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Sample records for aborted sudden cardiac

  1. 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

  2. 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

  3. Recurrent aborted sudden cardiac death with seizures and rhabdomyolysis due to bulimia-induced hypokalemia: report of one case.

    PubMed

    Finsterer, Josef; Stöllberger, Claudia

    2014-06-01

    Recurrent vomiting due to bulimia associated with abuse of furosemide and laxatives causing severe hypokalemia may result in recurrent aborted sudden cardiac death (SCD) and seizures. We report a 25-year-old female with a history of bulimia associated with abuse of furosemide and laxatives since the age of 15 years, migraine since puberty, renal abscesses at age 20 y, and rhabdomyolysis of unknown cause at age 24 y. She experienced aborted SCD due to severe hypokalemia with symptomatic seizures at 21 and 25 years of age. Bulimia patients additionally taking laxatives or furosemide are at particular risk of SCD and rhabdomyolysis and require periodic determination of electrolytes, potassium substitution, and adequate psychiatric therapy and surveillance.

  4. Early repolarization with horizontal ST segment may be associated with aborted sudden cardiac arrest: a retrospective case control study

    PubMed Central

    2012-01-01

    Background Risk stratification of the early repolarization pattern (ERP) is needed to identify malignant early repolarization. J-point elevation with a horizontal ST segment was recently suggested as a malignant feature of the ERP. In this study, the prevalence of the ERP with a horizontal ST segment was examined among survivors of sudden cardiac arrest (SCA) without structural heart disease to evaluate the value of ST-segment morphology in risk stratification of the ERP. Methods We reviewed the data of 83 survivors of SCA who were admitted from August 2005 to August 2010. Among them, 25 subjects without structural heart disease were included. The control group comprised 60 healthy subjects who visited our health promotion center; all control subjects were matched for age, sex, and underlying disease (diabetes mellitus, hypertension). Early repolarization was defined as an elevation of the J point of at least 0.1 mV above the baseline in at least two continuous inferior or lateral leads that manifested as QRS slurring or notching. An ST-segment pattern of <0.1 mV within 100 ms after the J point was defined as a horizontal ST segment. Results The SCA group included 17 men (64%) with a mean age of 49.7 ± 14.5 years. The corrected QTc was not significantly different between the SCA and control groups (432.7 ± 37.96 vs. 420.4 ± 26.3, respectively; p = 0.089). The prevalence of ERP was not statistically different between the SCA and control groups (5/25, 20% vs. 4/60, 6.7%, respectively; p = 0.116). The prevalence of early repolarization with a horizontal ST segment was more frequent in the SCA than in the control group (20% vs. 3.3%, respectively; p = 0.021). Four SCA subjects (16%) and one control subject (1.7%) had a J-point elevation of >2 mm (p = 0.025). Four SCA subjects (16%) and one (1.7%) control subject had an ERP in the inferior lead (p = 0.025). Conclusion The prevalence of ERP with a horizontal ST segment was higher in patients with aborted SCA than in

  5. 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

  6. 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

  7. 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 ...

  8. 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

  9. 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

  10. Sudden cardiac death risk stratification.

    PubMed

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

    2015-06-01

    Arrhythmic sudden cardiac death (SCD) may be caused by ventricular tachycardia/fibrillation or pulseless electric activity/asystole. Effective risk stratification to identify patients at risk of arrhythmic SCD is essential for targeting our healthcare and research resources to tackle this important public health issue. Although our understanding of SCD because of pulseless electric activity/asystole is growing, the overwhelming majority of research in risk stratification has focused on SCD-ventricular tachycardia/ventricular fibrillation. This review focuses on existing and novel risk stratification tools for SCD-ventricular tachycardia/ventricular fibrillation. For patients with left ventricular dysfunction 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-ventricular tachycardia/ventricular fibrillation 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.

  11. 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

  12. 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…

  13. 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

  14. 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

  15. Surface Electrocardiogram Predictors of Sudden Cardiac Arrest

    PubMed Central

    Abdelghani, Samy A.; Rosenthal, Todd M.; Morin, Daniel P.

