. Apollo experience report: Abort planning

    NASA Technical Reports Server (NTRS)

    Hyle, C. T.; Foggatt, C. E.; Weber, B. D.

    1972-01-01

    Definition of a practical return-to-earth abort capability was required for each phase of an Apollo mission. A description of the basic development of the complex Apollo abort plan is presented. The process by which the return-to-earth abort plan was developed and the constraining factors that must be included in any abort procedure are also discussed. Special emphasis is given to the description of crew warning and escape methods for each mission phase.

  6. Space Shuttle Abort Evolution

    NASA Technical Reports Server (NTRS)

    Henderson, Edward M.; Nguyen, Tri X.

    2011-01-01

    This paper documents some of the evolutionary steps in developing a rigorous Space Shuttle launch abort capability. The paper addresses the abort strategy during the design and development and how it evolved during Shuttle flight operations. The Space Shuttle Program made numerous adjustments in both the flight hardware and software as the knowledge of the actual flight environment grew. When failures occurred, corrections and improvements were made to avoid a reoccurrence and to provide added capability for crew survival. Finally some lessons learned are summarized for future human launch vehicle designers to consider.

  7. Orion Abort Flight Test

    NASA Technical Reports Server (NTRS)

    Hayes, Peggy Sue

    2010-01-01

    The purpose of NASA's Constellation project is to create the new generation of spacecraft for human flight to the International Space Station in low-earth orbit, the lunar surface, as well as for use in future deep-space exploration. One portion of the Constellation program was the development of the Orion crew exploration vehicle (CEV) to be used in spaceflight. The Orion spacecraft consists of a crew module, service module, space adapter and launch abort system. The crew module was designed to hold as many as six crew members. The Orion crew exploration vehicle is similar in design to the Apollo space capsules, although larger and more massive. The Flight Test Office is the responsible flight test organization for the launch abort system on the Orion crew exploration vehicle. The Flight Test Office originally proposed six tests that would demonstrate the use of the launch abort system. These flight tests were to be performed at the White Sands Missile Range in New Mexico and were similar in nature to the Apollo Little Joe II tests performed in the 1960s. The first flight test of the launch abort system was a pad abort (PA-1), that took place on 6 May 2010 at the White Sands Missile Range in New Mexico. Primary flight test objectives were to demonstrate the capability of the launch abort system to propel the crew module a safe distance away from a launch vehicle during a pad abort, to demonstrate the stability and control characteristics of the vehicle, and to determine the performance of the motors contained within the launch abort system. The focus of the PA-1 flight test was engineering development and data acquisition, not certification. In this presentation, a high level overview of the PA-1 vehicle is given, along with an overview of the Mobile Operations Facility and information on the White Sands tracking sites for radar & optics. Several lessons learned are presented, including detailed information on the lessons learned in the development of wind

  8. Did Legalized Abortion Lower Crime?

    ERIC Educational Resources Information Center

    Joyce, Ted

    2004-01-01

    Changes in homicide and arrest rates were compared among cohorts born before and after legalization of abortion and those who were unexposed to legalized abortion. It was found that legalized abortion improved the lives of many women as they could avoid unwanted births.

  9. Abortion and compelled physician speech.

    PubMed

    Orentlicher, David

    2015-01-01

    Informed consent mandates for abortion providers may infringe the First Amendment's freedom of speech. On the other hand, they may reinforce the physician's duty to obtain informed consent. Courts can promote both doctrines by ensuring that compelled physician speech pertains to medical facts about abortion rather than abortion ideology and that compelled speech is truthful and not misleading. PMID:25846035

  10. Community study of the causes of "natural" sudden death.

    PubMed Central

    Thomas, A. C.; Knapman, P. A.; Krikler, D. M.; Davies, M. J.

    1988-01-01

    Three hundred and fifty cases of "natural" sudden death within six hours of onset of symptoms in people ranging in age from 18 to 69 years in Wandsworth were studied using a detailed necropsy protocol to determine the cause of death. Sudden death occurred in 28 (8%) Asians and blacks, but because of the small number they were excluded from the study, leaving 322 cases. Ischaemic heart disease accounted for 189 (59%) of the 322 sudden deaths (155 (65%) men; 34 (41%) women) and no proportional increase in instantaneous compared with non-instantaneous sudden death was found. Non-ischaemic cardiac disease was the cause of sudden death in 24 cases (7.5%). Non-cardiac disease included pulmonary emboli, aortic aneurysms, and intracerebral haemorrhage and caused 89 (27.6%) deaths. Alcohol was the cause of nine deaths (2.8%) and in 11 (3.4%) cases (six men and five women) no cause of death was found. This study shows that although ischaemic heart disease is the single largest cause of sudden natural death there are other major causes. Images p1456-a PMID:3147014

  11. Sudden Infant Death Syndrome (SIDS)

    MedlinePlus

    ... Information Clinical Trials Resources and Publications Sudden Infant Death Syndrome (SIDS): Condition Information Skip sharing on social ... Share this: Page Content SIDS is the sudden death of an infant younger than 1 year of ...

  12. [Abortion and conscientious objection].

    PubMed

    Czarkowski, Marek

    2015-03-01

    Polish laws specify the parties responsible for lawful medical care in the availability of abortion differently than the Resolution of the Council of Europe. According to Polish regulations they include all Polish doctors while according to the Resolution, the state. Polish rules should not discriminate against anyone in connection with his religion or belief, even more so because the issue of abortion is an example of an unresolved ethical dispute. The number of lawful abortion in Poland does not exceed 1000 per year and can be carried out by only a few specialists contracted by the National Health Fund. Sufficient information and assistance should be provided to all pregnant women by the National Health Fund. The participation of all physicians in the informing process is not necessary, as evidenced by the lack of complaints to provide information on where in vitro fertilization treatment can be found - until recently only available when paid for by the individual and performed in much larger numbers than abortion. Entities performing this paid procedure made sure to provide information on their own. The rejection of the right to the conscientious objection clause by negating the right to refuse information may lead some to give up the profession or cause the termination of certain professionals on the basis of the professed worldview. Meanwhile, doctors are not allowed to be discriminated against on the basis of their conscience or religion. PMID:25815623

  13. Roundtable: Legal Abortion

    ERIC Educational Resources Information Center

    Guttmacher, Alan F.; And Others

    1971-01-01

    A roundtable discussion on legal abortion includes Dr. Alan F. Guttmacher, President of The Planned Parenthood Federation of America, Robert Hall, Associate Professor of Obstetrics and Gynecology at Columbia University College of Physicians and Surgeons, Christopher Tietze, a diretor of The Population Council, and Harriet Pilpel, a lawyer.…

  14. Sudden infant death triggered by dive reflex.

    PubMed

    Matturri, L; Ottaviani, G; Lavezzi, A M

    2005-01-01

    The dive reflex is the reflex mechanism most frequently considered in the aetiopathogenesis of sudden infant death syndrome (SIDS). This seems to persist in human beings as an inheritance from diver birds and amphibians. It has been reported that washing the face with cold water or plunging into cold water can provoke cardiac deceleration through the intervention of the ambiguus and the vagal dorsal nuclei. This report describes a case of SIDS that offers a unique insight into the role of the dive reflex in determining a lethal outcome. Examination of the brainstem on serial sections revealed severe bilateral hypoplasia of the arcuate nucleus and gliosis of the other cardiorespiratory medullary nuclei. The coronary and cardiac conduction arteries presented early atherosclerotic lesions. The possible role of parental cigarette smoking in the pathogenesis of arcuate nucleus hypoplasia and early coronary atherosclerotic lesions is also discussed. PMID:15623488

  15. Observations on abortion in Zambia.

    PubMed

    Castle, M A; Likwa, R; Whittaker, M

    1990-01-01

    This report describes the findings of a preliminary investigation of women who sought treatment for abortion from the Gynecological Emergency Ward at the University Teaching Hospital (UTH) in Lusaka, Zambia. Barriers to obtaining legal abortions are identified and the harsh experiences of women seeking treatment for complications of illegally induced abortion are discussed. The data contribute to an understanding of the intensity of abortion for Zambian women and draw attention to the value of small-scale, qualitative research on women's reproductive health care needs. It is suggested that a study be planned at UTH to determine how health care delivery can be improved for women who seek abortion. PMID:2219228

  16. Abortion health services in Canada

    PubMed Central

    Norman, Wendy V.; Guilbert, Edith R.; Okpaleke, Christopher; Hayden, Althea S.; Steven Lichtenberg, E.; Paul, Maureen; White, Katharine O’Connell; Jones, Heidi E.

    2016-01-01

    Abstract Objective To determine the location of Canadian abortion services relative to where reproductive-age women reside, and the characteristics of abortion facilities and providers. Design An international survey was adapted for Canadian relevance. Public sources and professional networks were used to identify facilities. The bilingual survey was distributed by mail and e-mail from July to November 2013. Setting Canada. Participants A total of 94 abortion facilities were identified. Main outcome measures The number and location of services were compared with the distribution of reproductive-age women by location of residence. Results We identified 94 Canadian facilities providing abortion in 2012, with 48.9% in Quebec. The response rate was 83.0% (78 of 94). Facilities in every jurisdiction with services responded. In Quebec and British Columbia abortion services are nearly equally present in large urban centres and rural locations throughout the provinces; in other Canadian provinces services are chiefly located in large urban areas. No abortion services were identified in Prince Edward Island. Respondents reported provision of 75 650 abortions in 2012 (including 4.0% by medical abortion). Canadian facilities reported minimal or no harassment, in stark contrast to American facilities that responded to the same survey. Conclusion Access to abortion services varies by region across Canada. Services are not equitably distributed in relation to the regions where reproductive-age women reside. British Columbia and Quebec have demonstrated effective strategies to address disparities. Health policy and service improvements have the potential to address current abortion access inequity in Canada. These measures include improved access to mifepristone for medical abortion; provincial policies to support abortion services; routine abortion training within family medicine residency programs; and increasing the scope of practice for nurses and midwives to include abortion

  17. Structural imaging biomarkers of sudden unexpected death in epilepsy

    PubMed Central

    Wandschneider, Britta; Koepp, Matthias; Scott, Catherine; Micallef, Caroline; Balestrini, Simona; Sisodiya, Sanjay M.; Thom, Maria; Harper, Ronald M.; Sander, Josemir W.; Vos, Sjoerd B.; Duncan, John S.; Lhatoo, Samden

    2015-01-01

    Sudden unexpected death in epilepsy is a major cause of premature death in people with epilepsy. We aimed to assess whether structural changes potentially attributable to sudden death pathogenesis were present on magnetic resonance imaging in people who subsequently died of sudden unexpected death in epilepsy. In a retrospective, voxel-based analysis of T1 volume scans, we compared grey matter volumes in 12 cases of sudden unexpected death in epilepsy (two definite, 10 probable; eight males), acquired 2 years [median, interquartile range (IQR) 2.8] before death [median (IQR) age at scanning 33.5 (22) years], with 34 people at high risk [age 30.5 (12); 19 males], 19 at low risk [age 30 (7.5); 12 males] of sudden death, and 15 healthy controls [age 37 (16); seven males]. At-risk subjects were defined based on risk factors of sudden unexpected death in epilepsy identified in a recent combined risk factor analysis. We identified increased grey matter volume in the right anterior hippocampus/amygdala and parahippocampus in sudden death cases and people at high risk, when compared to those at low risk and controls. Compared to controls, posterior thalamic grey matter volume, an area mediating oxygen regulation, was reduced in cases of sudden unexpected death in epilepsy and subjects at high risk. The extent of reduction correlated with disease duration in all subjects with epilepsy. Increased amygdalo-hippocampal grey matter volume with right-sided changes is consistent with histo-pathological findings reported in sudden infant death syndrome. We speculate that the right-sided predominance reflects asymmetric central influences on autonomic outflow, contributing to cardiac arrhythmia. Pulvinar damage may impair hypoxia regulation. The imaging findings in sudden unexpected death in epilepsy and people at high risk may be useful as a biomarker for risk-stratification in future studies. PMID:26264515

  18. Sudden unexpected death in epileptics following sudden, intense, increases in geomagnetic activity: Prevalence of effect and potential mechanisms

    NASA Astrophysics Data System (ADS)

    Persinger, M. A.; Psych, C.

    1995-12-01

    Abrupt, intense increases in global geomagnetic activity during the local night may precipitate a significant proportion of sudden unexpected (or unexplained) deaths (SUD) in epileptics. Over a 2-year period SUD in healthy chronic epileptic rats occurred when the average daily geomagnetic activity exceeded 50 nT (nanoTesla) and suddenly began during local night. Other experiments demonstrated that epileptic rats displayed more spontaneous seizures per night if there had been sudden increases in geomagnetic activity. Analyses of previously published data indicated that the number of SUDs/month in a population of human epileptics was positively associated with the number of days/month when the average geomagnetic activity exceeded 50 nT. The results support the hypothesis that suppression of the nocturnal concentrations of the endogenous anticonvulsant melatonin by sudden increases in geomagnetic activity may encourage fatal cardiac arrhythmias by uncoupling the insular/amygdaloid-paraventricular hypothalamic-solitary nucleus pathways.

  19. Sudden Unexpected Death in Fetal Life Through Early Childhood.

    PubMed

    Goldstein, Richard D; Kinney, Hannah C; Willinger, Marian

    2016-06-01

    In March 2015, the Eunice Kennedy Shriver National Institute of Child Health and Human Development held a workshop entitled "Sudden Unexpected Death in Fetal Life Through Early Childhood: New Opportunities." Its objective was to advance efforts to understand and ultimately prevent sudden deaths in early life, by considering their pathogenesis as a potential continuum with some commonalities in biological origins or pathways. A second objective of this meeting was to highlight current issues surrounding the classification of sudden infant death syndrome (SIDS), and the implications of variations in the use of the term "SIDS" in forensic practice, and pediatric care and research. The proceedings reflected the most current knowledge and understanding of the origins and biology of vulnerability to sudden unexpected death, and its environmental triggers. Participants were encouraged to consider the application of new technologies and "omics" approaches to accelerate research. The major advances in delineating the intrinsic vulnerabilities to sudden death in early life have come from epidemiologic, neural, cardiac, metabolic, genetic, and physiologic research, with some commonalities among cases of unexplained stillbirth, SIDS, and sudden unexplained death in childhood observed. It was emphasized that investigations of sudden unexpected death are inconsistent, varying by jurisdiction, as are the education, certification practices, and experience of death certifiers. In addition, there is no practical consensus on the use of "SIDS" as a determination in cause of death. Major clinical, forensic, and scientific areas are identified for future research. PMID:27230764

  20. The consequences of abortion legislation.

    PubMed

    Braude, M

    1983-01-01

    This article examines the consequences of the 1973 US Supreme Court decision legalizing abortion as well as potential implications of proposed legilation aimed at nullifying this decision. In addition to giving women the right to determine their own reproduction, legal abortion had had beneficial health effects for both mothers and infants. The partial reversal of abortion gains due to restrictions on public funding and limitations on how and where abortions can be performed has produced a slight increase in abortion mortality, but the impact has not been dramatic. Moreover, each year since 1973, women have been obtaining abortions earlier in pregnancy. Abortion may be experienced as a loss by the mother, but there is no evidence of serious psychological sequelae. In contrast, a large body of evidence supports the physical, psychological, and social benefits of legal abortion to women, children, and families. However, proponents of the proposed Human Life Amendment place protection of the rights of the fetus over all other considerations. Their antiabortion actions have challenged the medical tradition of privacy and the confidentiality of the doctor-patient relationship. Most supporters of legal abortion would prefer that there be fewer abortions; such a decrease is more likely as a result of better education and contraceptive methods rather than coercion. PMID:12340335

  1. Abortion: taking the debate seriously.

    PubMed

    Kottow Lang, Miguel Hugo

    2015-01-01

    Voluntarily induced abortion has been under permanent dispute and legal regulations, because societies invariably condemn extramarital pregnancies. In recent decades, a measure of societal tolerance has led to decriminalize and legalize abortion in accordance with one of two models: a more restricted and conservative model known as therapeutic abortion, and the model that accepts voluntary abortion within the first trimester of pregnancy. Liberalization of abortion aims at ending clandestine abortions and decriminalizes the practice in order to increase reproductive education and accessibility of contraceptive methods, dissuade women from interrupting their pregnancy and, ultimately, make abortion a medically safe procedure within the boundaries of the law, inspired by efforts to reduce the incidence of this practice. The current legal initiative to decriminalize abortion in Chile proposes a notably rigid set of indications which would not resolve the three main objectives that need to be considered: 1) Establish the legal framework of abortion; 2) Contribute to reduce social unrest; 3) Solve the public health issue of clandestine, illegal abortions. Debate must urgently be opened to include alternatives in line with the general tendency to respect women's decision within the first trimester of pregnancy. PMID:26057783

  2. Unsafe abortion: the preventable pandemic.

    PubMed

    Grimes, David A; Benson, Janie; Singh, Susheela; Romero, Mariana; Ganatra, Bela; Okonofua, Friday E; Shah, Iqbal H

    2006-11-25

    Ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights imperative. As with other more visible global-health issues, this scourge threatens women throughout the developing world. Every year, about 19-20 million abortions are done by individuals without the requisite skills, or in environments below minimum medical standards, or both. Nearly all unsafe abortions (97%) are in developing countries. An estimated 68 000 women die as a result, and millions more have complications, many permanent. Important causes of death include haemorrhage, infection, and poisoning. Legalisation of abortion on request is a necessary but insufficient step toward improving women's health; in some countries, such as India, where abortion has been legal for decades, access to competent care remains restricted because of other barriers. Access to safe abortion improves women's health, and vice versa, as documented in Romania during the regime of President Nicolae Ceausescu. The availability of modern contraception can reduce but never eliminate the need for abortion. Direct costs of treating abortion complications burden impoverished health care systems, and indirect costs also drain struggling economies. The development of manual vacuum aspiration to empty the uterus, and the use of misoprostol, an oxytocic agent, have improved the care of women. Access to safe, legal abortion is a fundamental right of women, irrespective of where they live. The underlying causes of morbidity and mortality from unsafe abortion today are not blood loss and infection but, rather, apathy and disdain toward women. PMID:17126724

  3. The Politicization of Abortion and the Evolution of Abortion Counseling

    PubMed Central

    2013-01-01

    The field of abortion counseling originated in the abortion rights movement of the 1970s. During its evolution to the present day, it has faced significant challenges, primarily arising from the increasing politicization and stigmatization of abortion since legalization. Abortion counseling has been affected not only by the imposition of antiabortion statutes, but also by the changing needs of patients who have come of age in a very different era than when this occupation was first developed. One major innovation—head and heart counseling—departs in significant ways from previous conventions of the field and illustrates the complex and changing political meanings of abortion and therefore the challenges to abortion providers in the years following Roe v Wade. PMID:23153144