    2016-01-01

    Background: Heart disease is a major cause of death in industrialized nations, with approximately 50% of these deaths attributable to sudden cardiac arrest. If patients at high risk for sudden cardiac arrest can be identified, their odds of surviving fatal arrhythmias can be significantly improved through prophylactic implantable cardioverter defibrillator placement. This review summarizes the current knowledge pertaining to surface electrocardiogram (ECG) predictors of sudden cardiac arrest. Methods: We conducted a literature review focused on methods of predicting sudden cardiac arrest through noninvasive electrocardiographic testing. Results: Several electrocardiographic-based methods of risk stratification of sudden cardiac arrest have been studied, including QT prolongation, QRS duration, fragmented QRS complexes, early repolarization, Holter monitoring, heart rate variability, heart rate turbulence, signal-averaged ECG, T wave alternans, and T-peak to T-end. These ECG findings have shown variable effectiveness as screening tools. Conclusion: At this time, no individual ECG finding has been found to be able to adequately stratify patients with regard to risk for sudden cardiac arrest. However, one or more of these candidate surface ECG parameters may become useful components of future multifactorial risk stratification calculators.

  16. Surface Electrocardiogram Predictors of Sudden Cardiac Arrest

    PubMed Central

    Abdelghani, Samy A.; Rosenthal, Todd M.; Morin, Daniel P.

    2016-01-01

    Background: Heart disease is a major cause of death in industrialized nations, with approximately 50% of these deaths attributable to sudden cardiac arrest. If patients at high risk for sudden cardiac arrest can be identified, their odds of surviving fatal arrhythmias can be significantly improved through prophylactic implantable cardioverter defibrillator placement. This review summarizes the current knowledge pertaining to surface electrocardiogram (ECG) predictors of sudden cardiac arrest. Methods: We conducted a literature review focused on methods of predicting sudden cardiac arrest through noninvasive electrocardiographic testing. Results: Several electrocardiographic-based methods of risk stratification of sudden cardiac arrest have been studied, including QT prolongation, QRS duration, fragmented QRS complexes, early repolarization, Holter monitoring, heart rate variability, heart rate turbulence, signal-averaged ECG, T wave alternans, and T-peak to T-end. These ECG findings have shown variable effectiveness as screening tools. Conclusion: At this time, no individual ECG finding has been found to be able to adequately stratify patients with regard to risk for sudden cardiac arrest. However, one or more of these candidate surface ECG parameters may become useful components of future multifactorial risk stratification calculators. PMID:27660578

  17. Athletes at risk for sudden cardiac death.

    PubMed

    Subasic, Kim

    2010-02-01

    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 have the highest incidence of sudden cardiac death. Screening of athletes prior to participation in competitive sports usually falls short of recommended guidelines. Poorly defined legislation and the absence of a national standard for sports physicals have contributed to inadequate health screenings of athletes. This article will describe the incidence and causes of sudden cardiovascular death in young athletes as well as guidelines intended to prevent this unfortunate problem.

  18. Racial differences in sudden cardiac death.

    PubMed

    Fender, Erin A; Henrikson, Charles A; Tereshchenko, Larisa

    2014-01-01

    There is an increased risk of sudden cardiac death (SCD) and sudden cardiac arrest (SCA), in African Americans, the basis of which is likely multifactorial. African Americans have higher rates of traditional cardiac risk factors including hypertension, left ventricular hypertrophy, diabetes, coronary heart disease, and heart failure. There are also significant disparities in health care delivery. While these factors undoubtedly affect health outcomes, there is also growing evidence that genetics may have a significant impact as well. In this paper, we discuss data and hypotheses in support of both sides of the controversy around racial differences in SCD/SCA.

  19. Short-coupled variant of Torsade de Pointes as a cause of electrical storm and aborted sudden cardiac death: insights into mechanism and treatment.

    PubMed

    Chiladakis, John A; Spiroulias, Georgios; Koutsogiannis, Nikolaos; Zagli, Fani; Alexopoulos, Dimritrios

    2008-01-01

    This case report describes a 50-year-old woman with normal repolarization duration who survived multiple electrical storms and cardiac arrest related to recurrent short-coupled torsade de pointes (TdP). Overdrive ventricular pacing could not prevent malignant TdP, but exposed a pause-related TdP initiation pattern. Isoproterenol and atrial pacing completely suppressed TdP, suggesting that ventricular pacing may entail vulnerability to this condition.

  20. Pathological view of sudden cardiac death.

    PubMed Central

    Davies, M J

    1981-01-01

    The common cause of sudden cardiac death is ischaemic heart disease. Such patients may have an occlusive recent thrombosis in a major coronary artery but the largest group has no recent occlusion. Comparison of such patients without occlusion with non-cardiac death control hearts suggests that an area of stenosis of 85 per cent is the best discriminating level. Most subjects who die of ischaemic heart disease suddenly have this degree of stenosis in two or three major arteries. Non-ischaemic sudden cardiac death occurs in hypertrophic obstructive cardiomyopathy and in severe left ventricular hypertrophy particularly from aortic valve stenosis. When the heart is macroscopically normal, review of previous electrocardiograms is the most helpful guide and may disclose conditions such as a long QT interval or pre-excitation. When no such data are available examination of the conduction system histologically may be helpful but is often non-specific. Use of the term "cardiomyopathy" by pathologists to cover all non-ischaemic sudden cardiac death is clinically misleading. PMID:6450599

  1. The Debate in Cuba's Scientific Community on Sudden Cardiac Death.

    PubMed

    Vilches, Ernesto; Ochoa, Luis A; Ramos, Lianne

    2015-10-01

    Sudden cardiac death poses a challenge to modern medicine because of its high incidence, the unexpected and dramatic nature of the event, and years of potential life lost. What's more, despite modest decreases in global mortality attributed to cardiovascular diseases, incidence of sudden cardiac death has not declined. Cuba, like most of the Americas, suffers from knowledge gaps that hamper adequate strategies to address sudden cardiac death as a population health problem. We suggest that a generally accepted operational definition of sudden cardiac death be agreed upon, and a national registry developed that recognizes this cause of death on death certificates. These two actions will enable Cuba's public health authorities to assess the extent of the problem and to design intervention strategies for the population with intermediate and lower cardiovascular risk, the group in which most cases occur. KEYWORDS Sudden cardiac death, cardiovascular disease, sudden death, sudden cardiac arrest, risk reduction, prevention and control, Cuba.

  2. Dying, sudden cardiac death and resuscitation technology.

    PubMed

    Walker, Wendy M

    2008-04-01

    Many nurses will be familiar with the demanding role of caring for a patient who requires cardiopulmonary resuscitation following a sudden, life-threatening illness or event. This paper examines the phenomenon of sudden cardiac death and in particular, focuses on the medical-technical discourse of dying and death in the context of resuscitation for the victims of sudden cardiac arrest. The process of dying is distinguished from the end point of death by drawing upon biomedical determinants and definitions of death. Comparison is made between the use of resuscitation techniques in an attempt to reverse 'clinical death' and the notion of a 'natural death' that is proffered as a means to a 'good' or 'ideal' death. The humanistic versus technological imperative is further deliberated by examining the role of the emergency team in end of life care and includes consideration of the effects that medical dominance may have on the dying process. The practice of family witnessed resuscitation is recognised as one way in which a holistic approach to emergency resuscitative care may be achieved.

  3. Secondary prevention of sudden cardiac death.

    PubMed

    Curnis, Antonio; Mascioli, Giosuè; Bontempi, Luca; Bordonali, Tania; Dei Cas, Livio

    2005-03-01

    Sudden cardiac death is still the largest cause of natural death in western countries, especially in patients with coronary artery disease and in those who have already experienced an episode of resuscitated out-of-hospital cardiac arrest or ventricular tachycardia. Prevention of arrhythmia recurrences (i.e. secondary prevention) in these patients remains a challenge for the cardiologist. To date no studies have demonstrated that drug therapy can be of some value in preventing arrhythmia recurrences or sudden death in these patients, and only cardioverter-defibrillator (ICD) implantation resulted effective in reducing mortality rate. It remains, however, to be defined which patients who survived an out-of-hospital cardiac arrest or who already experienced a sustained ventricular tachycardia could benefit the most from an ICD, but to date no invasive or non-invasive tests have proven to be effective for this stratification. Vaughan-Williams class II and III drugs could be of some value in reducing tachycardia cycle length thus increasing antitachycardia pacing efficacy and reducing ICD shocks.

  4. Sudden cardiac death after modified electroconvulsive therapy.

    PubMed

    Wang, Zhihui; Wang, Jiyu

    2015-10-01

    Sudden deaths associated with the use of electroconvulsive therapy are rare. In this case report a 58-year-old male with a 20-year history of bipolar disorder and no history or signs of cardiac illness died from cardiac arrest within one hour of receiving an initial session of modified electroconvulsive therapy (MECT) to treat a recurrent episode of non-psychotic mania. The patient regained consciousness and was medically stable immediately after the MECT session (which did not produce a convulsion) but deteriorated rapidly after transfer to the recovery room. It was not possible to conduct an autopsy, but the authors surmise that the most probable cause was that the use of haloperidol 17 hours prior to MECT exacerbated the cardiac effects of nonconvulsive MECT. The case highlights the need for a thorough cardiac work-up on patients being considered for MECT (possibly including assessment of cardiac enzymes in older individuals) and careful consideration of the concurrent use of antipsychotic medications and MECT.