  4. Magnesium and sudden death.

    PubMed

    Leary, W P; Reyes, A J

    1983-10-22

    Magnesium deficiency may result from reduced dietary intake of the ion or increased losses in sweat, urine or faeces. Stress potentiates magnesium deficiency, and an increased incidence of sudden death associated with ischaemic heart disease is found in some areas in which soil and drinking water lack magnesium. Furthermore, it has been demonstrated experimentally that reduction of the plasma magnesium level is associated with arterial spasm. Careful studies are required to assess the clinical importance of magnesium and the benefits of magnesium supplementation in man. PMID:6353622

  5. Bodies, rights and abortion.

    PubMed

    McLachlan, H V

    1997-06-01

    The issue of abortion is discussed with reference to the claim that people have a right of control over their own bodies. Do people "own" their own bodies? If so, what would be entailed? These questions are discussed in commonsense terms and also in relation to the jurisprudence of Hohfeld, Honore, Munzer and Waldron. It is argued that whether or not women are morally and/or should be legally entitled to have abortions, such entitlements cannot be derived from a general moral entitlement to do what we will with our own bodies since there is no such entitlement. Whether or not we "own" them, we can have rights duties, liabilities, restrictions and disadvantages as well as rights concerning our own bodies. PMID:9220332

  6. Austerity and Abortion in the European Union.

    PubMed

    Lima, Joana Madureira; Reeves, Aaron; Billari, Francesco; McKee, Martin; Stuckler, David

    2016-06-01

    Economic hardship accompanying large recessions can lead families to terminate unplanned pregnancies. To assess whether abortions have risen during the recession, we collected crude abortion data from 2000 to 2012 from Eurostat for countries that had legal abortions and complete data. Declining trends in abortion ratios between 2000 and 2009 have been reversing. Excess abortions between 2010 and 2012 totaled 10.6 abortions per 1000 pregnancies ending in abortion or birth or 6701 additional abortions (95% CI 1190-9240) with stronger effects in younger ages. Economic shocks may increase recourse to abortion. Further research should explore causal pathways and protective factors. PMID:27009038

  7. Austerity and Abortion in the European Union

    PubMed Central

    Reeves, Aaron; Billari, Francesco; McKee, Martin; Stuckler, David

    2016-01-01

    Economic hardship accompanying large recessions can lead families to terminate unplanned pregnancies. To assess whether abortions have risen during the recession, we collected crude abortion data from 2000 to 2012 from Eurostat for countries that had legal abortions and complete data. Declining trends in abortion ratios between 2000 and 2009 have been reversing. Excess abortions between 2010 and 2012 totaled 10.6 abortions per 1000 pregnancies ending in abortion or birth or 6701 additional abortions (95% CI 1190–9240) with stronger effects in younger ages. Economic shocks may increase recourse to abortion. Further research should explore causal pathways and protective factors. PMID:27009038

  8. Immunologically mediated abortion (IMA).

    PubMed

    Giacomucci, E; Bulletti, C; Polli, V; Prefetto, R A; Flamigni, C

    1994-06-01

    Roughly 20% of all clinical pregnancies evolve into "spontaneous abortions". The causes of spontaneous abortion have been determined in under 60% of the total and comprise genetic, infectious, hormonal and immunological factors. In some cases the immune tolerance mechanism may be impaired and the foetus immunologically rejected (IMA, immunologically mediated abortion). The immunological mechanism implicated depends on the time in which pregnancy loss takes place. During preimplantation and up to the end of implantation (13th day) the cell-mediated immune mechanism (potential alloimmune etiologies) is responsible for early abortion. This mechanism involves immunocompetent decidual cells (eGL, endometrial granulated lymphocytes) already present during pre-decidualization (late luteal phase) and their production of soluble factors or cytokines. Once the implantation process is over, after blastocyst penetration of the stroma and the decidual reaction of uterine tissue, IMA could be caused by cell-mediated and humoral mechanism (anti-paternal cytotoxic antibodies or autoantibody etiology), by the production of paternal anti major histocompatibility complex antibodies, or even by an autoimmune disorder leading to the production of autoantibodies (antiphospholipid antibodies, antinuclear antibodies or polyclonal B cell activation). The diagnostic work-up adopted to select IMA patients is crucial and includes primary (karyotype of both partners, toxo-test, hysterosalpingography, endometrial biopsy, thyroid function tests, serum hprolactin, luteal phase dating) and secondary (full hemochromocytometric test, search for LE cells, lupus anticoagulant, anticardiolipin, antinuclear antibodies, Rheumatoid factor, blood complement VDRL) investigations. Therapeutical approaches vary. If autoimmune disorders are demonstrated therapies with different combinations of corticosteroids, aspirin and heparin or intravenous immunoglobulin are administered. Otherwise, therapy with paternal

  9. Understand Your Risk for Cardiac Arrest

    MedlinePlus

    ... life-threatening ventricular arrhythmias. The first six months after a heart attack is a particularly high-risk period for sudden cardiac arrest in patients with atherosclerotic heart disease . ...

  10. Sudden infant death syndrome.

    PubMed

    Adams, Stephen M; Ward, Chad E; Garcia, Karla L

    2015-06-01

    Sudden infant death syndrome (SIDS) is the sudden unexpected death of a child younger than one year during sleep that cannot be explained after a postmortem evaluation including autopsy, a thorough history, and scene evaluation. The incidence of SIDS has decreased more than 50% in the past 20 years, largely as a result of the Back to Sleep campaign. The most important risk factors relate to the sleep environment. Prone and side sleeping positions are significantly more dangerous than the supine position. Bed sharing with a parent is strongly correlated with an increased risk of SIDS, especially in infants younger than 12 weeks. Apparent life-threatening events are not a risk factor for SIDS. Parents should place infants on their backs to sleep, should not share a bed, and should avoid exposing the infant to tobacco smoke. Other risk-reducing measures include using a firm crib mattress, breastfeeding, keeping vaccinations up to date, avoiding overheating due to overbundling, avoiding soft bedding, and considering the use of a pacifier during sleep once breastfeeding is established. One consequence of the Back to Sleep campaign is a significant increase in the incidence of occipital flattening. Infants who develop a flat spot should be placed with the head facing alternating directions each time he or she is put to bed. Supervised prone positioning while the infant is awake, avoiding excessive use of carriers, and upright positioning while awake are also recommended. PMID:26034855

  11. The abortion debate in Australia.

    PubMed

    Read, Christine Margaret

    2006-09-01

    I recently watched a fascinating documentary about the crusade of Dr Bertram Wainer in the 1960s to bring the practice of illegal abortion in Victoria to an end. It documented the profound horror of the backyard abortion that so often ended in infection, sterility or death, and served as a potent reminder of a practice to which we must never return. Of course that cant happen again, abortion is legal now, isnt it? In Victoria in 1969 a Supreme Court judge ruled that an abortion is not unlawful if a doctor believed that: the abortion is necessary to preserve the woman from serious danger to her life or physical or mental health (Menhennit ruling). In Australia today however, abortion law remains conditional, unclear and inconsistent and, except in the ACT, is still part of criminal statutes. PMID:16969440

  12. Legal abortion and public health.

    PubMed

    Tietze, C

    1984-01-01

    Over 15 million abortions have been performed in the US since the process of abortion legalization began in 1967. Consequences of legalization have included a marked reduction of pregnancy-related mortality and the prevention in many cases of the birth of infants with major physical or mental defects. Prenatal diagnosis, backed up by selective abortion, has made procreation a possibility for many couples who might otherwise avoid childbearing. However, the number of abortions performed on the basis of prenatal diagnosis remains small, comprising only about .01% of all legal abortions. In recent months, the pro-choice movement in the US has been handed 2 important victories: the US Supreme Court reaffirmed the 1973 decision legalizing abortion and the US Senate defeated a constitutional amendment intended to reverse this decision. As a result of these victories, contributions to pro-choice groups have declined. Continued vigilance is needed to protect these victories. PMID:12267089

  13. Abortion law reform in Nepal.

    PubMed

    Upreti, Melissa

    2014-08-01

    Across four decades of political and social action, Nepal changed from a country strongly enforcing oppressive abortion restrictions, causing many poor women's long imprisonment and high rates of abortion-related maternal mortality, into a modern democracy with a liberal abortion law. The medical and public health communities supported women's rights activists in invoking legal principles of equality and non-discrimination as a basis for change. Legislative reform of the criminal ban in 2002 and the adoption of an Interim Constitution recognizing women's reproductive rights as fundamental rights in 2007 inspired the Supreme Court in 2009 to rule that denial of women's access to abortion services because of poverty violated their constitutional rights. The government must now provide services under criteria for access without charge, and services must be decentralized to promote equitable access. A strong legal foundation now exists for progress in social justice to broaden abortion access and reduce abortion stigma. PMID:24890742

  14. Advanced Electrocardiographic Predictors of Sudden Death in Familial Dysautonomia

    NASA Technical Reports Server (NTRS)

    Solaimanzadeh, I.; Schlegel, T. T.; Greco, E. C.; DePalma, J. L.; Starc, V.; Marthol, H.; Tutaj, M.; Buechner, S.; Axelrod, F. B.; Hilz, M. J.

    2007-01-01

    To identify accurate predictors for the risk of sudden death in patients with familial dysautonomia (FD). Ten-minute resting high-fidelity 12-lead ECGs were obtained from 14 FD patients and 14 age/gender-matched healthy subjects. Multiple conventional and advanced ECG parameters were studied for their ability to predict sudden death in FD over a subsequent 4.5-year period, including multiple indices of linear and non-linear heart rate variability (HRV); QT variability; waveform complexity; high frequency QRS; and derived Frank-lead parameters. Four of the 14 FD patients died suddenly during the follow-up period, usually with concomitant pulmonary disorder. The presence of low vagally-mediated HRV was the ECG finding most predictive of sudden death. Concomitant left ventricular hypertrophy and other ECG abnormalities such as increased QTc and JTc intervals, spatial QRS-T angles, T-wave complexity, and QT variability were also present in FD patients, suggesting that structural heart disease is fairly common in FD. Although excessive or unopposed cardiac vagal (relative to sympathetic) activity has been postulated as a contributor to sudden death in FD, the presence of low vagally-mediated HRV was paradoxically the best predictor of sudden death. However, we suggest that low vagally-mediated HRV be construed not as a direct cause of sudden death in FD, but rather as an effect of concurrent pathological processes, especially hypoxia due to pulmonary disorders and sleep apnea, that themselves increase the risk of sudden death in FD and simultaneously diminish HRV. We speculate that adenosine may play a role in sudden death in FD, possibly independently of vagal activity, and that adenosine inhibitors such as theophylline might therefore be useful as prophylaxis in this disorder.

  15. Dworkin and Casey on abortion.

    PubMed

    Stroud, Sarah

    1996-01-01

    This article responds to two important recent treatments of abortion rights. I will mainly discuss Ronald Dworkin's recent writings concerning abortion: his article "Unenumerated rights: whether and how Roe should be overruled," and his book Life's Dominion. In these writings Dworkin presents a novel view of what the constitutional and moral argument surronding abortion is really about. Both debates actually turn, he argues, on the question of how to interpret the widely shared idea that human life is sacred. At the heart of the abortion debate is the essentially religious notion that human life has value which transcends its value to any particular person; abortion is therefore at bottom a religious issue. Dworkin hopes to use this analysis to show that the religion clauses of the First Amendment provide a "textual home" for a woman's right to choose abortion. I wish to scrutinize this suggestion here; I want to probe the precise consequences for abortion rights of such an understanding of their basis. I will argue that the consequences are more radical than Dworkin seems to realize. The other work I will examine here is the important 1992 Supreme Court decision on abortion, Planned Parenthood v. Casey. The controlling opinion in that case, written jointly by Justices Kennedy, O'Connor, and Souter, strongly reaffirmed Roe v. Wade, but also upheld most of the provisions of a Pennsylvania statute that had mandated various restrictions on abortion. The justices' basis for upholding these restictions was their introduction of a new constitutional standard for abortion regulations, an apparently weaker standard than those that had governed previous Supreme Court abortion decisions. I think there is a flaw in Casey's new constitutional test for abortion regulations, and I will explain, when we turn to Casey, what it is and why it bears a close relation to Dworkin's reluctance to carry his argument as far as it seems to go. PMID:11660187

  16. Simplified classification of spontaneous abortions.

    PubMed Central

    Rushton, D I

    1978-01-01

    A simple classification of products of conception aborted in early pregnancy is described. This classification bears a closer relation to the aetiology of the abortions and the timing of the teratological insult in those conceptuses with morphological abnormalities than have previous classifications. It is hoped it may be of value in counselling patients who abort recurrently and also in the assessment of some environmental hazards purported to cause early pregnancy wastage and congenital malformations. Images PMID:564967

  17. Anti-abortion movement.

    PubMed

    Wilson, K

    1985-01-01

    At the same time that American women celebrate the freedoms won thus far for so many Americans, American women must realize they face some of the greatest threats to liberty in recent memory. To understand this movement against American women, it is necessary to first understand the roots of the historic movement for women's rights. Reproductive freedom for many years topped the agenda of the modern women's movement. At a time and in a land where rights were being enriched and liberty prized, choice took a prominent role, specifically, the right to abortion but also generally to repdocuctive freedom and the many underlying issues involved. This is why the various efforts to criminalize abortion effect every citizen, because they pose a serious threat to the constitutional rights of each individual. This is the intellectual view, or the "head" argument. The Constitution states that: "Congress shall make no laws respecting an establishment of religion, or prohibiting the free exercise thereof; the enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people; and no state shall make or enforce any laws which shall abridge the privileges or immunities of citizens of the US." Each of these clauses expresses the philosophy on which the Constitution was founded -- individual liberty. While there has been some legitimate disagreement over what constitutes an inalienable right, the concept is clear: the government should not become involved in personal philosophical or religious matters, except to permit the freedom of personal philosophical or religious expression. The anti-abortion contignent makes its case by claiming that a fertilized egg is a cona fide person and should, therefore, be guaranteed the Constitution's full roster of protections. In its landmark Roe v. Wade opinion, the Supreme Court held what pro-choice activities have been claiming for years. Since there is no empirical test by which measure

  18. Second trimester abortions in India.

    PubMed

    Dalvie, Suchitra S

    2008-05-01

    This article gives an overview of what is known about second trimester abortions in India, including the reasons why women seek abortions in the second trimester, the influence of abortion law and policy, surgical and medical methods used, both safe and unsafe, availability of services, requirements for second trimester service delivery, and barriers women experience in accessing second trimester services. Based on personal experiences and personal communications from other doctors since 1993, when I began working as an abortion provider, the practical realities of second trimester abortion and case histories of women seeking second trimester abortion are also described. Recommendations include expanding the cadre of service providers to non-allopathic clinicians and trained nurses, introducing second trimester medical abortion into the public health system, replacing ethacridine lactate with mifepristone-misoprostol, values clarification among providers to challenge stigma and poor treatment of women seeking second trimester abortion, and raising awareness that abortion is legal in the second trimester and is mostly not requested for reasons of sex selection. PMID:18772082

  19. [Psychological consequences of induced abortion].

    PubMed

    Schleiss, L; Mygind, K A; Borre, R V; Petersson, B H

    1997-06-01

    One hundred and thirty consecutive women were interviewed about the development of psychological symptoms related to induced abortion two days before and four months after the abortion. Sixty-one (47%) participated in the second interview. Of the 61 women, 52% were psychologically influenced before the abortion to an extent which indicated severe crisis or actual psychiatric illness. Four months after the abortion 13 of these women were still psychologically affected. Furthermore, five women who were not affected before the abortion had developed psychological problems. Among ten of these women (16%) the physiological problems could only be related to the circumstance in connection with the abortion. For a number of women (30%) the abortion had a negative influence on their relationships and their sex lives, whereas other claimed that their relationship had become closer because of their reactions towards the abortions. In spite of these conditions all women indicated that their decision about the abortion had been the correct one under the given circumstances. PMID:9206861

  20. Sudden Sensorineural Hearing Loss

    PubMed Central

    Kuhn, Maggie; Heman-Ackah, Selena E.; Shaikh, Jamil A.

    2011-01-01

    Sudden sensorineural hearing loss (SSNHL) is commonly encountered in audiologic and otolaryngologic practice. SSNHL is most commonly defined as sensorineural hearing loss of 30dB or greater over at least three contiguous audiometric frequencies occurring within a 72-hr period. Although the differential for SSNHL is vast, for the majority of patients an etiologic factor is not identified. Treatment for SSNHL of known etiology is directed toward that agent, with poor hearing outcomes characteristic for discoverable etiologies that cause inner ear hair cell loss. Steroid therapy is the current mainstay of treatment of idiopathic SSNHL in the United States. The prognosis for hearing recovery for idiopathic SSNHL is dependent on a number of factors including the severity of hearing loss, age, presence of vertigo, and shape of the audiogram. PMID:21606048

  1. Sudden death of feedlot cattle.

    PubMed

    Glock, R D; DeGroot, B D

    1998-01-01

    Sudden deaths or the sudden death syndrome are perceived as major concerns in cattle feedlots because most of these deaths occur in cattle near market weight. Etiology and preventive measures are poorly defined. The current literature indicates that sudden deaths are associated most commonly with digestive upsets. Death is thought to be the result of interactions between factors including acidosis, bloat, and endotoxemia. Trauma, peracute interstitial pneumonia, and other identifiable events are specifically defined but relatively uncommon. Enterotoxemia is of questionable significance as a cause of sudden deaths. PMID:9464913

  2. Unnatural sudden infant death

    PubMed Central

    Meadow, R.

    1999-01-01

    AIM—To identify features to help paediatricians differentiate between natural and unnatural infant deaths.
METHOD—Clinical features of 81 children judged by criminal and family courts to have been killed by their parents were studied. Health and social service records, court documents, and records from meetings with parents, relatives, and social workers were studied.
RESULTS—Initially, 42 children had been certified as dying from sudden infant death syndrome (SIDS), and 29 were given another cause of natural death. In 24 families, more than one child died; 58died before the age of 6 months and most died in the afternoon or evening. Seventy per cent had experienced unexplained illnesses; over half were admitted to hospital within the previous month, and 15 had been discharged within 24 hours of death. The mother, father, or both were responsible for death in 43, five, and two families, respectively. Most homes were disadvantaged—no regular income, receiving income support—and mothers smoked. Half the perpetrators had a history of somatising or factitious disorder. Death was usually by smothering and 43% of children had bruises, petechiae, or blood on the face.
CONCLUSIONS—Although certain features are indicative of unnatural infant death, some are also associated with SIDS. Despite the recent reduction in numbers of infants dying suddenly, inadequacies in the assessment of their deaths exist. Until a thorough postmortem examination is combined with evaluation of the history and circumstances of death by an experienced paediatrician, most cases of covert fatal abuse will go undetected. The term SIDS requires revision or abandonment.