  5. Cardiac ganglionitis associated with sudden unexpected death.

    PubMed

    James, T N; Zipes, D P; Finegan, R E; Eisele, J W; Carter, J E

    1979-11-01

    In a postmortem study of the hearts of two young women who died suddenly and unexpectedly, we found a remarkably similar and distinctive ganglionitis, predominantly in the region of the sinus node. Both women had ventricular fibrillation at the time of collapse. Vesicular neuritis and older neural degeneration were present in other regions of the heart. Except for focal fibromuscular dysplasia of the sinus node artery and atrioventricular node artery of one heart, there was no other significant anatomic abnormality in either heart. The functional significance of this cardiac ganglionitis is unclear, but its location in and around the conduction system makes it a possible cause of the fatal electrical instability. Recognition that ganglionitis of the heart may be associated with sudden death should stimulate a number of additionally useful studies.

  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. Risk stratification for sudden cardiac death.

    PubMed

    Sabir, Ian N; Usher-Smith, Juliet A; Huang, Christopher L-H; Grace, Andrew A

    2008-01-01

    Recent advances in pharmacological and device-based therapies have provided a range of management options for patients at risk of sudden cardiac death (SCD). Since all such interventions come with their attendant risks, however, stratification procedures aimed at identifying those who stand to benefit overall have gained a new degree of importance. This review assesses the value of risk stratification measures currently available in clinical practice, as well as of others that may soon enter the market. Parameters that may be obtained only by performing invasive cardiac catheterisation procedures are considered separately from those that may be derived using more readily available non-invasive techniques. It is concluded that effective stratification is likely to require the use of composite parameters and that invasive procedures might only be justified in specific sub-groups of patients.

  8. Risk stratification for sudden cardiac death.

    PubMed

    Sabir, Ian N; Usher-Smith, Juliet A; Huang, Christopher L-H; Grace, Andrew A

    2008-01-01

    Recent advances in pharmacological and device-based therapies have provided a range of management options for patients at risk of sudden cardiac death (SCD). Since all such interventions come with their attendant risks, however, stratification procedures aimed at identifying those who stand to benefit overall have gained a new degree of importance. This review assesses the value of risk stratification measures currently available in clinical practice, as well as of others that may soon enter the market. Parameters that may be obtained only by performing invasive cardiac catheterisation procedures are considered separately from those that may be derived using more readily available non-invasive techniques. It is concluded that effective stratification is likely to require the use of composite parameters and that invasive procedures might only be justified in specific sub-groups of patients. PMID:19351522

  9. 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

  10. 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

  11. Sudden cardiac death in adults: causes, incidence and interventions.

    PubMed

    Walker, Wendy Marina

    Many nurses will be familiar with the unexpected death of an adult patient following a sudden, life-threatening cardiac event. It is a situation that demands sensitive nursing care and skilled interventions to provide a foundation for recovery and promote healthy bereavement. This article examines the causes and incidence of sudden cardiac death in adults. Possible reactions of those who are suddenly bereaved are described and immediate care interventions aimed at dealing with the grief process are discussed. The article concludes by identifying ways in which the incidence of sudden cardiac death may be reduced.

  12. [EPIDEMIOLOGY OF SUDDEN CARDIAC DEATH: DATA FROM THE PARIS SUDDEN DEATH EXPERTISE CENTER REGISTRY].

    PubMed

    Jouven, Xavier; Bougouin, Wulfran; Karam, Nicole; Marijon, Eloi

    2015-09-01

    Sudden cardiac death is an unexpected cardiac arrest without obvious extra-cardiac cause. Epidemiology of sudden cardiac death has been poorly documented in France, mainly because of challenging requirement in order to capture all cases in a specific area. The Parisian registry (Sudden Death Expertise Center, European Georges Pompidou Hospital, Paris) was initiated in May 2011 and analyzed data of all sudden death in Paris and suburbs (6.6 millions inhabitants). Over 3 years, the annual incidence estimated to 50-70 per 100,000. Those occurred mainly in men (69%), with a mean age of 65 year, and at home (75%). The event was witnessed in 80% of cases, but bystander cardiopulmonary resuscitation was initiated in only half of cases. Initial cardiac rhythm was ventricular fibrillation in 25%. Survival to hospital discharge remains low (8%).