 PMID:10325752

  3. Legal abortion: a painful necessity.

    PubMed

    Kero, A; Högberg, U; Jacobsson, L; Lalos, A

    2001-12-01

    This study was conducted to increase knowledge about the psychosocial background and current living conditions of Swedish women seeking abortion, along with their motives for abortion and their feelings towards pregnancy and abortion. Two hundred and eleven women answered a questionnaire when they consulted the gynaecologist for the first time. The study indicates that legal abortion may be sought by women in many circumstances and is not confined to those in special risk groups. For example, most women in the sample were living in stable relationships with adequate finances. The motives behind a decision to postpone or limit the number of children revealed a wish to have children with the right partner and at the right time in order to combine good parenting with professional career. The study shows that prevailing expectations about lifestyle render abortion a necessity in family planning. One-third of the women had had a previous abortion(s) and 12% had become pregnant in a situation where they had felt pressured or threatened by the man. Two-thirds of the women characterised their initial feelings towards the pregnancy solely in painful words while nearly all the others reported contradictory feelings. Concerning feelings towards the coming abortion, more than half expressed both positive and painful feelings such as anxiety, relief, grief, guilt, anguish, emptiness and responsibility, while one-third expressed only painful feelings. However, almost 70% stated that nothing could change their decision to have an abortion. Thus, this study highlights that contradictory feelings in relation to both pregnancy and the coming abortion are common but are very seldom associated with doubts about the decision to have an abortion. PMID:11710423

  4. Adolescent pregnancy: a study of aborters and non-aborters.

    PubMed

    Kane, F J; Lachenbruch, P A

    1973-10-01

    In a June 1970 through January 1971 study of 99 single girls seeking abortion and 33 single girls choosing to complete the pregnancy, knowledge of and/or access to contraceptives were not the problem. Emotional factors such as guilt over sexual activity, acting-out disorders (rebellious attitude, hippie lifestyle, indifference toward others), or severe reactions to loss of a love relationship contributed to pregnancy in both groups. The girls who became pregnant, especially the ones who chose to complete the pregnancy, viewed pregnancy and motherhood as a source of gratification and self-esteem. Research on motivational factors in adolescent pregnancy is needed to prevent high recidivism. The majority of state abortion laws requiring phychiatric deficiencies for abortions are misguided, since the girls who chose not to abort were more psychiatrically disturbed than the ones who had abortions. PMID:4742821

  5. Abortion and parental responsibility.

    PubMed

    Winston, M E

    1986-01-01

    A theory on the morality of abortion is derived from the presumption that parents have special moral obligations to nurture their immature children. Three alternative models of the acquisition of parental responsibilities are examined: one based on biological relationships, one based on consent, and one based on causal responsibility. Each of the models is examined in terms of its ability to handle cases involving nonstandard methods of procreation, such as surrogate motherhood, artificial insemination by donor, and embryo transfer. It is concluded that the model based on causal responsibility provides the most adequate criterion for the ascription of parental responsibility toward fetuses. PMID:11650732

  6. Denial of abortion in legal settings

    PubMed Central

    Gerdts, Caitlin; DePiñeres, Teresa; Hajri, Selma; Harries, Jane; Hossain, Altaf; Puri, Mahesh; Vohra, Divya; Foster, Diana Greene

    2015-01-01

    Background Factors such as poverty, stigma, lack of knowledge about the legal status of abortion, and geographical distance from a provider may prevent women from accessing safe abortion services, even where abortion is legal. Data on the consequences of abortion denial outside of the US, however, are scarce. Methods In this article we present data from studies among women seeking legal abortion services in four countries (Colombia, Nepal, South Africa and Tunisia) to assess sociodemographic characteristics of legal abortion seekers, as well as the frequency and reasons that women are denied abortion care. Results The proportion of women denied abortion services and the reasons for which they were denied varied widely by country. In Colombia, 2% of women surveyed did not receive the abortions they were seeking; in South Africa, 45% of women did not receive abortions on the day they were seeking abortion services. In both Tunisia and Nepal, 26% of women were denied their wanted abortions. Conclusions The denial of legal abortion services may have serious consequences for women's health and wellbeing. Additional evidence on the risk factors for presenting later in pregnancy, predictors of seeking unsafe illegal abortion, and the health consequences of illegal abortion and childbirth after an unwanted pregnancy is needed. Such data would assist the development of programmes and policies aimed at increasing access to and utilisation of safe abortion services where abortion is legal, and harm reduction models for women who are unable to access legal abortion services. PMID:25511805

  7. Partner violence and abortion characteristics.

    PubMed

    Colarossi, Lisa; Dean, Gillian

    2014-01-01

    We conducted a retrospective cohort study using randomly selected medical charts of women reporting a history of partner violence and women with no history of partner violence at the time of a family planning or abortion appointment (n = 6,564 per group). We analyzed lifetime history of partner violence for odds of lifetime history of abortion and miscarriage number, and birth control problems. To more closely match timing, we analyzed a subsample of 2,186 women reporting current violence versus not at the time of an abortion appointment for differences in gestational age, medical versus surgical method choice, and return for follow-up visit. After adjusting for years at risk and demographic characteristics, women with a past history of partner violence were not more likely to have ever had one abortion, but they were more likely to have had problems with birth control, repeat abortions, and miscarriages than women with no history of violence. Women with current partner violence were also more likely to be receiving an abortion at a later gestational age. We found no differences between the groups in return for abortion follow-up visit or choice of surgical versus medication abortion. Findings support screening for the influence of partner violence on reproductive health and related safety planning. PMID:24580133

  8. Second-Trimester Abortion Overview

    MedlinePlus

    ... carrying a pregnancy to term – the risk for women having an abortion increases with gestation. xiv Qualitative evidence suggests the abortion referral process – connecting a pregnant woman with the right provider – is patchy. xv In short, a woman ...

  9. Sex Guilt in Abortion Patients

    ERIC Educational Resources Information Center

    Gerrard, Meg

    1977-01-01

    A measure of sex guilt was administered to clients of a university problem pregnancy counseling service who were planning to have abortions and to a group of sexually active nonpregnant university coeds. Sex guilt was found to be significantly higher for the abortion patients than for the nonpregnant group. (Author)

  10. Sudden event recognition: a survey.

    PubMed

    Suriani, Nor Surayahani; Hussain, Aini; Zulkifley, Mohd Asyraf

    2013-01-01

    Event recognition is one of the most active research areas in video surveillance fields. Advancement in event recognition systems mainly aims to provide convenience, safety and an efficient lifestyle for humanity. A precise, accurate and robust approach is necessary to enable event recognition systems to respond to sudden changes in various uncontrolled environments, such as the case of an emergency, physical threat and a fire or bomb alert. The performance of sudden event recognition systems depends heavily on the accuracy of low level processing, like detection, recognition, tracking and machine learning algorithms. This survey aims to detect and characterize a sudden event, which is a subset of an abnormal event in several video surveillance applications. This paper discusses the following in detail: (1) the importance of a sudden event over a general anomalous event; (2) frameworks used in sudden event recognition; (3) the requirements and comparative studies of a sudden event recognition system and (4) various decision-making approaches for sudden event recognition. The advantages and drawbacks of using 3D images from multiple cameras for real-time application are also discussed. The paper concludes with suggestions for future research directions in sudden event recognition. PMID:23921828

  11. Sudden Fiction: What Is It?

    ERIC Educational Resources Information Center

    Tindall, James

    Initially an assignment for a library science class, this paper presents various definitions of the current creative writing phenomenon called "sudden fiction" (very short short stories with concise character sketches, and terse tales limited in length to several pages). The paper includes: (1) a list of well regarded sudden fiction anthologies;…

  12. Sudden Event Recognition: A Survey

    PubMed Central

    Suriani, Nor Surayahani; Hussain, Aini; Zulkifley, Mohd Asyraf

    2013-01-01

    Event recognition is one of the most active research areas in video surveillance fields. Advancement in event recognition systems mainly aims to provide convenience, safety and an efficient lifestyle for humanity. A precise, accurate and robust approach is necessary to enable event recognition systems to respond to sudden changes in various uncontrolled environments, such as the case of an emergency, physical threat and a fire or bomb alert. The performance of sudden event recognition systems depends heavily on the accuracy of low level processing, like detection, recognition, tracking and machine learning algorithms. This survey aims to detect and characterize a sudden event, which is a subset of an abnormal event in several video surveillance applications. This paper discusses the following in detail: (1) the importance of a sudden event over a general anomalous event; (2) frameworks used in sudden event recognition; (3) the requirements and comparative studies of a sudden event recognition system and (4) various decision-making approaches for sudden event recognition. The advantages and drawbacks of using 3D images from multiple cameras for real-time application are also discussed. The paper concludes with suggestions for future research directions in sudden event recognition. PMID:23921828

  13. Exome Sequencing Identifies a Novel LMNA Splice-Site Mutation and Multigenic Heterozygosity of Potential Modifiers in a Family with Sick Sinus Syndrome, Dilated Cardiomyopathy, and Sudden Cardiac Death.

    PubMed

    Zaragoza, Michael V; Fung, Lianna; Jensen, Ember; Oh, Frances; Cung, Katherine; McCarthy, Linda A; Tran, Christine K; Hoang, Van; Hakim, Simin A; Grosberg, Anna

    2016-01-01

    The goals are to understand the primary genetic mechanisms that cause Sick Sinus Syndrome and to identify potential modifiers that may result in intrafamilial variability within a multigenerational family. The proband is a 63-year-old male with a family history of individuals (>10) with sinus node dysfunction, ventricular arrhythmia, cardiomyopathy, heart failure, and sudden death. We used exome sequencing of a single individual to identify a novel LMNA mutation and demonstrated the importance of Sanger validation and family studies when evaluating candidates. After initial single-gene studies were negative, we conducted exome sequencing for the proband which produced 9 gigabases of sequencing data. Bioinformatics analysis showed 94% of the reads mapped to the reference and identified 128,563 unique variants with 108,795 (85%) located in 16,319 genes of 19,056 target genes. We discovered multiple variants in known arrhythmia, cardiomyopathy, or ion channel associated genes that may serve as potential modifiers in disease expression. To identify candidate mutations, we focused on ~2,000 variants located in 237 genes of 283 known arrhythmia, cardiomyopathy, or ion channel associated genes. We filtered the candidates to 41 variants in 33 genes using zygosity, protein impact, database searches, and clinical association. Only 21 of 41 (51%) variants were validated by Sanger sequencing. We selected nine confirmed variants with minor allele frequencies <1% for family studies. The results identified LMNA c.357-2A>G, a novel heterozygous splice-site mutation as the primary mutation with rare or novel variants in HCN4, MYBPC3, PKP4, TMPO, TTN, DMPK and KCNJ10 as potential modifiers and a mechanism consistent with haploinsufficiency. PMID:27182706

  14. Exome Sequencing Identifies a Novel LMNA Splice-Site Mutation and Multigenic Heterozygosity of Potential Modifiers in a Family with Sick Sinus Syndrome, Dilated Cardiomyopathy, and Sudden Cardiac Death

    PubMed Central

    Zaragoza, Michael V.; Fung, Lianna; Jensen, Ember; Oh, Frances; Cung, Katherine; McCarthy, Linda A.; Tran, Christine K.; Hoang, Van; Hakim, Simin A.; Grosberg, Anna

    2016-01-01

    The goals are to understand the primary genetic mechanisms that cause Sick Sinus Syndrome and to identify potential modifiers that may result in intrafamilial variability within a multigenerational family. The proband is a 63-year-old male with a family history of individuals (>10) with sinus node dysfunction, ventricular arrhythmia, cardiomyopathy, heart failure, and sudden death. We used exome sequencing of a single individual to identify a novel LMNA mutation and demonstrated the importance of Sanger validation and family studies when evaluating candidates. After initial single-gene studies were negative, we conducted exome sequencing for the proband which produced 9 gigabases of sequencing data. Bioinformatics analysis showed 94% of the reads mapped to the reference and identified 128,563 unique variants with 108,795 (85%) located in 16,319 genes of 19,056 target genes. We discovered multiple variants in known arrhythmia, cardiomyopathy, or ion channel associated genes that may serve as potential modifiers in disease expression. To identify candidate mutations, we focused on ~2,000 variants located in 237 genes of 283 known arrhythmia, cardiomyopathy, or ion channel associated genes. We filtered the candidates to 41 variants in 33 genes using zygosity, protein impact, database searches, and clinical association. Only 21 of 41 (51%) variants were validated by Sanger sequencing. We selected nine confirmed variants with minor allele frequencies <1% for family studies. The results identified LMNA c.357-2A>G, a novel heterozygous splice-site mutation as the primary mutation with rare or novel variants in HCN4, MYBPC3, PKP4, TMPO, TTN, DMPK and KCNJ10 as potential modifiers and a mechanism consistent with haploinsufficiency. PMID:27182706

  15. Abortion: epidemiology, safety, and technique.

    PubMed

    Blumenthal, P D

    1992-08-01

    In 1991, the abortion literature was characterized by articles relating to 1) epidemiologic issues in abortion care, 2) advances in knowledge and experience with medical abortifacients such as mifepristone (RU 486), and 3) cervical ripening prior to abortion with the use of both mifepristone and prostaglandins. Technical methods of achieving termination of pregnancy continue to be similar in the United States, the United Kingdom, and Europe, although induction-abortion times are generally slower in Europe than in the United States. Surgically, dilatation and evacuation procedures continue to be more common in the United States than in other countries. The effectiveness of mifepristone is undisputed, and the recommended dose for early first-trimester termination is being compared with lower dose alternative regimens. There is additional evidence that at least in the short term, the negative psychological sequelae of abortion are infrequent and are inconsequential as a public health issue. PMID:1504270

  16. Birth, meaningful viability and abortion.

    PubMed

    Jensen, David

    2015-06-01

    What role does birth play in the debate about elective abortion? Does the wrongness of infanticide imply the wrongness of late-term abortion? In this paper, I argue that the same or similar factors that make birth morally significant with regard to abortion make meaningful viability morally significant due to the relatively arbitrary time of birth. I do this by considering the positions of Mary Anne Warren and José Luis Bermúdez who argue that birth is significant enough that the wrongness of infanticide does not imply the wrongness of late-term abortion. On the basis of the relatively arbitrary timing of birth, I argue that meaningful viability is the point at which elective abortion is prima facie morally wrong. PMID:25012846

  17. Teenage pregnancies and abortion.

    PubMed

    Morgenthau, J E

    1984-01-01

    The issue of abortion, except when it is rendered moot because the fetus endangers the life of the mother, is not really a medical issue. The physician's role is to help patients achieve and maintain their maximum potential for physical, mental, and social well-being. To accomplish this, the physician must acquire a constantly evolving database of scientific knowledge, must evaluate this information in a critical and ethical manner, and must be prepared to apply what is learned. In the realm of applied ethics, no particular religion, profession, culture, class, or sex should be thought of as having all the answers in the realm of applied ethics. This physician's actions are predicated on the belief that, to a large extent, ethical precepts reflect the broader social and economic issues of the period in which they are articulated. If this is the case, then in today's world the population explosion, the postindustrial society, the women's rights movement, inequality of access, and the ability to perform prenatal diagnosis are all factors which have molded the approach to the issue of abortion. Only the last 3 of these can in any way be considered as medical. When considering the role of a physician in dealing with the issue of abortion in the adolescent, this individual relies on the concept articulated by the World Health Association (WHA): promoting the physical, emotional, and social well-being of one's patients. Each year in the US over 1 million 15-19 year olds become pregnant, resulting in over 600,000 births. Most of these pregnancies are unintentional, yet approximately 90% of the infants are kept in the home by mothers who are ill prepared to be parents. What is most disturbing is that the pregnancy rate for the younger mother, 16 years or under, is accounting for an ever increasing percentage of the total. Studies at the Adolescent Health Center of the Mount Sinai Hospital in New York City as well as national studies suggest that the younger teens are more

  18. Sudden unexpected death due to Graves' disease during physical altercation.

    PubMed

    Wei, Dengming; Yuan, Xiaogang; Yang, Tiantong; Chang, Lin; Zhang, Xiang; Burke, Allen; Fowler, David; Li, Ling

    2013-09-01

    We report a case of a 30-year-old woman who suddenly collapsed after having a physical altercation with her husband. Despite immediate resuscitation, she died on arrival at the hospital. The victim's parents requested an autopsy because they believed that their daughter was killed by her husband. Postmortem examination revealed that the victim had a diffusely enlarged thyroid gland and cardiomegaly with left ventricular hypertrophy. There was no evidence of significant trauma on the body. Further postmortem thyroid function tests and review of her medical history indicated that her death was due to Graves' disease. To the best of our knowledge, this is the first case reported of sudden death due to cardiac arrhythmia from Graves' disease induced by physical and emotional stress associated with the criminal activity of another person. The autopsy findings are described. In addition, the literature is reviewed and the significance of postmortem evaluation of thyroid hormones in the cases of sudden death is discussed. PMID:23919315

  19. Sudden flaccid paralysis.

    PubMed

    Tariq, Mohammad; Peshin, Rohit; Ellis, Oliver; Grover, Karan

    2015-01-01

    Periodic thyrotoxic paralysis is a genetic condition, rare in the West and in Caucasians. Thyrotoxicosis, especially in western hospitals, is an easily overlooked cause of sudden-onset paralysis. We present a case of a 40-year-old man who awoke one morning unable to stand. He had bilateral lower limb flaccid weakness of 0/5 with reduced reflexes and equivocal plantars; upper limbs were 3/5 with reduced tone and reflexes. ECG sinus rhythm was at a rate of 88/min. PR interval was decreased and QT interval increased. Bloods showed potassium of 1.8 mEq/L (normal range 3.5-5), free T4 of 29.2 pmol/L (normal range 6.5-17) and thyroid-stimulating hormone (TSH) of <0.01 mIU/L (normal range 0.35-4.94). Random urinary potassium was 8.8 mEq/L (normal range 12.5-62.5). The patient was admitted initially to intensive therapy unit and given intravenous potassium. His symptoms resolved within 24 h. He was diagnosed with thyrotoxic periodic paralysis. He was discharged on carbimazole and propanolol, and follow-up was arranged in the endocrinology clinic. PMID:25566931

  20. Sudden infant death syndrome

    PubMed Central

    Hunt, Carl E.; Hauck, Fern R.