  13. 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.

  14. 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

  15. 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

  16. [Sudden cardiac death in non-professional athletes].

    PubMed

    Nappo, A; Varesi, C; Rossi, L; Matturri, L

    1997-10-01

    Sudden death during sports activities in non-professional athletes is a rare occurrence, however it is of great interest in clinical pathology and forensic medicine. We performed chemico-toxicologic and histopathologic investigations in three cases of sudden cardiac death in non-professional athletes, focusing in particular on the cardiac conduction system. Examination of conduction tissue was performed on sections seriated every 150 microns, stained alternately with hematoxylin-eosin and Heidenhain's trichrome (azan). In all three cases diagnostic evidence showed hyperacute myocardial infarction, due to spasm of coronaries with mild atherosclerosis, and myocardial lesions due to reperfusive necrosis. The pathogenesis of sudden death in young athletes is not related only to ischemic-coronary damage that is not exclusively mechanical, but also a dynamic event (spasm and reperfusion), but also to fatal arrhythmias related to abnormal findings in the conduction system. Such findings can therefore be considered the morphologic substrate of sudden cardiac death.

  17. 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.

  18. [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.

  19. [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

  20. 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

  1. 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

  2. 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

  3. 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 ...

  4. 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

  5. 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

    2015-11-30

    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.

  6. 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

  7. 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

  8. 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.

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

    PubMed Central

    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

  10. 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

  11. Causes and prevention of sudden cardiac death in the elderly.

    PubMed

    Tung, Patricia; Albert, Christine M

    2013-03-01

    Sudden cardiac death (SCD) is a major cause of mortality in elderly individuals owing to a high prevalence of coronary heart disease, systolic dysfunction, and congestive heart failure (CHF). Although the incidence of SCD increases with age, the proportion of cardiac deaths that are sudden decreases owing to high numbers of other cardiac causes of death in elderly individuals. Implantable cardioverter-defibrillator (ICD) therapy has been demonstrated to improve survival and prevent SCD in selected patients with systolic dysfunction and CHF. However, ICD therapy in elderly patients might not be effective because of a greater rate of pulseless electrical activity underlying SCD and other competing nonarrhythmic causes of death in this population. Although under-represented in randomized trials of ICD use, elderly patients comprise a substantial proportion of the population that qualifies for and receives an ICD for primary prevention under current guidelines. Cardiac resynchronization therapy (CRT), which has been demonstrated to reduce mortality in selected populations with heart failure, is also more commonly used in this group of patients than in younger individuals. In this Review, we examine the causes of SCD in elderly individuals, and discuss the existing evidence for effectiveness of ICD therapy and CRT in this growing population.

  12. Sudden cardiac death due to coronary artery dissection as a complication of cardiac sarcoidosis.

    PubMed

    Kanaroglou, Savas; Nair, Vidhya; Fernandes, John R

    2015-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), cardiac tamponade and sudden cardiac death that typically affects young women in the postpartum period. Rarely, it can be caused by systemic inflammatory conditions such as sarcoidosis. Sarcoidosis is an inflammatory disease most often affecting the lung and lymph nodes that can sometimes affect the heart. The authors report a case of sudden cardiac death caused by SCAD in the context of undiagnosed and subclinical cardiac sarcoidosis. The decedent was a 47-year-old male with a relatively innocuous past medical history. He was found dead in bed. At autopsy, there was a lethal hemopericardium resulting in cardiac tamponade. Gross examination of the heart revealed dissection of the posterior descending coronary branch of the right coronary artery. Histologically, the coronary artery showed acute and organizing dissection with evidence of vasculitis. A chronic inflammatory infiltrate consisting of lymphocytes, histiocytes, eosinophils and giant cells was seen. Sections of the myocardium showed myocarditis with a nonnecrotizing granuloma. The death was attributed to cardiac tamponade secondary to SCAD in the context of systemic sarcoidosis. The presented case demonstrates two concurrent rare pathologies and highlights the importance of considering SCAD in cases of sudden cardiac death at autopsy.

  13. 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.

  14. 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

  15. 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

  16. [Sudden cardiac death in acromegaly. Anatomopathological observation of a case].