    2006-01-01

    Sudden infant death syndrome (SIDS) continues to be the most common cause of postneonatal infant death. SIDS is a complex, multifactorial disorder, the cause of which is still not fully understood. However, much is known now about environmental risk factors, some of which are modifiable. These include maternal and antenatal risk factors such as smoking during pregnancy, as well as infant-related risk factors such as non-supine sleeping position and soft bedding. Emerging evidence also substantiates an expanding number of genetic risk factors. Interactions between environmental and genetic risk factors may be of critical importance in determining an infant's actual risk of SIDS. Although no practical way exists to identify which infants will die of SIDS, nor is there a safe and proven prevention strategy even if identification were feasible, reducing exposure to modifiable risk factors has helped to lower the incidence of SIDS. Current challenges include wider dissemination of guidelines to all people who care for infants, dissemination of guidelines in culturally appropriate ways, and surveillance of SIDS trends and other outcomes associated with implementation of these guidelines. PMID:16785462

  1. Defining Sudden Stratospheric Warmings

    NASA Astrophysics Data System (ADS)

    Butler, Amy; Seidel, Dian; Hardiman, Steven; Butchart, Neal; Birner, Thomas; Match, Aaron

    2015-04-01

    The general form of the definition for Sudden Stratospheric Warmings (SSWs) is largely agreed to be a reversal of the temperature gradient and of the zonal circulation polewards of 60° latitude at the 10 hPa level, as developed by the World Meteorological Organization (WMO) in the 1960s and 1970s. However, the details of the definition and its calculation are ambiguous, resulting in inconsistent classifications of SSW events. These discrepancies are problematic for understanding the observed frequency and statistical relationships with SSWs, and for maintaining a robust metric with which to assess wintertime stratospheric variability in observations and climate models. To provide a basis for community-wide discussion, we examine how the SSW definition has changed over time and how sensitive the detection of SSWs is to the definition used. We argue that the general form of the SSW definition should be clarified to ensure that it serves current research and forecasting purposes, and propose possible ways to update the definition.

  2. A Unique Case of Cardiac Arrest following K2 Abuse

    PubMed Central

    Wannenburg, Thomas

    2014-01-01

    Sudden cardiac death (SCD) accounts for up to 450,000 deaths every year in the United States (Zipes et al. (2006)). Most cases of sudden cardiac death occur in subjects with no prior history of heart disease (Myerburg et al. (1998)). The incidence of sudden death in a general population has been shown to increase contemporaneously with substance abuse (Phillips et al. (1999)). The causative association of sudden death with cocaine, methadone, and volatile agents is well established (Adgey et al. (1995) and Isner et al. (1986)). We describe a case of out-of-hospital cardiac arrest temporally related to abuse of the synthetic cannabinoid street drug known as K2. To our knowledge, there are no previously documented cases of sudden cardiac death associated with synthetic cannabinoids although they have been linked to myocardial infarction in teenagers despite normal coronary angiography (Mir et al. (2011)). PMID:24963415

  3. Sudden Death in Hospital after Discharge from Coronary Care Unit

    PubMed Central

    Thompson, Peter; Sloman, Graeme

    1971-01-01

    In a group of 339 patients with acute myocardial infarction treated in a coronary care unit, 273 left the unit while improving and were expected to leave hospital alive; 23 had a cardiac arrest or died suddenly while still in hospital—17 died immediately or after temporary resuscitation and six were resuscitated to leave hospital alive. Ventricular fibrillation was found in 13 of the 20 patients attended by the cardiac arrest team. The incidents were scattered from the 4th to the 24th day after the onset of infarction. Risk factors in these “late sudden death” patients were compared with the 250 patients who left the unit while improving and did not die or suffer cardiac arrest. The patients susceptible to late sudden death were characterized early in their hospital course by the findings of severe, predominantly anterior infarction, left ventricular failure, persistent sinus tachycardia, and frequent ventricular arrhythmias. It is suggested that such patients be chosen for prolonged observation in a second-stage coronary care unit. PMID:5113015

  4. [Psychological aspects of induced abortion].

    PubMed

    Mouniq, C; Moron, P

    1982-06-01

    Results are presented of a literature review to identify social and psychological aspects of abortion. The literature does not provide a true profile of women requesting abortions, but some characteristics emerge. Reasons for requesting abortion include economic problems, difficult previous pregnancies, general medical contraindications to pregnancy, marital conflicts, feelings of loneliness, professional aspirations, problems with existing children, and feelings of insecurity about the future. However, the same feelings are found among women carrying their pregnancies to term. Unplanned pregnancies are more common during periods of depression. Most authors have found about 1/2 of women seeking abortions to be single and about 1/2 to be under 25 years old. Religion does not appear to be a determining factor. 1 study of psychological factors in abortion seekers found that a large number of single women seeking abortion had suffered traumatic experiences in childhood and were seeking security in inappropriate amorous relationships. Helene Deutsch stressed the destructive impulses latent in all pregnancies. Others have cited the ambivalence of the desire for pregnancy and feelings of loss after abortion. Studies published after legalization of abortion in the US and France however have stressed the nearly total absence of moderate or severe psychiatric symptoms after abortion. Responses immediately after the abortion may include feelings of relief, guilt, indifference, or ambivalence. Secondary affects appear minor to most authors. Psychological effects do not appear to be influenced by age, marital status, parity, intelligence, occupation, existence of a later pregnancy, or concommitant sterilization. "Premorbidity" and coercion by spouse or family were most closely associated with psychological symptoms. Numerous authors have found about twice as many negative reactions among women undergoing abortion for medical reasons. Most patients undergoing abortions for

  5. Herpesviral abortion in domestic animals.

    PubMed

    Smith, K C

    1997-05-01

    Abortion or neonatal disease may follow infection with several alpha, beta and gamma-herpesviruses. The alpha-herpesvirus, equid herpesvirus-1 (EHV-1), causes single or epizootic abortions or neonatal deaths in equids, and the closely related virus EHV-4 causes sporadic equine abortions. In cattle, the alpha-herpesviruses, bovine herpesvirus-1 (infectious bovine rhinotracheitis virus) and bovine herpesvirus-5 (bovine encephalitis virus), and a gamma-herpesvirus, bovine herpesvirus-4, have all been implicated as causes of abortion. In pigs, suid herpesvirus-1 (SHV-1: pseudorabies virus), an alpha-herpesvirus, and SHV-2 (porcine cytomegalovirus), a beta-herpesvirus, each cause abortion or neonatal piglet losses. Caprine herpesvirus-1, canine herpesvirus and feline herpesvirus-1, all alpha-herpesviruses, cause abortions or neonatal deaths in goats, dogs and cats, respectively. This review discusses the pathogenesis, pathology and laboratory diagnosis of these herpesviral abortions and neonatal diseases, with an emphasis on experimental studies of each disease. Alternative reviews covering other aspects of each infection, such as the genetic and antigenic structure of the viruses, host immune responses and approaches to vaccination and disease control are indicated at appropriate points in the text. PMID:9232116

  6. Republic of Ireland: abortion controversy.

    PubMed

    1998-01-01

    The problems associated with illegal abortion dominate public discussion in Ireland. While abortion is illegal in Ireland, the Supreme Court directed in 1992 that Irish women can go to Britain for abortions when their lives are thought to be at risk. Abortion was a constant feature during the Irish Presidential election campaign in October, while a dispute about the future of a 13-year-old girl's pregnancy dominated the headlines in November. The presidential election on October 30 resulted in a victory for one of the two openly anti-choice candidates, Mary McAleese, a lawyer from Northern Ireland. With a voter turnout of 47.6%, McAleese polled 45.2% of the votes cast. Although the president may refuse to sign bills which have been passed by parliament, McAleese has said that she will sign whatever bill is placed before her, even if it liberalizes abortion law in the republic. As for the case of the 13-year-old pregnant girl, she was taken into the care of Irish health authority officials once the case was reported to the police. However, the health board, as a state agency, is prevented by Irish law from helping anyone travel abroad for abortion. The girl was eventually given leave in a judgement by a High Court Judicial Review on November 28 to travel to England for an abortion. PMID:12321445

  7. 28 CFR 551.23 - Abortion.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Abortion. 551.23 Section 551.23 Judicial..., Pregnancy, Child Placement, and Abortion § 551.23 Abortion. (a) The inmate has the responsibility to decide either to have an abortion or to bear the child. (b) The Warden shall offer to provide each...

  8. 28 CFR 551.23 - Abortion.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Abortion. 551.23 Section 551.23 Judicial..., Pregnancy, Child Placement, and Abortion § 551.23 Abortion. (a) The inmate has the responsibility to decide either to have an abortion or to bear the child. (b) The Warden shall offer to provide each...

  9. 28 CFR 551.23 - Abortion.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Abortion. 551.23 Section 551.23 Judicial..., Pregnancy, Child Placement, and Abortion § 551.23 Abortion. (a) The inmate has the responsibility to decide either to have an abortion or to bear the child. (b) The Warden shall offer to provide each...

  10. 28 CFR 551.23 - Abortion.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Abortion. 551.23 Section 551.23 Judicial..., Pregnancy, Child Placement, and Abortion § 551.23 Abortion. (a) The inmate has the responsibility to decide either to have an abortion or to bear the child. (b) The Warden shall offer to provide each...

  11. 28 CFR 551.23 - Abortion.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Abortion. 551.23 Section 551.23 Judicial..., Pregnancy, Child Placement, and Abortion § 551.23 Abortion. (a) The inmate has the responsibility to decide either to have an abortion or to bear the child. (b) The Warden shall offer to provide each...

  12. Induced abortion and contraception use

    PubMed Central

    du Prey, Beatrice; Talavlikar, Rachel; Mangat, Rupinder; Freiheit, Elizabeth A.; Drummond, Neil

    2014-01-01

    Abstract Objective To determine what proportion of women seeking induced abortion in the Calgary census metropolitan area were immigrants. Design For 2 months, eligible women were asked to complete a questionnaire. Women who refused were asked to provide their country of birth (COB) to assess for selection bias. Setting Two abortion clinics in Calgary, Alta. Participants Women presenting at or less than 15 weeks’ gestational age for induced abortion for maternal indications. Main outcome measures The primary outcome was the proportion of women seeking induced abortion services who were immigrants. Secondary outcomes compared socioeconomic characteristics and contraception use between immigrant and Canadian-born women. Results A total of 752 women either completed a questionnaire (78.6%) or provided their COB (21.4%). Overall, 28.9% of women living in the Calgary census metropolitan area who completed the questionnaire were immigrants, less than the 31.2% background proportion of immigrant women of childbearing age. However, 46.0% of women who provided only COB were immigrants. When these data were combined, 34.2% of women presenting for induced abortion identified as immigrant, a proportion not significantly different from the background proportion (P = .127). Immigrant women presenting for induced abortion tended to be older, more educated, married with children, and have increased parity. They were similar to Canadian-born women in number of previous abortions, income status, and employment status. Conclusion This study suggests that immigrant women in Calgary are not presenting for induced abortion in disproportionately higher numbers, which differs from existing European literature. This is likely owing to differing socioeconomic characteristics among the immigrant women in our study from what have been previously described in the literature (typically lower socioeconomic status). Much still needs to be explored with regard to factors influencing the use of

  13. New German abortion law agreed.

    PubMed

    Karcher, H L

    1995-07-15

    The German Bundestag has passed a compromise abortion law that makes an abortion performed within the first three months of pregnancy an unlawful but unpunishable act if the woman has sought independent counseling first. Article 218 of the German penal code, which was established in 1871 under Otto von Bismarck, had allowed abortions for certain medical or ethical reasons. After the end of the first world war, the Social Democrats tried to legalize all abortions performed in the first three months of pregnancy, but failed. In 1974, abortion on demand during the first 12 weeks was declared legal and unpunishable under the social liberal coalition government of chancellor Willy Brandt; however, the same year, the German Federal Constitution Court in Karlsruhe ruled the bill was incompatible with article 2 of the constitution, which guarantees the right to life and freedom from bodily harm to everyone, including the unborn. The highest German court also ruled that a pregnant woman had to seek a second opinion from an independent doctor before undergoing an abortion. A new, extended article 218, which included a clause giving social indications, was passed by the Bundestag. When Germany was unified, East Germans agreed to be governed by all West German laws, except article 218. The Bundestag was given 2 years to revise the article; however, in 1993, the Federal Constitution Court rejected a version legalizing abortion in the first 3 months of the pregnancy if the woman sought counsel from an independent physician, and suggested the recent compromise passed by the Bundestag, the lower house of the German parliament. The upper house, the Bundesrat, where the Social Democrats are in the majority, still has to pass it. Under the bill passed by the Bundestag, national health insurance will pay for an abortion if the monthly income of the woman seeking the abortion falls under a certain limit. PMID:7613423

  14. [Genetics of sudden unexplained death].

    PubMed

    Campuzano, Oscar; Allegue, Catarina; Brugada, Ramon

    2014-03-20

    Sudden unexplained death is defined by death without a conclusive diagnosis after autopsy and it is responsible for a large percentage of sudden deaths. The progressive interaction between genetics and forensics in post-mortem studies has identified inheritable alterations responsible for pathologies associated with arrhythmic sudden death. The genetic diagnosis of the deceased enables the undertaking of preventive measures in family members, many of them asymptomatic but at risk. The implications of this multidisciplinary translational medical approach are complex, requiring the dedication of a specialized team. PMID:24018251

  15. Abortion-seeking behaviour among Nigerian women.

    PubMed

    Bankole, Akinrinola; Sedgh, Gilda; Oye-Adeniran, Boniface A; Adewole, Isaac F; Hussain, Rubina; Singh, Susheela

    2008-03-01

    This study used data from a community-based survey to examine women's experiences of abortion in Nigeria. Fourteen percent of respondents reported that they had ever tried to terminate a pregnancy, and 10% had obtained an abortion. The majority of women who sought an abortion did so early in the pregnancy. Forty-two percent of women who obtained an abortion used the services of a non-professional provider, a quarter experienced complications and 9% sought treatment for complications from their abortions. Roughly half of the women who obtained an abortion used a method other than D&C or MVA. The abortion prevalence and conditions under which women sought abortions varied by women's socio-demographic characteristics. Because abortion is illegal in Nigeria except to save the woman's life, many women take significant risks to terminate unwanted pregnancies. Reducing the incidence of unwanted pregnancy and unsafe abortion can significantly impact the reproductive health of women in Nigeria. PMID:17711597

  16. Cardiac Rehabilitation

    MedlinePlus

    ... from the NHLBI on Twitter. What Is Cardiac Rehabilitation? Cardiac rehabilitation (rehab) is a medically supervised program ... be designed to meet your needs. The Cardiac Rehabilitation Team Cardiac rehab involves a long-term commitment ...

  17. A Case of Sudden Infant Death Due to Incomplete Kawasaki Disease.

    PubMed

    Yajima, Daisuke; Shimizu, Keiko; Oka, Kumiko; Asari, Masaru; Maseda, Chikatoshi; Okuda, Katsuhiro; Shiono, Hiroshi; Ohtani, Seiji; Ogawa, Katsuhiro

    2016-01-01

    Although Kawasaki disease (KD) is a self-limiting disease, it may cause sudden cardiac death. Diagnosis of KD is principally based on clinical signs; however, some infant cases do not meet the criteria. Such cases are identified as incomplete KD. The sudden death risk in incomplete KD cases is similar to conventional KD. In our 5-month-old case, he had been admitted to a hospital for a fever and suppuration at the site of Bacille de Calmette et Guerin (BCG) vaccination. However, after discharge from the hospital, his C-reactive protein (CRP) levels declined, he got indisposed and died suddenly. A medico-legal autopsy revealed myocarditis, coronaritis, platelet-aggregated emboli in coronary arteries, and myocardial degeneration, suggesting that the fatal myocardial infarction was due to thrombus emboli in the coronary arteries. Forensic pathologists therefore should pay attention to the cardiac pathology originated from incomplete KD as a potential cause in cases of sudden infant death. PMID:26347043

  18. MedlinePlus: Cardiac Arrest

    MedlinePlus

    ... Journal Articles References and abstracts from MEDLINE/PubMed (National Library of Medicine) Article: A Prospective Study of Sudden Cardiac Death ... Players MedlinePlus Connect for EHRs For Developers U.S. National Library of Medicine 8600 Rockville Pike, Bethesda, MD 20894 U.S. Department ...

  19. Launch Abort System Pathfinder Arrival

    NASA Video Gallery

    The Orion Launch Abort System, or LAS, pathfinder returned home to NASA Langley on Oct. 18 on its way to NASA's Kennedy Space Center. The hardware was built at Langley and was used in preparation f...

  20. The Development of Instruments to Measure Attitudes toward Abortion and Knowledge of Abortion

    ERIC Educational Resources Information Center

    Snegroff, Stanley

    1976-01-01

    This study developed an abortion attitude scale and abortion knowledge inventory that may be utilized by health educators, counselors, and researchers for assessing attitudes toward abortion and knowledge about it. (SK)

  1. Participation of nurses in abortions.

    PubMed

    Neustatter, P L

    1980-11-29

    Doctors for a Woman's Choice on Abortion would agree with 1 point in Lord Denning's ruling on the role of nurses in abortions induced by (PGS) prostaglandins (November 15, p. 1091). The nurse should not be doing a doctor's job, as Lord Denning indicated, and we sympathize with any nurse who is doing so (though the 1967 Abortion Act allows any nurse to abstain, on grounds of conscience). However, the ruling that nurses are not legally covered to participate in any way with the "procuring of a miscarriage" (using terminology of the 1861 Offenses against the Persons Act upon which the ruling is based) does not require a radical change in the practice of late abortions (constituting only 7% of the terminations) or any change in the law. PG abortion can be done without a nurse. With the extraamniotic technique, a very cheap pump can be used to give subsequent doses of the PG (a function normally performed by a nurse) through the catheter left inserted through the cervix after the 1st dose has been given by the doctor. Alternatively, the intraamniotic method can be used, where PG is instilled into the amniotic sac via a needle passed through the abdominal wall. This normally requires only 1 dose, given by the doctor. Rarely are subsequent doses needed; however they could be given by the doctor with very little addition to his or her workload. While the fact that PG abortion can be done without nurses is not realized, late abortion will be restricted, a situation which is entirely deplorable. Also deplorable are the comments of an antiabortion nature made by Lord Denning, over and above the legal ruling in his jurisdiction to make. His ruling, furthermore, seems to have been sufficiently confused for the Department of Health to withdraw its circular on abortion and await an interpretation before issuing another. PMID:6107800

  2. Paris court attacks abortion law.

    PubMed

    Dorozynski, A

    1995-07-15

    A Paris court last week challenged a 1993 law that makes it a criminal offense to obstruct abortions. The court acquitted nine anti-abortion protestors who had broken into the maternity ward of the public hospital Pitie-Salpetriere last November and prayed at the entrance of a ward where patients are admitted for abortions. The judges ruled that the protestors had not interfered with abortions being carried out because none were taking place at the time of the demonstration; furthermore, the judges stated, because the fetus could be considered a person (child), the protestors were protected by other laws which give immunity to those breaking a law in order to protect another person's life, or to defend a child that had been abandoned. The court continued to say that a fetus should be protected, whether or not it was considered a person, because it was definitely more than nothing. The Syndicat de la Magistrature, the association of French magistrates, believes the tribunal has denied the right to abortion guaranteed in the 1975 law. Veronique Neietz, who drafted the 1993 law, was "scandalized" by the decision and believes the decision of the court was made in retribution for a recent parliamentary decision to exclude anti-abortion protestors from the general amnesty given after presidential elections to minor offenders. During the same week of this court decision, two tribunals, in Lyons and in Bourg-en-Bresse, sentenced 45 anti-abortionists to suspended prison terms with fines. PMID:7613424

  3. Crew Exploration Vehicle Ascent Abort Overview

    NASA Technical Reports Server (NTRS)

    Davidson, John B., Jr.; Madsen, Jennifer M.; Proud, Ryan W.; Merritt, Deborah S.; Sparks, Dean W., Jr.; Kenyon, Paul R.; Burt, Richard; McFarland, Mike

    2007-01-01

    One of the primary design drivers for NASA's Crew Exploration Vehicle (CEV) is to ensure crew safety. Aborts during the critical ascent flight phase require the design and operation of CEV systems to escape from the Crew Launch Vehicle and return the crew safely to the Earth. To accomplish this requirement of continuous abort coverage, CEV ascent abort modes are being designed and analyzed to accommodate the velocity, altitude, atmospheric, and vehicle configuration changes that occur during ascent. The analysis involves an evaluation of the feasibility and survivability of each abort mode and an assessment of the abort mode coverage. These studies and design trades are being conducted so that more informed decisions can be made regarding the vehicle abort requirements, design, and operation. This paper presents an overview of the CEV, driving requirements for abort scenarios, and an overview of current ascent abort modes. Example analysis results are then discussed. Finally, future areas for abort analysis are addressed.