    PubMed

    Matturri, L; Varesi, C; Nappo, A; Cuttin, M S; Rossi, L

    1998-01-01

    Involvement of the cardiovascular system in patients affected by acromegaly is an important factor in morbidity and mortality. The diagnosis in these subjects is acromegalic cardiomyopathy with cardiac decompensation, arrhythmias and sudden death. The pathologic substrate has rarely been described. The present study reports the findings in a case of sudden death in a 54-year-old man, affected by acromegaly. Subsequent diagnostic investigation revealed the characteristic aspects of acromegalic cardiomyopathy in the common myocardium and the presence of hyperacute myocardial infarct of the antero-septal wall of the left ventricle. Examination of conduction tissue revealed slight fibrolipomatosis and dispersion of the atrio-ventricular node (AVN), which extended to the His bundle and bifurcation. The right branch was prematurely intramural with sclerosis and lipomatosis. This location in atrio-ventricular conduction system has seldom been reported in the literature and if so, with different lesions from those found in the case we investigated. The results of microscopic examination convalidate the hypothesis of electrical instability in the heart, as confirmed by the subject's history of ventricular extrasystoles, left branch block and attacks of angina after effort. Death was correlated to hyperacute myocardial infarction of the anteroseptal wall of the left ventricle, in a subject with history of angina, affected by acromegalic cardiomegaly and electric instability. In this case, sudden death could also be considered arrhythmogenic in relation to the additional workload by persistent hormonal stimulation.

  17. 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

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

    PubMed Central

    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

  19. [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.

  20. The role of pharmacotherapy in the prevention of sudden cardiac death in patients with heart failure.

    PubMed

    Weeks, Phillip A; Sieg, Adam; Gass, Jennifer Ann; Rajapreyar, Indranee

    2016-07-01

    Sudden cardiac death remains a significant threat to the survival of patients with heart failure. Long-term cardiac remodeling predisposes these patients to develop malignant ventricular arrhythmias. Permanent implantable and temporary external defibrillators remain a mainstay for the prevention of sudden cardiac death in this population. For decades, researchers have attempted to identify reliable drug therapies to avoid such arrhythmias; however, to date, success has been inconsistent. This review aims to explore the evidence defining the role of drug therapies for direct and indirect suppression of arrhythmias that may cause sudden cardiac death in patients with heart failure. PMID:27003591

  1. Cardiac imaging in evaluating patients prone to sudden death

    PubMed Central

    Tamene, Ashenafi; Tholakanahalli, Venkatakrishna N.; Chandrashekhar, Y.

    2014-01-01

    Identifying subjects who are at risk for SCD and stratifying them correctly into low or high-risk groups is the holy grail of Cardiology. While imaging shows a lot of promise, it is plagued by the fact that most SCD occurs in relatively healthy subjects, a massive group who would not ordinarily be subjected to imaging. Left ventricular ejection fraction (LVEF) currently is our primary parameter for risk stratification for sudden cardiac death but is a poor marker with low sensitivity and specificity. Current data shows that sophisticated imaging with techniques, mainly Cardiac magnetic resonance Imaging (CMR), have the potential to identify novel high-risk markers underlying SCD, beyond ejection fraction. Imaging seems to further refine risk in patients with low LVEF as well as in those with normal EF; this is a major strength of advanced imaging. Clinical application has been slow and not fully prime time. It is important to remember that while promising, imaging techniques including CMR, have not been tested in rigorous prospective studies and thus have not as yet replaced EF as the gatekeeper to ICD implantation. PMID:24568832

  2. 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

  3. Sudden cardiac death in haemodialysis patients: preventative options.

    PubMed

    Chiu, Diana Yuan Yng; Sinha, Smeeta; Kalra, Philip A; Green, Darren

    2014-12-01

    Sudden cardiac death (SCD) is the most common cause of death in haemodialysis patients, accounting for 25% of all-cause mortality. There are many potential pathological precipitants as most patients with end-stage renal disease have structurally or functionally abnormal hearts. For example, at initiation of dialysis, 74% of patients have left ventricular hypertrophy. The pathophysiological and metabolic milieu of patients with end-stage renal disease, allied to the regular stresses of dialysis, may provide the trigger to a fatal cardiac event. Prevention of SCD can be seen as a legitimate target to improve survival in this patient group. In the general population, this is most effective by reducing the burden of ischaemic heart disease. However, the aetiology of SCD in haemodialysis patients appears to be different, with myocardial fibrosis, vascular calcification and autonomic dysfunction implicated as possible causes. Thus, the range of therapies is different to the general population. There are potential preventative measures emerging as our understanding of the underlying mechanisms progresses. This article aims to review the evidence for therapies to prevent SCD effective in the general population when applied to dialysis patients, as well as promising new treatments specific to this population group.

  4. 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.

  5. 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

  6. Sudden cardiac arrest in people with epilepsy in the community

    PubMed Central

    Lamberts, Robert J.; Blom, Marieke T.; Wassenaar, Merel; Bardai, Abdennasser; Leijten, Frans S.; de Haan, Gerrit-Jan; Sander, Josemir W.; Thijs, Roland D.

    2015-01-01

    Objective: To ascertain whether characteristics of ventricular tachycardia/fibrillation (VT/VF) differed between people with epilepsy and those without and which individuals with epilepsy were at highest risk. Methods: We ascertained 18 people with active epilepsy identified in a community-based registry of sudden cardiac arrest (SCA) with ECG-confirmed VT/VF (cases). We compared them with 470 individuals with VT/VF without epilepsy (VT/VF controls) and 54 individuals with epilepsy without VT/VF (epilepsy controls). Data on comorbidity, epilepsy severity, and medication use were collected and entered into (conditional) logistic regression models to identify determinants of VT/VF in epilepsy. Results: In most cases, there was an obvious (10/18) or presumed cardiovascular cause (5/18) in view of preexisting heart disease. In 2 of the 3 remaining events, near–sudden unexpected death in epilepsy (SUDEP) was established after successful resuscitation. Cases had a higher prevalence of congenital/inherited heart disease (17% vs 1%, p = 0.002), and experienced VT/VF at younger age (57 vs 64 years, p = 0.023) than VT/VF controls. VT/VF in cases occurred more frequently at/near home (89% vs 58%, p = 0.009), and was less frequently witnessed (72% vs 89%, p = 0.048) than in VT/VF controls. Cases more frequently had clinically relevant heart disease (50% vs 15%, p = 0.005) and intellectual disability (28% vs 1%, p < 0.001) than epilepsy controls. Conclusion: Cardiovascular disease rather than epilepsy characteristics is the main determinant of VT/VF in people with epilepsy in the community. SCA and SUDEP are partially overlapping disease entities. PMID:26092917

  7. 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

  8. 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

  9. 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

  10. 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

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

    PubMed

    Sodhi, Sandeep S; Cedars, Ari M

    2015-08-01

    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

  12. Sudden cardiac death in China: current status and future perspectives.

    PubMed

    Zhang, Shu

    2015-10-01

    Sudden cardiac death (SCD) is a major cause of mortality worldwide. Similar to the number of SCDs in western countries including the USA, the number of SCDs in China is ∼544,000 annually. However, there are significant differences in patient characteristics between Chinese primary prevention population and U.S. primary prevention population. In contrast to western countries where implantable cardioverter-defibrillator (ICD) devices have been well adopted as a major effective method for both primary and secondary prevention of SCD, China has a low prevalence of ICD utilization (∼1.5 device per 1 million people). Socioeconomic and political factors, awareness and knowledge of SCD, and the difference in disease patterns have led to the underutilization of ICD in China. China, as the most populated and the second largest economic country in the world, has now taken variable approaches to address this pressing health problem and enhances the delivery of lifesaving therapies, including arrhythmia ablation and medical treatment besides ICD, to patients who are at risk of SCD.

  13. 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

  14. 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

  15. Sudden death due to an unrecognized cardiac hydatid cyst: three medicolegal autopsy cases.

    PubMed

    Pakis, Isil; Akyildiz, Elif Ulker; Karayel, Ferah; Turan, Arzu Akcay; Senel, Berna; Ozbay, Mehmet; Cetin, Gursel

    2006-03-01

    Echinococcosis is a human infection caused by the larval stage of Echinococcocus granulosus. The most common sites of infection are the liver and the lungs. Cardiac hydatid cysts are very rare, even in regions where hydatic cysts are endemic (the Mediterranean, South America, Africa, and Australia). It has been reported that cardiac involvement is seen in about 0.5-3% of human echinococcosis cases. Three cases of cardiac hydatid disease that caused sudden death and which were histopathologically diagnosed are reported. Cardiac echinococcosis is rare, but due to its insidious presentation and affinity to cause sudden death, it is important that it be identified in the histopathological examination.