  4. Abortion restrictions may undermine welfare reform.

    PubMed

    1999-02-01

    Results from a study conducted by Pennsylvania State University's Population Research Institute indicate that more restrictive abortion laws in the US may have led to an increase in the number of single mothers, even given new welfare reform laws which make unmarried childbearing more costly. Study findings are based upon county rates of female-headed families from the 1980 and 1990 censuses, excluding those in Alaska and Hawaii. By making unmarried childbearing more costly, welfare reform has sparked a demand for abortion, while at the same time abortion laws have restricted access to abortion. An increasing number of unmarried women on welfare have therefore chosen childbearing over abortion. The study found a decline in the number of abortions in counties where abortion laws had become more strict. That states can now require abortion providers to notify the parents of minors who have abortions, to restrict Medicaid funding for abortions, and to establish 24-hour waiting periods has made abortion either a difficult or impossible option for some women. These restrictive abortion laws and geographic barriers to abortion have discouraged women from undergoing the procedure, increasing the number of female-headed families and single mothers. The public policy goal of reducing unmarried childbearing and female-headed families is being undermined by the growing geographic and legal barriers designed to discourage abortion. PMID:12348920

  5. Repeat abortions in New York City, 2010.

    PubMed

    Toprani, Amita; Cadwell, Betsy L; Li, Wenhui; Sackoff, Judith; Greene, Carolyn; Begier, Elizabeth

    2015-06-01

    This study aims to describe factors associated with the number of past abortions obtained by New York City (NYC) abortion patients in 2010. We calculated rates of first and repeat abortion by age, race/ethnicity, and neighborhood-level poverty and the mean number of self-reported past abortions by age, race/ethnicity, neighborhood-level poverty, number of living children, education, payment method, marital status, and nativity. We used negative binomial regression to predict number of past abortions by patient characteristics. Of the 76,614 abortions reported for NYC residents in 2010, 57% were repeat abortions. Repeat abortions comprised >50% of total abortions among the majority of sociodemographic groups we examined. Overall, mean number of past abortions was 1.3. Mean number of past abortions was higher for women aged 30-34 years (1.77), women with ≥5 children (2.50), and black non-Hispanic women (1.52). After multivariable regression, age, race/ethnicity, and number of children were the strongest predictors of number of past abortions. This analysis demonstrates that, although socioeconomic disparities exist, all abortion patients are at high risk for repeat unintended pregnancy and abortion. PMID:25779755

  6. Gene and Cell Therapies for the Failing Heart to Prevent Sudden Arrhythmic Death

    PubMed Central

    Sovari, Ali A.; Dudley, Samuel C.

    2013-01-01

    Current therapies for treatment and prevention of sudden cardiac death have certain limitations, and a search for new therapeutic approaches is desirable to reduce the burden of sudden arrhythmic death. Gene therapy and stem cell therapy have been investigated as new, valuable tools in treating cardiac diseases such as arrhythmias. In this review, the basics of each modality, important related experimental and clinical studies, and potential advantages and limitations of these treatments will be discussed. The future success of gene and cell therapy to become practical clinical tools greatly depends on our understanding of the mechanisms of ventricular arrhythmia and the mechanisms of action of gene and cell therapy. PMID:22858914

  7. [Readers' position against induced abortion].

    PubMed

    1981-08-25

    Replies to the request by the Journal of Nursing on readers' positions against induced abortion indicate there is a definite personal position against induced abortion and the assistance in this procedure. Some writers expressed an emotional "no" against induced abortion. Many quoted arguments from the literature, such as a medical dictionary definition as "a premeditated criminally induced abortion." The largest group of writers quoted from the Bible, the tenor always being: "God made man, he made us with his hands; we have no right to make the decision." People with other philosophies also objected. Theosophical viewpoint considers reincarnation and the law of cause and effect (karma). This philosophy holds that induced abortion impedes the appearance of a reincarnated being. The fundamental question in the abortion problem is, "can the fetus be considered a human life?" The German anatomist Professor E. Bleckschmidt points out that from conception there is human life, hence the fertilized cell can only develop into a human being and is not merely a piece of tissue. Professional nursing interpretation is that nursing action directed towards killing of a human being (unborn child) is against the nature and the essence of the nursing profession. A different opinion states that a nurse cares for patients who have decided for the operation. The nurse doesn't judge but respects the individual's decision. Some proabortion viewpoints considered the endangering of the mother's life by the unborn child, and the case of rape. With the arguments against abortion the question arises how to help the woman with unwanted pregnancy. Psychological counseling is emphasized as well as responsible and careful assistance. Referral to the Society for Protection of the Unborn Child (VBOK) is considered as well as other agencies. Further reader comments on this subject are solicited. PMID:6913282

  8. House subcmte. tightens abortion language.

    PubMed

    1978-05-10

    Medicaid would help pay for abortion in fewer circumstances under the fiscal 1979 Department of Health, Education, and Welfare (HEW), appropriations bill approved May 4, 1978, by the House HEW Appropriations Subcommittee than it did in 1978. The new language would permit the funding only if the mother's life would be endangered if the pregnancy were carried to term. Current law permits abortion payments for this reason; if pregnancy results from rape or incest, or if the birth would cause the mother severe and long-lasting physical damage. Behind the scenes pressure probably will be applied to resolve the issue quickly this year since all House members are up for reelection and do not want to have such a sensitive issue intruding on their campaigns. 1 strategy being discussed is the inclusion of riders that would directly or indirectly provide federal funds for abortions in other appropriation measures such as funding for the Defense Department and federal employees health benefits. The House will have to contend with Senator Brooke (R-Massachusetts) ranking minority member on the Senate HEW Appropriations Subcommittee, who is determined to stand firm in favor of liberal abortion funding. With only minimal opposition for his Senate seat this year, Senate staffers say Brooke is not concerned with the possibility of abortion becoming a major campaign issue. It was Brooke who forced the House's hand last year and obtained a more relaxed abortion curb, much to the chagrin of the Carter Administration. The White House, with the President's popularity at a low ebb, would prefer not to be put in a position of taking sides publicly although it prefers the strict curbs. Carter is currently deciding which House members to assist during the campaign and such a no-win issue would only serve to complicate matters. He will have enough of a problem reconciling health spending increases without the added burden of abortion. PMID:12335662

  9. Contraception and abortion in two Vietnamese communes.

    PubMed Central

    Gorbach, P M; Hoa, D T; Nhan, V Q; Tsui, A

    1998-01-01

    OBJECTIVES: The authors examined factors predicting abortion use in two communes in northern Vietnam. METHODS: A survey of 504 rural and 523 urban women of childbearing age was conducted. RESULTS: For the 13.6% of urban and 19% of rural commune women having had an abortion in the previous year, logistic regression analyses demonstrated that use of an intrauterine device reduced the likelihood of subsequent abortion in both communes. Traditional method use in the rural commune, however, increased women's likelihood of a subsequent abortion. CONCLUSIONS: Contraceptive use in these 2 communes affected abortion more than sociodemographic factors. Traditional method use by rural women is a risk for abortion. PMID:9551014

  10. Sudden death of effective entanglement

    SciTech Connect

    Roszak, K.; Horodecki, P.; Horodecki, R.

    2010-04-15

    Sudden death of entanglement is a well-known effect resulting from the finite volume of separable states. We study the case when the observer has a limited measurement capability and analyze the effective entanglement (i.e., entanglement minimized over the output data). We show that in the well-defined system of two quantum dots monitored by single-electron transistors, one may observe a sudden death of effective entanglement when real, physical entanglement is still alive. For certain measurement setups, this occurs even for initial states for which sudden death of physical entanglement is not possible at all. The principles of the analysis may be applied to other analogous scenarios, such as estimation of the parameters arising from quantum process tomography.

  11. Abortion and the law: the Supreme Court, privacy, and abortion.

    PubMed

    Marsh, F H

    1997-01-01

    This article examines the impact of the continuing politicization of the abortion issue in the US on the rights of women and on the emerging concept of fetal rights. The introduction 1) attributes the "final and total politicization" of a woman's right to control her reproduction to the "undue burden" standard introduced by the Supreme Court in its 1992 Casey decision and 2) claims that, if unchecked, the concept of fetal rights may give the state's interest in protecting potential life supremacy over women's rights. The next section presents an in-depth discussion of the politicization of the right to abortion that covers such topics as how the courts before Casey became the forum for debating abortion policy, how the "undue burden" standard fails to set definite parameters of acceptable state behavior, how the Casey decision in effect abandons the trimester-based framework of reference provided in Roe vs. Wade, how Casey allows states to subtly coerce women seeking abortions, how the Casey decision failed to reduce the intense politicization of abortion, and how the court failed to protect individual rights to health care and abortion funding from states. Part 3 of the article begins its exploration of the concept of "fetal rights" with a sketch of the history of this concept in the US courts starting in 1884 when damages for miscarriage were denied. Ways in which fetal rights compete with the rights of a pregnant woman are described, the Supreme Court is blamed for allowing states to develop this concept, and issues of patient confidentiality versus reporting requirements are considered. It is concluded that the Supreme Court will have to act to limit fetal rights. PMID:12348324

  12. Global consequences of unsafe abortion.

    PubMed

    Singh, Susheela

    2010-11-01

    Unsafe abortion is a significant cause of death and ill health in women in the developing world. A substantial body of research on these consequences exists, although studies are of variable quality. However, unsafe abortion has a number of other significant consequences that are much less widely recognized. These include the economic consequences, the immediate costs of providing medical care for abortion-related complications, the costs of medical care for longer-term health consequences, lost productivity to the country, the impact on families and the community, and the social consequences that affect women and families. This article will review the scientific evidence on the consequences of unsafe abortion, highlight gaps in the evidence base, suggest areas where future research efforts are needed, and speculate on the future situation regarding consequences and evidence over the next 5-10 years. The information provided is useful and timely given the current heightened interest in the issue of unsafe abortion, growing from the recent focus of national and international agencies on reducing maternal mortality by 75% by 2015 (as one of the Millennium Development Goals established in 2000). PMID:21118043

  13. The Road to Pad Abort 1

    NASA Video Gallery

    At the White Sands Missile Range in Las Cruces, N.M., engineers and technicians are preparing for the Pad Abort 1 flight test. The Launch Abort System is a sophisticated new rocket tower designed t...

  14. Cardiac Catheterization

    MedlinePlus

    ... from the NHLBI on Twitter. What Is Cardiac Catheterization? Cardiac catheterization (KATH-eh-ter-ih-ZA-shun) is a ... disease. Doctors also can use ultrasound during cardiac catheterization to see blockages in the coronary arteries. Ultrasound ...

  15. Abortion counseling and the school counselor.

    PubMed

    Duncan, J A; Moffett, C F

    1974-01-01

    The Supreme Court decision of January 22, 1973, legalizing abortion now requires school counselors to examine both their personal and professional positions on abortion information and abortion counseling. To date a review of school counseling literature reveals a failure to deal with abortion as a counseling issue. Also, schools have failed to develop official policies regarding abortion counseling and the distribution of abortion information. The counselors who have provided abortion information to date have done so at the request of a student or parent rather than by making the information generally available. A study in 1973 in Virginia, however, revealed that Virginia counselor educators believed that there was a need for counselors in training to be exposed to abortion information as part of their formal training experience. Generally, today's present exposure to abortion information makes it impossible for counselors to continue to ignore a growing demand for both abortion information and counseling. School counselors must deal with the following questions: 1) What course of action should school counselors take when a pregnant young seeks counseling on alternatives to pregnancy continuation? 2) What is the counselor's professional role in abortion counseling with respect to his or her personal feelings and beliefs? 3) What kind of training if any should school counselors receive regarding abortion counseling? 4) Is there a need for in-service training on abortion counseling for school counselors? 5) Should various professional organizations develop materials that would assist their members in providing abortion counseling? 6) Should institutions such as schools, churches, and community agencies establish policies concerning abortion counseling? Although the answers are not simple, the school counselors and their professional organizations must begin to develop the answers in order to provide good counseling services to young women exercising their right to

  16. [The Sudden Infant Death Syndrome.

    ERIC Educational Resources Information Center

    Florida's Health, 1976

    1976-01-01

    This collection of articles on the Sudden Infant Death Syndrome (SIDS), drawn from a southeastern regional symposium on the subject, summarizes much of what is known about the occurrence of SIDS, including current information about its causes. The background of state action in Florida is reviewed, with emphasis on the need for increased public and…

  17. Procured abortion in Ilorin, Nigeria.

    PubMed

    Anate, M; Awoyemi, O; Oyawoye, O; Petu, O

    1995-06-01

    A prospective study of the maternal mortality and morbidity and other related social problems among 144 cases of procured abortion in Ilorin, Nigeria over a 24-month period is presented. A mortality rate of 90.3 per thousand procured abortions was recorded. Genital sepsis, haemorrhagic anaemia, gut injury, uterine perforation and vesico vaginal fistulae (VVF) were encountered. Poor referral system, late presentation, poor blood transfusion services and inadequate availability of drugs had adverse effects on the patients. The implications (the menace and frequency) of these and possible measures like improving the literacy level, the moral standards, contraceptive practice and family life education (sex education) are discussed. PMID:7498012

  18. Mechanisms underlying Phalaris aquatica "sudden death" syndrome in sheep.

    PubMed

    Bourke, C A; Carrigan, M J

    1992-07-01

    Twenty outbreaks of Phalaris aquatica "sudden death" syndrome in sheep were investigated between 1981 and 1991. Four were confirmed and one was suspected, to be a cardiac disorder; 5 were confirmed and 3 were suspected, to be a polioencephalomalacic disorder; the aetiology of the remaining 7 outbreaks could not be determined. Potentially toxic levels of hydrocyanic acid (20 to 36 mg/100 g) were measured in the 3 toxic phalaris pastures tested. The measurement of potentially toxic levels of nitrate nitrogen (2920 micrograms/g) in toxic phalaris pastures by others, was noted. It is suggested that phalaris "sudden death" syndrome could have as many as 4 different underlying mechanisms, and that these might reflect the presence in the plant of a cardio-respiratory toxin, a thiaminase and amine co-substate, cyanogenic compounds, and nitrate compounds. PMID:1445081

  19. Abortion, Moral Maturity and Civic Journalism.

    ERIC Educational Resources Information Center

    Patterson, Maggie Jones; Hall, Megan Williams

    1998-01-01

    Contributes to rhetoric, moral reasonings scholarship, and journalism scholarship by examining public rhetoric on abortion and American popular media coverage (1940s to 1990s). Finds that the feminine means of moral reasoning has emerged into the foreground of discourse on abortion. Compares emergence of a common-ground rhetoric on abortion with a…

  20. Objective versus Subjective Responses to Abortion.

    ERIC Educational Resources Information Center

    Robbins, James M.

    1979-01-01

    Measured psychological sequelae to induced abortion among women pregnant out of wedlock, using the Minnesota Multiphasic Personality Inventory and questions specific to willingness to repeat abortion under similar circumstances. Analyses indicated no relation between objective and subjective indicators. Affectivity after induced abortion had…

  1. Abortion and Mental Health: Evaluating the Evidence

    ERIC Educational Resources Information Center

    Major, Brenda; Appelbaum, Mark; Beckman, Linda; Dutton, Mary Ann; Russo, Nancy Felipe; West, Carolyn

    2009-01-01

    The authors evaluated empirical research addressing the relationship between induced abortion and women's mental health. Two issues were addressed: (a) the relative risks associated with abortion compared with the risks associated with its alternatives and (b) sources of variability in women's responses following abortion. This article reflects…

  2. Orientation toward Abortion: Guilt or Knowledge?

    ERIC Educational Resources Information Center

    Allgeier, A.R.; And Others

    1981-01-01

    Students (N=118) were classified as pro-choice, anti-abortion, or mixed on the basis of their responses to 10 fictitious case histories of women who requested abortion. Attitudinal differences are discussed in the context of the public controversy over abortion. (Author/CM)

  3. [Out-of-hospital cardiac arrest].

    PubMed

    Virkkunen, Ilkka; Hoppu, Sanna; Kämäräinen, Antti

    2011-01-01

    Cardiac arrest as the first symptom of coronary artery disease is not uncommon. Some of previously healthy people with sudden cardiac arrest may be saved by effective resuscitation and post-resuscitative therapy. The majority of cardiac arrest patients experience the cardiac arrest outside of the hospital, in which case early recognition of lifelessness, commencement of basic life support and entry to professional care without delay are the prerequisites for recovery. After the heart has started beating again, the clinical picture of post-resuscitation syndrome must be recognized and appropriate treatment utilized. PMID:22204143

  4. Defects in Cytoskeletal Signaling Pathways, Arrhythmia, and Sudden Cardiac Death

    PubMed Central

    Smith, Sakima; Curran, Jerry; Hund, Thomas J.; Mohler, Peter J.

    2012-01-01

    Ankyrin polypeptides are cellular adapter proteins that tether integral membrane proteins to the cytoskeleton in a host of human organs. Initially identified as integral components of the cytoskeleton in erythrocytes, a recent explosion in ankyrin research has demonstrated that these proteins play prominent roles in cytoskeletal signaling pathways and membrane protein trafficking/regulation in a variety of excitable and non-excitable cells including heart and brain. Importantly, ankyrin research has translated from bench to bedside with the discovery of human gene variants associated with ventricular arrhythmias that alter ankyrin–based pathways. Ankyrin polypeptides have also been found to play an instrumental role in various forms of sinus node disease and atrial fibrillation (AF). Mouse models of ankyrin-deficiency have played fundamental roles in the translation of ankyrin-based research to new clinical understanding of human sinus node disease, AF, and ventricular tachycardia. PMID:22586405

  5. How Can Death Due to Sudden Cardiac Arrest Be Prevented?

    MedlinePlus

    ... heartbeats that can trigger the ICD. Implantable Cardioverter Defibrillator The illustration shows the location of an implantable cardioverter defibrillator in the upper chest. The electrodes are inserted ...

  6. Sudden unexpected death due to severe pulmonary and cardiac sarcoidosis.

    PubMed

    Ginelliová, Alžbeta; Farkaš, Daniel; Farkašová Iannaccone, Silvia; Vyhnálková, Vlasta

    2016-09-01

    In this paper we report the autopsy findings of a 57 year old woman who died unexpectedly at home. She had been complaining of shortness of breath, episodes of dry coughing, and nausea. Her past medical and social history was unremarkable. She had no previous history of any viral or bacterial disease and no history of oncological disorders. Autopsy revealed multiple grayish-white nodular lesions in the pleura and epicardial fat and areas resembling fibrosis on the cut surface of the anterior and posterior wall of the left ventricle and interventricular septum. Histological examination of the lungs and heart revealed multiple well-formed noncaseating epithelioid cell granulomas with multinucleated giant cells. Death was attributed to myocardial ischemia due to vasculitis of intramural coronary artery branches associated with sarcoidosis. Sarcoidosis is a multisystemic disease of unknown etiology characterized by the formation of noncaseating epithelioid cell granulomas in the affected organs and tissues. The diagnosis of sarcoidosis in this case was established when other causes of granulomatous disease such as tuberculosis, berylliosis, hypersensitivity pneumonitis, and giant cell myocarditis had been reasonably excluded. PMID:27379608

  7. Sudden cardiac death in marathons: a systematic review.

    PubMed

    Waite, Oliver; Smith, Andy; Madge, Luke; Spring, Hannah; Noret, Nathalie

    2016-02-01

    The aim of this systematic review is to summarise the results of cohort studies that examined the incidence of SCD in marathons and to assess the quality of the methods used. A search of the PROSPERO international database revealed no prospective or published systematic reviews investigating SCD in marathons. The review was conducted using studies that reported and characterised the incidence of SCD in people participating in marathons. Studies were identified via electronic database searches (Medline, CINAHL, SPORTDiscus and Google Scholar) from January 1, 1966 to October 1, 2014 and through manual literature searches. 7 studies met the inclusion criteria and were included in this review. 6 of the studies were conducted in the USA and 1 in the UK. These studies covered a 34-year period involving between 215,413 and 3,949,000 runners. The SCD of between 4 and 28 people are recorded in the papers and the reported estimates of the incidence of SCD in marathons ranged widely from 0.6 to 1.9 per 100,000 runners. The proportion of those suffering SCD who were male ranged from 57.1% to 100% and the mean age reported in the papers, ranged from 37 to 48. This review raises 4 methodological concerns over i) collating reports of SCD in marathons; ii) time of death in relation to the marathon; iii) the use of registrants rather than runners in the estimates of sample size and iv) limited detail on runners exercise history. These four concerns all threaten the reliability and interpretation of any estimate of SCD incidence rates in marathons.  This review recommends that the methods used to collect data on SCD in marathons be improved and that a central reporting system be established. PMID:26765272

  8. [Is a sociology of abortion possible?].

    PubMed

    Isambert, F A

    1982-01-01

    Abortion is a thorny problem whose study is problematic because it is a source of social and juridical discord, of moral incertitude, of medical and psychiatric confusion, and of personal anguish. The question arises of whether a single perspective can be found which allows comprehension of the entire phenomenon. This work uses published sources to examine the abortion debate, beginning with the varying views of abortion expressed in the struggles to liberalize abortion legislation in France, Europe, and the US. 4 particular views of abortion were identified in the Paris press; the traditional religious view, which condemns abortion because the fetus is regarded as fully human from conception; the view of abortion as a means of fertility regulation; the view of abortion as a cause of public health problems that could be alleviated through legalization and medical control; and the view that abortion allows women to control their own bodies. The law is obliged to reconcile these diverse positions. Abortion legislation in different countries ranges along a continuum from severe to lenient, but regional variations are also evident. Abortion trials in the US and France shortly before liberalization of the laws of either country showed striking similarities but also notable differences due largely to dissimilarities in the social structures of the 2 countries. The relations between the individual and the state, morality, and the law, as reflected in the abortion debate, rested on inverse bases in the 2 countries. The typically American doctrine of privacy occupied a prominent place in the American legislation, while the French was more concerned with the humanitarian goal of reducing health damage from illegal abortions. Tension and ambiguity nevertheless unavoidably characterize the abortion regulations in the 2 countries. Abortion as an institution is a controlled and practical compromise between 2 poles, those giving primacy to individual interests, as in the US, and

  9. Sports and Marfan Syndrome: Awareness and Early Diagnosis Can Prevent Sudden Death.

    ERIC Educational Resources Information Center

    Salim, Mubadda A.; Alpert, Bruce S.

    2001-01-01

    Physicians who work with athletes play an important role in preventing sudden death related to physical activity in people who have Marfan syndrome. Flagging those who have the physical stigmata and listening for certain cardiac auscultation sounds are early diagnostic keys that can help prevent deaths. People with Marfan syndrome should be…

  10. RU-486: the "abortion pill".

    PubMed

    Herranz, G

    1991-05-23

    A report sent by the Vatican to bishops' conferences throughout the world calls RU-486, the so-called abortion pill currently available in France, "a new, serious threat to human life." The report was developed at the Vatican's request by Gonzalo Herranz, a Spanish bioethicist. A cover letter to bishops' conferences from Cardinal Alfonso Lopez Trujillo, president of the Pontifical Council for the Family, suggested that the report be used "to resist the introduction of the abortion pill RU-486 into your country." Related to TU-486 and to new terminology some use to characterize its non-surgical approach to abortion is an intention "to amoralize and thereby place the transmission of human life into an ethically neutral terrain and reduce it to pure biology," says the report. The report discusses possible future uses of RU-486 as a contraceptive, stating: "Women would no longer have to worry themselves about whether they have conceived or not. Each month they would proceed to clean out their uterus chemically." The report refers to RU-486 as "a technical step forward in an area that did not need it." It says, "The abortion pill favors a woman's privacy and secret, but it condemns her to solitude." The English text from the Vatican follows. PMID:16145821

  11. Seventeen years of legalized abortion in Singapore.

    PubMed

    Saw, S

    1988-06-01

    "In this paper we first discuss the two-stage process of legalizing induced abortion in Singapore, the initial legalization to make it available on a restrictive basis in 1970 and the complete liberalization to make it available on demand from 1975 onwards. The incidence of abortions registered in the last seventeen years and the major characteristics of aborters are analysed. The impact of abortion on the rapid decline of fertility to below-replacement level is highlighted, and the need to reduce abortion by amending the more liberal aspects of the law are considered at the end of the paper." PMID:12341971

  12. Unintended pregnancy and abortion in Uganda.

    PubMed

    Hussain, Rubina

    2013-01-01

    Unintended pregnancy is common in Uganda, leading to high levels of unplanned births, unsafe abortions, and maternal injury and death. Because most pregnancies that end in abortion are unwanted, nearly all ill health and mortality resulting from unsafe abortion is preventable. This report summarizes evidence on the context and consequences of unintended pregnancy and unsafe abortion in Uganda, points out gaps in knowledge, and highlights steps that can be taken to reduce levels of unintended pregnancy and unsafe abortion, and, in turn, the high level of maternal mortality. PMID:23550324

  13. Family planning is reducing abortions.

    PubMed

    Clinton, H R

    1997-01-01

    This news brief presents the US President's wife's statement on the association between use of family planning and a decline in abortions worldwide. Hillary Rodham Clinton attended the Sixth Conference of Wives of Heads of State and Government of the Americas held in La Paz, Bolivia. The conference was suitably located in Bolivia, a country with the highest rates of maternal mortality in South America. Bolivia has responded by launching a national family planning campaign coordinated between government, nongovernmental, and medical organizations. Half of Bolivian women experience pregnancy and childbirth without the support of trained medical staff. Mortality from abortion complications account for about half of all maternal deaths in Bolivia. Voluntary family planning workers teach women about the benefits of child spacing, breast feeding, nutrition, prenatal and postpartum care, and safe deliveries. Bolivia has succeeded in increasing its contraceptive use rates and decreasing the number of safe and unsafe abortions. Bolivia's program effort was supported by USAID. USAID provided technical assistance and funds for the establishment of a network of primary health care clinics. Mrs. Clinton visited one such clinic in a poor neighborhood in La Paz, which in its first six months of operation provided 2200 consultations, delivered 200 babies, registered 700 new family planning users, and immunized 2500 children. Clinics such as this one will be affected by the US Congress's harsh cuts in aid, which reduce funding by 35% and delay program funding by 9 months. These US government cuts in foreign aid are expected to result in an additional 1.6 million abortions, over 8000 maternal deaths, and 134,000 infant deaths in developing countries. An investment in population assistance represents a sensible, cost-effective, and long-term strategy for improving women's health, strengthening families, and reducing abortion. PMID:12293000

  14. Sudden Arrhythmia Death Syndromes (SADS) Foundation

    MedlinePlus

    ... all proceeds benefiting the SADS Foundation (Sudden Arrhythmia Death Syndrome). Each year 4,000 young Americans die ... Investigator Awardees 5/19/2016 The Sudden Arrhythmia Death Syndromes (SADS) Foundation announces the winners for the ...

  15. Sudden Infant Death Syndrome: Facts for Caregivers.

    ERIC Educational Resources Information Center

    Texas Child Care, 2000

    2000-01-01

    Presents risk factors and prevention measures related to Sudden Infant Death Syndrome. Offers infant sleep recommendations and five discussion questions to test knowledge of Sudden Infant Death Syndrome. (DLH)

  16. Post-abortion syndrome: creating an affliction.

    PubMed

    Dadlez, E M; Andrews, William L

    2010-11-01

    The contention that abortion harms women constitutes a new strategy employed by the pro-life movement to supplement arguments about fetal rights. David C. Reardon is a prominent promoter of this strategy. Post-abortion syndrome purports to establish that abortion psychologically harms women and, indeed, can harm persons associated with women who have abortions. Thus, harms that abortion is alleged to produce are multiplied. Claims of repression are employed to complicate efforts to disprove the existence of psychological harm and causal antecedents of trauma are only selectively investigated. We argue that there is no such thing as post-abortion syndrome and that the psychological harms Reardon and others claim abortion inflicts on women can usually be ascribed to different causes. We question the evidence accumulated by Reardon and his analysis of data accumulated by others. Most importantly, we question whether the conclusions Reardon has drawn follow from the evidence he cites. PMID:19594725

  17. Abortion returns to haunt US presidential campaign.

    PubMed

    Greenberg, D S

    2000-04-01

    The abortion issue has infested national politics since 1973, now it returns to haunt the US presidential election politics. However, rather than serving as a customary rallying cause for Republicans, it is now a millstone around the neck of their candidate, Governor George Bush, who seeks a broad ideological span of voters to win his candidacy. Bush expressed strong anti-abortion sentiments to attract the die-hard right-to-life vote in the hard-fought primary campaign. For many years, the anti-abortion language in the US remains strident, however, it is clear that most voters support, or at least tolerate, the availability of abortion services. In his presidential campaign, Bush shied away from endorsing a constitutional amendment to ban abortion, and declared his opposition to any exceptions to an abortion ban. He is now on the record with numerous anti-abortion declarations, and holds endorsements from the pro-life camp. PMID:10791389

  18. Abortion counseling: to benefit maternal health.

    PubMed

    Steinberg, T N

    1989-01-01

    This Note examines how both the law and the health care profession neglect women's needs for abortion counseling before, during and after an abortion. Part I analyzes the health care profession's view of counseling, the psychological effects of abortion and how counseling both positively and negatively influences those effects. Part II reviews Supreme Court cases and state law regarding abortion counseling, critizing both the Court's narrow view of counseling and the states' failure to use the legislative process to create laws which benefit maternal health. Part III recommends an expanded role for abortion counseling, in which the counselor can provide emotional support from before the day of an abortion until a woman emotionally recovers from an abortion. This expanded role would be state-mandated, but would remain within constitutional boundaries by providing flexibility for counselors to give individual treatment while respecting a woman's privacy. PMID:2699161

  19. [Induced abortion--a historical outline].

    PubMed

    Glenc, F

    1974-11-11

    An historical review of the use of induced abortion is presented, beginning with early eras. The Chinese were the 1st to record the practice of induced abortion, with this operation being administered to royal concubines recorded at 500-515 B.C. Induced abortion was not used in ancient Greece, either for criminal or ethical reason. However, the ancient Greeks did utilize compulsory abortion for serious economic indications, as a means of controlling natural growth. Greek medical, gyneoclogigcal instruments for adminsitering abortions were described by Hippocrates. The Greek moral attitudes on abortion were largely adopted by the Romans, which were later altered by the appearance of Christianity and new ethical ideas. These ideas dominated European attitudes, along with the Church of Rome, limiting induced abortion to cases where the life of the mother was threatened. This attitude has existed until the present century, when these moral ideas are being challanged seriously for the 1st time in modern history. PMID:4610534

  20. [Periodic Repolarization Dynamics--innovative strategies for preventing sudden death].

    PubMed

    Rizas, Konstantinos; Bauer, Axel

    2016-04-01

    Sudden cardiac death (SCD) is the most common single cause of death in the industrialized world. Survivors of acute myocardial infarction (MI) are at increased risk of death. The vast majority of deaths occur in post-MI patients with preserved left ventricular ejection fraction (LVEF) for whom no prophylactic strategies exist. Periodic repolarization dynamics (PRD) is a novel electrocardiographic phenomenon that refers to low frequency (< 0.1 Hz) modulations of cardiac repolarization, most likely linked to sympathetic activity. Increased PRD is a strong and independent predictor of mortality after acute MI. PRD assessment allows to identify a new high risk group of post-MI patients with preserved LVEF (35-50 %) who have the same mortality risk as patients with LVEF ≤ 35 %. Future studies are needed to test the efficacy of preventive strategies in this new high risk group. PMID:27031208

  1. Deranged sodium to sudden death

    PubMed Central

    Clancy, Colleen E; Chen-Izu, Ye; Bers, Donald M; Belardinelli, Luiz; Boyden, Penelope A; Csernoch, Laszlo; Despa, Sanda; Fermini, Bernard; Hool, Livia C; Izu, Leighton; Kass, Robert S; Lederer, W Jonathan; Louch, William E; Maack, Christoph; Matiazzi, Alicia; Qu, Zhilin; Rajamani, Sridharan; Rippinger, Crystal M; Sejersted, Ole M; O'Rourke, Brian; Weiss, James N; Varró, András; Zaza, Antonio

    2015-01-01

    In February 2014, a group of scientists convened as part of the University of California Davis Cardiovascular Symposium to bring together experimental and mathematical modelling perspectives and discuss points of consensus and controversy on the topic of sodium in the heart. This paper summarizes the topics of presentation and discussion from the symposium, with a focus on the role of aberrant sodium channels and abnormal sodium homeostasis in cardiac arrhythmias and pharmacotherapy from the subcellular scale to the whole heart. Two following papers focus on Na+ channel structure, function and regulation, and Na+/Ca2+ exchange and Na+/K+ ATPase. The UC Davis Cardiovascular Symposium is a biannual event that aims to bring together leading experts in subfields of cardiovascular biomedicine to focus on topics of importance to the field. The focus on Na+ in the 2014 symposium stemmed from the multitude of recent studies that point to the importance of maintaining Na+ homeostasis in the heart, as disruption of homeostatic processes are increasingly identified in cardiac disease states. Understanding how disruption in cardiac Na+-based processes leads to derangement in multiple cardiac components at the level of the cell and to then connect these perturbations to emergent behaviour in the heart to cause disease is a critical area of research. The ubiquity of disruption of Na+ channels and Na+ homeostasis in cardiac disorders of excitability and mechanics emphasizes the importance of a fundamental understanding of the associated mechanisms and disease processes to ultimately reveal new targets for human therapy. PMID:25772289

  2. Pediatric Sudden Sensorineural Hearing Loss.

    PubMed

    Kizilay, Ahmet; Koca, Çiğdem Firat

    2016-06-01

    Sudden sensorineural hearing loss is defined as sudden unilateral or bilateral sensorineural hearing loss with at least 30 dB decrease in threshold in 3 contiguous test frequencies occurring over 72 hours or less. It is rare among children. The mechanism of the process and prognosis of the disorder remains unclear. The current incidence of sudden sensorineural hearing loss among pediatric population is unknown. The authors carried out a retrospective chart analysis of patients under 15 years of age from 2004 to 2015, who consulted to the Otolaryngology Head and Neck Surgery Department of Inonu University Medical Faculty. Age, sex, number of affected ear and side, audiometric evaluations, medical follow-up, treatment method, duration of treatment recovery, associated complaints; tinnitus and/or vertigo, presence of mumps disease were recorded for each patient. A 4-frequency pure-tone average (500, 1000, 2000, and 4000 Hz) was calculated for each ear. Complete recovery, defined as some hearing level compared with the nonaffected ear, was observed in 3 patients (21.4 %) and there was no partial hearing recovery. The hearing loss of 11 patient remained unchanged after prednisolone treatment. Two of the 11 patients had bilaterally total sensorineural hearing loss and evaluated as appropriate for cochlear implantation. Sex of patient and laterality of hearing loss were not correlated with hearing recovery. Sensorineural hearing loss among pediatrics has been the issue of otolaryngologists. The incidence, etiology, and treatment methods should be more studied. PMID:27171971

  3. Serum lipoperoxides in induced and spontaneous abortions.

    PubMed

    Sane, A S; Chokshi, S A; Mishra, V V; Barad, D P; Shah, V C; Nagpal, S

    1991-01-01

    Abortion, primarily as a measure of population control, certainly continues to be an emotional, frustrating and stressful event. In continuation of our work on stressful situations in the female life span and biochemical parameters, serum lipid peroxide levels in terms of malondialdehyde (nmol/ml) have been determined in females undergoing abortion [suction curettage (n = 30), Emcredil-induced abortion (n = 30) and spontaneous abortion (n = 40)] and were compared with appropriate gestational controls. Irrespective of the type of abortion, the serum lipid peroxide levels before abortion [mean malondialdehyde concentrations (nmol/ml): suction curettage 2.67, Emcredil-induced abortion 3.22, and spontaneous abortion 3.49] were found to be significantly elevated in comparison with those after abortion (suction curettage 1.91, Emcredil 1.97 and spontaneous abortion 1.95), indicating a maximum at peak time of stress and a minimum at the end of stress. The levels of serum lipid peroxide encountered before abortion were found to be significantly elevated in case of Emcredil-induced abortion and spontaneous abortion when compared with controls (second trimester mean levels 1.82 and first trimester 2.4) whereas the levels before suction curettage were found to be nonsignificant in comparison with controls, indicating a lesser degree of stress. It is felt that monitoring of serum lipid peroxide levels in serum and tissues (placenta), backed by scavenging enzyme superoxide dismutase, can be more helpful for corroborating safety and the risk of free radical toxicity in pregnancy and abortion. PMID:2071057

  4. Unsafe abortion and postabortion care - an overview.

    PubMed

    Rasch, Vibeke

    2011-07-01

    Forty per cent of the world's women are living in countries with restrictive abortion laws, which prohibit abortion or only allow abortion to protect a woman's life or her physical or mental health. In countries where abortion is restricted, women have to resort to clandestine interventions to have an unwanted pregnancy terminated. As a consequence, high rates of unsafe abortion are seen, such as in Sub-Saharan Africa where unsafe abortion occurs at rates of 18-39 per 1 000 women. The circumstances under which women obtain unsafe abortion vary and depend on traditional methods known and types of providers present. Health professionals are prone to use instrumental procedures to induce the abortion, whereas traditional providers often make a brew of herbs to be drunk in one or more doses. In countries with restrictive abortion laws, high rates of maternal death must be expected, and globally an estimated 66 500 women die every year as a result of unsafe abortions. In addition, a far larger number of women experience short- and long-term health consequences. To address the harmful health consequences of unsafe abortion, a postabortion care model has been developed and implemented with success in many countries where women do not have legal access to abortion. Postabortion care focuses on treatment of incomplete abortion and provision of postabortion contraceptive services. To enhance women's access to postabortion care, focus is increasingly being placed on upgrading midlevel providers to provide emergency treatment as well as implementing misoprostol as a treatment strategy for complications after unsafe abortion. PMID:21542813

  5. Sudden fetal death due to dualism of the sino-atrial node.

    PubMed

    Pusiol, Teresa; Roncati, Luca; Lavezzi, Anna Maria; Taddei, Fabrizio; Piscioli, Francesco; Ottaviani, Giulia

    2016-01-01

    First, we report a sudden fetal death at 33(+3)weeks due to sino-atrial node dualism. The female stillborn was delivered by induced labor. The postmortem examination of the cardiac conduction system revealed a dualism of the sino-atrial node, associated with fragmentation of the atrio-ventricular node and His bundle. These abnormalities of the cardiac conduction system represent the morphological substrate for the development of malignant arrhythmias. In particular, the dualism of the sino-atrial node can cause the dissociation of the longitudinal nodal impulse into two distinct ways of different pulse generation, resulting in supraventricular tachyarrhythmias. This observation suggests new avenues of research on the pathogenesis of the sudden unexpected fetal death. Moreover, our findings confirm the need for an accurate postmortem examination, including serial sectioning of the cardiac conduction system, in every case of unexplained fetal death, following standardized autoptic protocols. PMID:27191041

  6. [Sudden death of a 16-year-old girl with WPW syndrome: a case report].

    PubMed

    Wöllner, Kirsten; Doberentz, Elke; Madea, Burkhard

    2015-01-01

    The Wolff-Parkinson-White syndrome is a usually benign heart disease with accessory pathways. Circling excitations arise between atria and ventricles which can lead to cardiac arrhythmias. Cases of sudden cardiac death are rare (0.2 %). Risk factors for sudden cardiac death in patients with WPW syndrome are old age, several accessory pathways, male sex and previous syncopes. A 16-year-old girl was found lying dead in her bed. The evening before, she didn't feel well and complained about abdominal pain. The girl had known epilepsy and Wolff- Parkinson-White syndrome. The macroscopic and histological findings are presented and discussed with reference to the pertinent literature. PMID:26419085

  7. Departure phase aborts for manned Mars missions

    NASA Astrophysics Data System (ADS)

    Dissel, Adam F.

    NASA goals are set on resumption of human activity on the Moon and extending manned missions to Mars. Abort options are key elements of any system designed to safeguard human lives and stated requirements stipulate the provision of an abort capability throughout the mission. The present investigation will focus on the formulation and analysis of possible abort modes during the Earth departure phase of manned Mars interplanetary transfers. Though of short duration, the departure phase encompasses a mission timeline where failures have frequently become manifest in historical manned spacecraft necessitating the inclusion of a departure phase abort capability. Investigated abort modes included aborts to atmospheric entry, and to Earth or Moon orbit. Considered interplanetary trajectory types included conjunction, opposition, and free-return trajectory classes. All abort modes were analyzed for aborts initiated at multiple points along each of these possible departure trajectories across all launch opportunities of the fifteen-year Earth-Mars inertial period. The consistently low departure velocities of the conjunction trajectories facilitated the greatest abort capability. An analysis of Mars transportation architectures was performed to determine the amount of available delta V inherent in each candidate architecture for executing departure aborts. Results indicate that a delta V of at least 4 km/s is required to achieve a continuous departure phase entry abort capability with abort flights less than three weeks duration for all transfer opportunity years. Less demanding transfer years have a corresponding increase in capability. The Earth orbit abort mode does not become widely achievable until more than 6 km/s delta V is provided; a capacity not manifest in any considered architecture. Optimization of the Moon abort mode resulted in slight departure date shifts to achieve improved lunar alignments. The Moon abort mode is only widely achievable for conjunction

  8. Stratospheric sudden warming and lunar tide

    NASA Astrophysics Data System (ADS)

    Yamazaki, Yosuke; Kosch, Michael

    2016-07-01

    A stratospheric sudden warming is a large-scale disturbance in the middle atmosphere. Recent studies have shown that the effect of stratospheric sudden warnings extends well into the upper atmosphere. A stratospheric sudden warming is often accompanied by an amplification of lunar tides in the ionosphere/theremosphere. However, there are occasionally winters when a stratospheric sudden warming occurs without an enhancement of the lunar tide in the upper atmosphere, and other winters when large lunar tides are observed without a strong stratospheric sudden warming. We examine the winters when the correlation breaks down and discuss possible causes.

  9. 78 FR 1162 - Cardiovascular Devices; Reclassification of External Cardiac Compressor

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-08

    ... rate and depth are necessary to increase the probability of survival in victims of sudden cardiac... CPR during patient transport or for use in situations where fatigue of or inaccessibility to emergency... (44 FR 13424), FDA published a proposed rule for classification of external cardiac compressors...

  10. Abort Options for Potential Mars Missions

    NASA Technical Reports Server (NTRS)

    Tartabini, P. V.; Striepe, S. A.; Powell, R. W.

    1994-01-01

    Mars trajectory design options were examined that would accommodate a premature termination of a nominal manned opposition class mission for opportunities between 2010 and 2025. A successful abort must provide a safe return to Earth in the shortest possible time consistent with mission constraints. In this study, aborts that provided a minimum increase in the initial vehicle mass in low Earth orbit (IMLEO) were identified by locating direct transfer nominal missions and nominal missions including an outbound or inbound Venus swing-by that minimized IMLEO. The ease with which these missions could be aborted while meeting propulsion and time constraints was investigated by examining free return (unpowered) and powered aborts. Further reductions in trip time were made to some aborts by the addition or removal of an inbound Venus swing-by. The results show that, although few free return aborts met the specified constraints, 85% of each nominal mission could be aborted as a powered abort without an increase in propellant. Also, in many cases, the addition or removal of a Venus swing-by increased the number of abort opportunities or decreased the total trip time during an abort.

  11. Is Induced Abortion Really Declining in Armenia?

    PubMed

    Jilozian, Ann; Agadjanian, Victor

    2016-06-01

    As in other post-Soviet settings, induced abortion has been widely used in Armenia. However, recent national survey data point to a substantial drop in abortion rates with no commensurate increase in modern contraceptive prevalence and no change in fertility levels. We use data from in-depth interviews with women of reproductive age and health providers in rural Armenia to explore possible underreporting of both contraceptive use and abortion. While we find no evidence that women understate their use of modern contraception, the analysis suggests that induced abortion might indeed be underreported. The potential for underreporting is particularly high for sex-selective abortions, for which there is growing public backlash, and medical abortion, a practice that is typically self-administered outside any professional supervision. Possible underreporting of induced abortion calls for refinement of both abortion registration and relevant survey instruments. Better measurement of abortion dynamics is necessary for successful promotion of effective modern contraceptive methods and reduction of unsafe abortion practices. PMID:27285426

  12. Induced abortion: a world review, 1990.

    PubMed

    Henshaw, S K

    1990-01-01

    The worldwide trend toward liberalization of abortion laws has continued in the last four years with changes in Canada, Czechoslovakia, Greece, Hungary, Romania, the Soviet Union and Vietnam. Forty percent of the world's population now lives in countries where induced abortion is permitted on request, and 25 percent lives where it is allowed only if the woman's life is in danger. In 1987, an estimated 26 to 31 million legal abortions and 10 to 22 million clandestine abortions were performed worldwide. Legal abortion rates ranged from a high of at least 112 abortions per 1,000 women of reproductive age in the Soviet Union to a low of five per 1,000 in the Netherlands. In recent years, abortion rates have been increasing in Czechoslovakia, England and Wales, New Zealand and Sweden and declining in China, France, Iceland, Italy, Japan and the Netherlands. In most Western European and English-speaking countries, about half of abortions are obtained by young, unmarried women seeking to delay a first birth, while in Eastern Europe and the developing countries, abortion is most common among married women with two or more children. Mortality from legal abortion averages 0.6 deaths per 100,000 procedures in developed countries with data. Abortion services are increasingly being provided outside of hospitals, and for those performed in hospitals, overnight stays are becoming less common. National health insurance covers abortions needed to preserve the health of a pregnant woman in all developed countries except the United States, where Medicaid and federal insurance programs do not cover abortion unless the woman's life is in danger. PMID:2347411

  13. The Incidence of Abortion in Nigeria

    PubMed Central

    Bankole, Akinrinola; Adewole, Isaac F.; Hussain, Rubina; Awolude, Olutosin; Singh, Susheela; Akinyemi, Joshua O.

    2016-01-01

    CONTEXT Because of Nigeria’s low contraceptive prevalence, a substantial number of women have unintended pregnancies, many of which are resolved through clandestine abortion, despite the country’s restrictive abortion law. Up-to-date estimates of abortion incidence are needed. METHODS A widely used indirect methodology was used to estimate the incidence of abortion and unintended pregnancy in Nigeria in 2012. Data on provision of abortion and postabortion care were collected from a nationally representative sample of 772 health facilities, and estimates of the likelihood that women who have unsafe abortions experience complications and obtain treatment were collected from 194 health care professionals with a broad understanding of the abortion context in Nigeria. RESULTS An estimated 1.25 million induced abortions occurred in Nigeria in 2012, equivalent to a rate of 33 abortions per 1,000 women aged 15–49. The estimated unintended pregnancy rate was 59 per 1,000 women aged 15–49. Fifty-six percent of unintended pregnancies were resolved by abortion. About 212,000 women were treated for complications of unsafe abortion, representing a treatment rate of 5.6 per 1,000 women of reproductive age, and an additional 285,000 experienced serious health consequences but did not receive the treatment they needed. CONCLUSION Levels of unintended pregnancy and unsafe abortion continue to be high in Nigeria. Improvements in access to contraceptive services and in the provision of safe abortion and postabortion care services (as permitted by law) may help reduce maternal morbidity and mortality. PMID:26871725

  14. ABORT GAP CLEANING IN RHIC.

    SciTech Connect

    DREES,A.; AHRENS,L.; III FLILLER,R.; GASSNER,D.; MCINTYRE,G.T.; MICHNOFF,R.; TRBOJEVIC,D.

    2002-06-03

    During the RHIC Au-run in 2001 the 200 MHz storage cavity system was used for the first time. The rebucketing procedure caused significant beam debunching in addition to amplifying debunching due to other mechanisms. At the end of a four hour store, debunched beam could account for approximately 30%-40% of the total beam intensity. Some of it will be in the abort gap. In order to minimize the risk of magnet quenching due to uncontrolled beam losses at the time of a beam dump, a combination of a fast transverse kicker and copper collimators were used to clean the abort gap. This report gives an overview of the gap cleaning procedure and the achieved performance.

  15. Evaluation of Known or Suspected Cardiac Sarcoidosis.

    PubMed

    Blankstein, Ron; Waller, Alfonso H

    2016-03-01

    Sarcoidosis is a multisystem disorder of unknown cause, and cardiac sarcoidosis affects at least 25% of patients and accounts for substantial mortality and morbidity from this disease. Cardiac sarcoidosis may present with heart failure, left ventricular systolic dysfunction, AV block, atrial or ventricular arrhythmias, and sudden cardiac death. Cardiac involvement can be challenging to detect and diagnose because of the focal nature of the disease, as well as the fact that clinical criteria have limited diagnostic accuracy. Nevertheless, the diagnosis of cardiac sarcoidosis can be enhanced by integrating both clinical and imaging findings. This article reviews the various roles that different imaging modalities provide in the evaluation and management of patients with known or suspected cardiac sarcoidosis. PMID:26926267

  16. RHIC Abort Kicker Prefire Report

    SciTech Connect

    Tan, Y.; Perlstein, S.

    2014-07-07

    In an attempt to discover any pattern to prefire events, abort prefire kicker data from 2007 to the present day have been recorded. With the 2014 operations concluding, this comprises 8 years of prefire data. Any activities that the Pulsed Power Group did to decrease prefire occurrences were recorded as well, but some information may be missing. The following information is a compilation of the research to date.

  17. Expectant Fathers, Abortion, and Embryos.

    PubMed

    Purvis, Dara E

    2015-01-01

    One thread of abortion criticism, arguing that gender equality requires that men be allowed to terminate legal parental status and obligations, has reinforced the stereotype of men as uninterested in fatherhood. As courts facing disputes over stored pre-embryos weigh the equities of allowing implantation of the pre-embryos, this same gender stereotype has been increasingly incorporated into a legal balancing test, leading to troubling implications for ART and family law. PMID:26242955

  18. [Request for abortion during the 2d pregnancy trimester].

    PubMed

    Treffers, P E; Van den Berg, G R; Jager-van Gelder, P A; Van Oenen, J J

    1976-12-18

    156 women, 12-20 weeks pregnant, applied for abortion at the Wilhelmo Clinic in Amsterdam; 102 abortions were granted. The 156 late-abortion seekers were compared with 282 early-abortion seekers and 490 pregnant women. The late-abortion seekers were significantly younger (P .05). A significantly greater number of women over 30 applied for early abortion (P .001). Unmarried or divorced women were more likely to apply to abortion (P .001). Nulliparae applied more frequently for late abortion, compared to early-abortion seekers (P .001). Women with only one child were more likely to be in the pregnancy group (p .05), with 2 children in the early-abortion group (p .001). Women from Surinam and the Antilles were more likely to be in the early abortion group (p .001). Of the late-abortion seekers, 9 had medical indications. Many had psychosocial problems; 91 had problems with partner relations. In 24 cases the delay in seeking abortion was due to a doctor. An ambivalent attitude toward the abortion existed in 22 of the patients. 83% of the late-abortion seekers and 11.3% of the early-abortion seekers had previously had an abortion. The contraceptive use of the late-abortion seekers was not regular. 1.3% of the late-abortion seekers and 9.9% of the early-abortion seekers were using IUDs at the time of conception. PMID:1012384

  19. Differential Impact of Abortion on Adolescents and Adults.

    ERIC Educational Resources Information Center

    Franz, Wanda; Reardon, David

    1992-01-01

    Compared adolescent and adult reactions to abortion among 252 women. Compared to adults, adolescents were significantly more likely to be dissatisfied with choice of abortion and with services received, to have abortions later in gestational period, to feel forced by circumstances to have abortion, to report being misinformed at time of abortion,…

  20. From unwanted pregnancy to safe abortion: Sharing information about abortion in Asia through animation.

    PubMed

    Krishnan, Shweta; Dalvie, Suchitra

    2015-05-01

    Although unsafe abortion continues to be a leading cause of maternal mortality in many countries in Asia, the right to safe abortion remains highly stigmatized across the region. The Asia Safe Abortion Partnership, a regional network advocating for safe abortion, produced an animated short film entitled From Unwanted Pregnancy to Safe Abortion to show in conferences, schools and meetings in order to share knowledge about the barriers to safe abortion in Asia and to facilitate conversations on the right to safe abortion. This paper describes the making of this film, its objectives, content, dissemination and how it has been used. Our experience highlights the advantages of using animated films in addressing highly politicized and sensitive issues like abortion. Animation helped to create powerful advocacy material that does not homogenize the experiences of women across a diverse region, and at the same time emphasize the need for joint activities that express solidarity. PMID:26278840

  1. Abortion in Sri Lanka: The Double Standard

    PubMed Central

    2013-01-01

    In Sri Lanka, women do not have access to legal abortion except under life-saving circumstances. Clandestine abortion services are, however, available and quite accessible. Although safe specialist services are available to women who can afford them, others access services under unsafe and exploitative conditions. At the time of this writing, a draft bill that will legalize abortion in instances of rape, incest, and fetal abnormalities awaits approval, amid opposition. In this article, I explore the current push for legal reform as a solution to unsafe abortion. Although a welcome effort, this amendment alone will be insufficient to address the public health consequences of unsafe abortion in Sri Lanka because most women seek abortions for other reasons. Much broader legal and policy reform will be required. PMID:23327236

  2. Abortion in Sri Lanka: the double standard.

    PubMed

    Kumar, Ramya

    2013-03-01

    In Sri Lanka, women do not have access to legal abortion except under life-saving circumstances. Clandestine abortion services are, however, available and quite accessible. Although safe specialist services are available to women who can afford them, others access services under unsafe and exploitative conditions. At the time of this writing, a draft bill that will legalize abortion in instances of rape, incest, and fetal abnormalities awaits approval, amid opposition. In this article, I explore the current push for legal reform as a solution to unsafe abortion. Although a welcome effort, this amendment alone will be insufficient to address the public health consequences of unsafe abortion in Sri Lanka because most women seek abortions for other reasons. Much broader legal and policy reform will be required. PMID:23327236

  3. The abortion decision: reasons and ambivalence.

    PubMed

    Allanson, S; Astbury, J

    1995-09-01

    Self-in-relation theory and pilot data responses to an Abortion Decision Balance Sheet by 20 women attending an abortion-providing clinic challenge previous formulations of the abortion decision. Pilot data suggest that: women may make an abortion decision based primarily on pragmatics, a belief in their right to choose and knowledge of the safety and simplicity of the procedure. A discrepancy may exist for a significant minority of women between their abstract beliefs/knowledge and the personal meaning for them of the pregnancy, abortion and its safety. Important links may exist between maternal attachment and anxiety about the safety of the abortion procedure. Ramifications for counselling and future research are discussed. PMID:8528379

  4. Iodine-123-metaiodobenzylguanidine scintigraphy in risk stratification of sudden death in heart failure.

    PubMed

    Martins da Silva, Marta Inês; Vidigal Ferreira, Maria João; Morão Moreira, Ana Paula

    2013-06-01

    Metaiodobenzylguanidine (MIBG) is a false neurotransmitter noradrenaline analogue that is taken up by the 'uptake 1' transporter mechanism in the cell membrane of presynaptic adrenergic neurons and accumulates in catecholamine storage vesicles. Since it is practically unmetabolized, it can be labeled with a radioisotope (iodine-123) in scintigraphic exams to noninvasively assess the functional status of the sympathetic innervation of organs with a significant adrenergic component, including the heart. Studies of its application in nuclear cardiology appear to confirm its value in the assessment of conditions such as coronary artery disease, heart failure, arrhythmias and sudden death. Heart failure is a global problem, with an estimated prevalence of 2% in developed countries. Sudden cardiac death is the main cause of its high mortality. The autonomic nervous system dysfunction, including sympathetic hyperactivity, that accompanies chronic heart failure is associated with progressive myocardial remodeling, declining left ventricular function and worsening symptoms, and contributes to the development of ventricular arrhythmias and sudden death. Since 123I-MIBG cardiac scintigraphy can detect changes in the cardiac adrenergic system, there is considerable interest in its role in obtaining diagnostic and prognostic information in patients with heart failure. In this article we present a literature review on the use of 123I-MIBG scintigraphy for risk stratification of sudden death in patients with heart failure. PMID:23731734

  5. Abortion checks at German-Dutch border.

    PubMed

    Von Baross, J

    1991-05-01

    The commentary on West German abortion law, particularly in illegal abortion in the Netherlands, finds the law restrictive and in violation of the dignity and rights of women. The Max-Planck Institute in 1990 published a study that found that a main point of prosecution between 1976 and 1986, as reported by Der Spiegal, was in border crossings from the Netherlands. It is estimated that 10,000 annually have abortions abroad, and 6,000 to 7,000 in the Netherlands. The procedure was for an official to stop a young person and query about drugs; later the woman would admit to an abortion, and be forced into a medical examination. The German Penal Code Section 218 stipulates abortion only for certain reasons testified to by a doctor other than the one performing the abortion. Counseling on available social assistance must be completed 3 days prior to the abortion. Many counseling offices are church related and opposed to abortions. Many doctors refuse legally to certify, and access to abortion is limited. The required hospital stay is 3-4 nights with no day care facilities. Penal Code Section 5 No. 9 allows prosecution for uncounseled illegal abortion. Abortion law reform is anticipated by the end of 1992 in the Bundestag due to the Treaty or the Unification of Germany. The Treaty states that the rights of the unborn child must be protected and that pregnant women relieve their distress in a way compatible with the Constitution, but improved over legal regulations from either West or East Germany, which permits abortion on request within 12 weeks of conception without counseling. It is hoped that the law will be liberalized and Penal Code Section 5 No. 9 will be abolished. PMID:12343177

  6. Abortion induced with methotrexate and misoprostol.

    PubMed Central

    Wiebe, E R

    1996-01-01

    OBJECTIVE: To determine the outcome and side effects of a new drug protocol to induce abortion. DESIGN: Case series. SETTING: An urban primary care practice. PATIENTS: One hundred consecutive patients who requested elective termination of pregnancies of less than 8 weeks' gestation. INTERVENTION: Subjects received methotrexate (50 mg/m2 body surface area, administered intramuscularly) and, 3 days afterward, misoprostol (800 micrograms, given vaginally). OUTCOME MEASURES: Number of abortions induced within 24 hours and within 10 days of misoprostol administration, number of surgical aspirations conducted because of incomplete abortion, mean amount of bleeding and pain and the number of women who, if faced with the same situation, said they would again choose a drug-induced abortion over a surgical one. RESULTS: Abortion occurred within 24 hours of misoprostol administration among 48 women and within 10 days among 69 women. In total, 89 women had an abortion without surgical aspiration. Of these women, 71 said they would choose a drug-induced abortion if faced with the choice again. CONCLUSION: Abortion induced with methotrexate and misoprostol appears to be a feasible alternative to surgical abortion and deserves further study. PMID:8548705

  7. Medical abortion in Australia: a short history.

    PubMed

    Baird, Barbara

    2015-11-01

    Surgical abortion has been provided liberally in Australia since the early 1970s, mainly in privately owned specialist clinics. The introduction of medical abortion, however, was deliberately obstructed and consequently significantly delayed when compared to similar countries. Mifepristone was approved for commercial import only in 2012 and listed as a government subsidised medicine in 2013. Despite optimism from those who seek to improve women's access to abortion, the increased availability of medical abortion has not yet addressed the disadvantage experienced by poor and non-metropolitan women. After telling the story of medical abortion in Australia, this paper considers the context through which it has become available since 2013. It argues that the integration of medical abortion into primary health care, which would locate abortion provision in new settings and expand women's access, has been constrained by the stigma attached to abortion, overly cautious institutionalised frameworks, and the lack of public health responsibility for abortion services. The paper draws on documentary sources and oral history interviews conducted in 2013 and 2015. PMID:26719008

  8. Abortion in Iranian legal system: a review.

    PubMed

    Abbasi, Mahmoud; Shamsi Gooshki, Ehsan; Allahbedashti, Neda

    2014-02-01

    Abortion traditionally means, "to miscarry" and is still known as a problem which societies has been trying to reduce its rate by using legal means. Despite the pregnant women and fetuses have being historically supported; abortion was firstly criminalized in 1926 in Iran, 20 years after establishment of modern legal system. During next 53 years this situation changed dramatically, so in 1979, the time of Islamic Revolution, aborting fetuses before 12 weeks and therapeutic abortion (TA) during all the pregnancy length was legitimate, based on regulations that used medical justification. After 1979 the situation changed into a totally conservative and restrictive approach and new Islamic concepts as "Blood Money" and "Ensoulment" entered the legal debates around abortion. During the next 33 years, again a trend of decriminalization for the act of abortion has been continuing. Reduction of punishments and omitting retaliation for criminal abortions, recognizing fetal and maternal medical indications including some immunologic problems as legitimate reasons for aborting fetuses before 4 months and omitting the fathers' consent as a necessary condition for TA are among these changes. The start point for this decriminalization process was public and professional need, which was responded by religious government, firstly by issuing juristic rulings (Fatwas) as a non-official way, followed by ratification of "Therapeutic Abortion Act" (TAA) and other regulations as an official pathway. Here, we have reviewed this trend of decriminalization, the role of public and professional request in initiating such process and the rule-based language of TAA. PMID:24338232

  9. Women's perceptions of first trimester spontaneous abortion.

    PubMed

    Wall-Haas, C L

    1985-01-01

    Fifteen to twenty percent of all pregnancies end in spontaneous abortion. For many women, this loss is nearly the equivalent of the loss of a real baby. To explore the complexity of women's responses to spontaneous abortion, nine women were given a questionnaire to complete regarding experiences and behaviors at the time of the miscarriage. The data revealed that each woman was affected, to some degree, by her experience with a spontaneous abortion. A comprehensive psychologic approach to this special client is needed to help more effectively the woman who aborts in the first trimester cope with the very real loss of an infant. PMID:3844461

  10. The male partner involved in legal abortion.

    PubMed

    Kero, A; Lalos, A; Högberg, U; Jacobsson, L

    1999-10-01

    This study comprises 75 men who have been involved in legal abortion. The men answered a questionnaire concerning living conditions and attitudes about pregnancy and abortion. Most men were found to be in stable relationships with good finances. More than half clearly stated that they wanted the woman to have an abortion while 20 stressed that they submitted themselves to their partner's decision. Only one man wanted the woman to complete the pregnancy. Apart from wanting children within functioning family units, the motivation for abortion revealed that the desire to have children depended on the ability to provide qualitatively good parenting. More than half the men had discussed with their partner what to do in event of pregnancy and half had decided to have an abortion if a pregnancy occurred. More than half expressed ambivalent feelings about the coming abortion, using words such as anxiety, responsibility, guilt, relief and grief. In spite of these contradictory feelings, prevailing expectations concerning lifestyle make abortion an acceptable form of birth control. A deeper understanding of the complexity of legal abortion makes it necessary to accept the role of paradox, which the ambivalence reflects. Obviously, men must constitute a target group in efforts to prevent abortions. PMID:10528006

  11. The abortion battle: the Canadian scene.

    PubMed

    Sachdev, P

    1994-01-01

    In January 1988 the Supreme Court of Canada struck down the country's archaic abortion law on the ground that it imposed arbitrary delays and unfair disparities in access to abortion across the country. Since then, the conservative government of Canada has made a few attempts to introduce a new abortion policy, but it did not get passed in the parliament because the revised bills failed to protect women's right to 'life, liberty, and security of the person' within the meaning of the Canadian Charter. Canada has been without an abortion law for over four years and there has been a wide range of provincial policies and confusion in the country. Despite the legal vacuum, Canadian women are not frenziedly having abortions. However, the militancy of the anti-abortion groups has steadily intensified with continued assault on a woman's right to make reproductive choices. Since no law, short of banning abortions altogether, is going to satisfy abortion opponents, the abortion battle will rage on in Canada. PMID:8065237

  12. Husbands' involvement in abortion in Vietnam.

    PubMed

    Johansson, A; Nga, N T; Huy, T Q; Dat, D D; Holmgren, K

    1998-12-01

    This study analyzes the involvement of men in abortion in Vietnam, where induced abortion is legal and abortion rates are among the highest in the world. Twenty men were interviewed in 1996 about the role they played in their wives' abortions and about their feelings and ethical views concerning the procedure. The results showed that both husbands and wives considered the husband to be the main decisionmaker regarding family size, which included the decision to have an abortion, but that, in fact, some women had undergone an abortion without consulting their husbands in advance. Parents and in-laws were usually not consulted; the couples thought they might object to the decision on moral grounds. Respondents' ethical perspectives on abortion are discussed. When faced with an unwanted pregnancy, the husbands adopted an ethics of care and responsibility toward family and children, although some felt that abortion was immoral. The study highlights the importance of understanding husbands' perspectives on their responsibilities and rights in reproductive decisionmaking and their ethical and other concerns related to abortion. PMID:9919633

  13. Nonmarital births and state abortion policies.

    PubMed

    Medoff, Marshall H

    2010-09-01

    This study examines the impact of various restrictive abortion laws on nonmarital childbearing since the passage of the 1996 welfare reform bill. The empirical results find that the price of an abortion, a Medicaid funding restriction, and a waiting period law are associated with a decrease in a state's nonmarital birthrate. The negative effects of restrictive abortion laws on a state's nonmarital birthrate are found to occur in various age groups. These findings are consistent with the hypothesis that restrictive abortion laws induce unmarried women to change their level of unprotected sexual activity or contraceptive behavior, thereby reducing the likelihood of an unwanted nonmarital pregnancy. PMID:20818592

  14. Abortion Decision and Ambivalence: Insights via an Abortion Decision Balance Sheet

    ERIC Educational Resources Information Center

    Allanson, Susie

    2007-01-01

    Decision ambivalence is a key concept in abortion literature, but has been poorly operationalised. This study explored the concept of decision ambivalence via an Abortion Decision Balance Sheet (ADBS) articulating reasons both for and against terminating an unintended pregnancy. Ninety-six women undergoing an early abortion for psychosocial…

  15. Abortion in the U.S.: Utilization, Financing, and Access

    MedlinePlus

    Abortion in the U.S.: Utilization, Financing, and Access June 2008 Approximately one-fifth (19%) of the 6. ... occurring annually in the U.S. end in induced abortion. 1 While abortion is one of the most ...

  16. National Athletic Trainers' Association Position Statement: Preventing Sudden Death in Sports

    PubMed Central

    Casa, Douglas J.; Guskiewicz, Kevin M.; Anderson, Scott A.; Courson, Ronald W.; Heck, Jonathan F.; Jimenez, Carolyn C.; McDermott, Brendon P.; Miller, Michael G.; Stearns, Rebecca L.; Swartz, Erik E.; Walsh, Katie M.

    2012-01-01

    Objective: To present recommendations for the prevention and screening, recognition, and treatment of the most common conditions resulting in sudden death in organized sports. Background: Cardiac conditions, head injuries, neck injuries, exertional heat stroke, exertional sickling, asthma, and other factors (eg, lightning, diabetes) are the most common causes of death in athletes. Recommendations: These guidelines are intended to provide relevant information on preventing sudden death in sports and to give specific recommendations for certified athletic trainers and others participating in athletic health care. PMID:22488236

  17. Ruptured pericardial perivascular epithelioid cell tumor (PEComa) leading to sudden death: an autopsy case report and review of the literature.

    PubMed

    Zhang, Lingxin; Carpenter, Danielle; Dehner, Louis P

    2016-01-01

    A 30-year-old man with past medical history of atrial fibrillation/flutter passed away after presenting with sudden-onset cardiac dysfunction. The postmortem examination revealed cardiac tamponade secondary to rupture of a 7.2-cm pericardial perivascular epithelioid cell tumor (PEComa). The tumor grossly appeared to arise from the transverse pericardial sinus and focally penetrated the epicardium of the right atrium. Microscopically, it was composed of predominately spindle cells with low nuclear grade, no pleomorphism, or readily apparent mitoses. Immunohistochemistry revealed cytoplasmic reactivity for HMB-45, desmin, and smooth muscle actin. Electron microscopic findings were characterized by melanosome-like structures intermixed with intermediate filaments and abundant stacked endoplasmic reticulum. The present case is unique among previously reported pericardial/myocardial PEComas as a first example resulting in unexpected cardiac tamponade and sudden cardiac death. PMID:26386746

  18. Incidence of Induced Abortion and Post-Abortion Care in Tanzania

    PubMed Central

    Keogh, Sarah C.; Kimaro, Godfather; Muganyizi, Projestine; Philbin, Jesse; Kahwa, Amos; Ngadaya, Esther; Bankole, Akinrinola

    2015-01-01

    Background Tanzania has one of the highest maternal mortality ratios in the world, and unsafe abortion is one of its leading causes. Yet little is known about its incidence. Objectives To provide the first ever estimates of the incidence of unsafe abortion in Tanzania, at the national level and for each of the 8 geopolitical zones (7 in Mainland plus Zanzibar). Methods A nationally representative survey of health facilities was conducted to determine the number of induced abortion complications treated in facilities. A survey of experts on abortion was conducted to estimate the likelihood of women experiencing complications and obtaining treatment. These surveys were complemented with population and fertility data to obtain abortion numbers, rates and ratios, using the Abortion Incidence Complications Methodology. Results In Tanzania, women obtained just over 405,000 induced abortions in 2013, for a national rate of 36 abortions per 1,000 women age 15–49 and a ratio of 21 abortions per 100 live births. For each woman treated in a facility for induced abortion complications, 6 times as many women had an abortion but did not receive care. Abortion rates vary widely by zone, from 10.7 in Zanzibar to 50.7 in the Lake zone. Conclusions The abortion rate is similar to that of other countries in the region. Variations by zone are explained mainly by differences in fertility and contraceptive prevalence. Measures to reduce the incidence of unsafe abortion and associated maternal mortality include expanding access to post-abortion care and contraceptive services to prevent unintended pregnancies. PMID:26361246

  19. The abortion debate in South Africa.

    PubMed

    Rees, H

    1991-01-01

    Before 1975 abortion was illegal in South Africa unless the life of the mother was at risk. The Abortion and Sterilization Act (ASA) of 1975 broadened the scope of legal abortion. The act allows abortion to save the life of the mother, in cases of severe fetal deformity, in cases or rape or incest, or if the woman is mentally incompetent. The procedure to get the abortion includes finding a doctor to recommend the procedure, then finding 2 other doctors to claim, in good faith, that abortion is indicated. At least 1 of these doctors must have been practicing for 4 years and neither can participate in the procedure. The operation must take place in a state controlled institution or an institution specifically designed for abortion. This law is currently not serving the needs of the women of South Africa, even among the women who are legally entitled to have an abortion. Annually only 40% of those that apply for abortion are approved and over 70% of the approved procedures are performed on psychological grounds. It is estimated that there are 200,000-300,000 illegal abortions every year. At Baragwanath there are 15,000 patients admitted for infection related to abortion every year. The ASA has failed to stop illegal abortion and failed to meet the needs of society. The abortion law should be liberalized for a variety of reasons. Women do not have adequate access to contraceptives in South Africa. This results in the birth of many unwanted children which are more likely to be abused and abandoned. Even if contraceptives were universally available, they all have associated failure rates. Since it is assumed that a women using contraceptives does not want to become pregnant, abortion needs to be available as a backup to contraceptives. Since South Africa is a patriarchal society, women must be given control over their reproduction if they are to achieve equal status. Thus for the reasons of preventing unwanted and unwanted and abused children, backing up contraceptives

  20. Shuttle Abort Flight Management (SAFM) - Application Overview

    NASA Technical Reports Server (NTRS)

    Hu, Howard; Straube, Tim; Madsen, Jennifer; Ricard, Mike

    2002-01-01

    One of the most demanding tasks that must be performed by the Space Shuttle flight crew is the process of determining whether, when and where to abort the vehicle should engine or system failures occur during ascent or entry. Current Shuttle abort procedures involve paging through complicated paper checklists to decide on the type of abort and where to abort. Additional checklists then lead the crew through a series of actions to execute the desired abort. This process is even more difficult and time consuming in the absence of ground communications since the ground flight controllers have the analysis tools and information that is currently not available in the Shuttle cockpit. Crew workload specifically abort procedures will be greatly simplified with the implementation of the Space Shuttle Cockpit Avionics Upgrade (CAU) project. The intent of CAU is to maximize crew situational awareness and reduce flight workload thru enhanced controls and displays, and onboard abort assessment and determination capability. SAFM was developed to help satisfy the CAU objectives by providing the crew with dynamic information about the capability of the vehicle to perform a variety of abort options during ascent and entry. This paper- presents an overview of the SAFM application. As shown in Figure 1, SAFM processes the vehicle navigation state and other guidance information to provide the CAU displays with evaluations of abort options, as well as landing site recommendations. This is accomplished by three main SAFM components: the Sequencer Executive, the Powered Flight Function, and the Glided Flight Function, The Sequencer Executive dispatches the Powered and Glided Flight Functions to evaluate the vehicle's capability to execute the current mission (or current abort), as well as more than IS hypothetical abort options or scenarios. Scenarios are sequenced and evaluated throughout powered and glided flight. Abort scenarios evaluated include Abort to Orbit (ATO), Transatlantic