  16. Intra-beat Scaling Properties of Cardiac Arrhythmias and Sudden Cardiac Death

    NASA Astrophysics Data System (ADS)

    Rodríguez, Eduardo; Lerma, Claudia; Echeverría, Juan C.; Alvarez-Ramirez, Jose

    2008-02-01

    We applied detrended fluctuation analysis (DFA) to characterize the intra-beat scaling dynamics of electrocardiographic (ECG) recordings from the PhysioNet Sudden Cardiac Death Holter Database. The main finding of this contribution is that, in such recordings involving different types of arrhythmias; the ECG waveform, besides showing a less-random intra-beat dynamics, becomes more regular during bigeminy, ventricular tachycardia (VT) or even atrial fibrillation (AFIB) and ventricular fibrillation (VF) despite the appearance of erratic traces. Thus, notwithstanding that these cardiac rhythm abnormalities are generally considered as irregular and some of them generated by random impulses or wavefronts, the intra-beat scaling properties suggest that regularity dominates the underlying mechanisms of arrhythmias. Among other explanations, this may result from shorted or restricted -less complex- pathways of conduction of the electrical activity within the ventricles.

  17. Sudden cardiac death in patients with diabetes mellitus and chronic heart failure.

    PubMed

    Walker, Andrew Mn; Cubbon, Richard M

    2015-07-01

    In patients with diabetes mellitus, around 50% of deaths due to cardiovascular causes are sudden cardiac deaths. The prevalence of diabetes in cohorts with chronic heart failure is increasing, and while sudden cardiac death is an increasingly rare mode of death in chronic heart failure patients as a whole, the risk of this outcome remains high in those with diabetes. This review summarises the current knowledge on the incidence of sudden cardiac death in patients with diabetes and chronic heart failure, before discussing the causes of the excess risk seen in those with these coexistent conditions. We then describe current strategies for risk stratification and prevention of sudden cardiac death in these patients before discussing the priorities for further study in this area.

  18. 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

  19. 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.

  20. 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.

  1. Physical exertion as a trigger of myocardial infarction and sudden cardiac death.

    PubMed

    Mittleman, M A; Siscovick, D S

    1996-05-01

    The data reviewed in this article indicate that physical exertion can trigger the onset of nonfatal myocardial infarction and sudden cardiac death. In addition, it is clear that although the relative risk associated with heavy exertion may be high, the absolute risk is actually quite small. It also is clear that regular exercise reduces the risk of triggering of myocardial infarction and sudden cardiac death by isolated bouts of exertion. Thus, these data provide further support for encouragement of regular exercise, as recommended by the American Heart Association. Such a program is likely to lower the overall risk of myocardial infarction and sudden cardiac death because it may lower the baseline risk and also decrease the relative risk that an episode of exertion will trigger a myocardial infarction or sudden cardiac death. Specific recommendations for patients with a history of myocardial infarction or angina are complex. Patients with coronary artery disease have the same relative risk of myocardial infarction and sudden cardiac death as those with no such history. Because of their elevated and variable baseline risk, however, specific recommendations regarding the risks and benefits of heavy physical exertion must be provided by their individual physicians, acting on recommended guidelines for exercise in such patients.

  2. [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

  3. 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

  4. 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

  5. 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.

  6. 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

  7. 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

  8. Physical and chemical injury as causes of sudden cardiac death: the forensic forum.

    PubMed

    Riddick, L

    1994-01-01

    Physical and chemical injuries account for the largest number of sudden, unexpected cardiac deaths in persons between the ages of 1 and 44 years. Blunt-force injuries, lacerations, avulsions, and contusions of the heart and great vessels sustained during motor vehicle crashes constitute the most prevalent type of lethal physical trauma to the cardiovascular system. The second most prevalent type of trauma is from penetrating and perforating wounds inflicted by firearms. The mechanisms of these injuries are discussed, with emphasis placed on those factors contributing to lethality. The three most prevalent chemicals associated with sudden cardiac death-ethyl alcohol, cocaine, and tricylic antidepressants-are briefly mentioned.

  9. Sudden infant death syndrome caused by cardiac arrhythmias: only a matter of genes encoding ion channels?

    PubMed

    Sarquella-Brugada, Georgia; Campuzano, Oscar; Cesar, Sergi; Iglesias, Anna; Fernandez, Anna; Brugada, Josep; Brugada, Ramon

    2016-03-01

    Sudden infant death syndrome is the unexpected demise of a child younger than 1 year of age which remains unexplained after a complete autopsy investigation. Usually, it occurs during sleep, in males, and during the first 12 weeks of life. The pathophysiological mechanism underlying the death is unknown, and the lethal episode is considered multifactorial. However, in cases without a conclusive post-mortem diagnosis, suspicious of cardiac arrhythmias may also be considered as a cause of death, especially in families suffering from any cardiac disease associated with sudden cardiac death. Here, we review current understanding of sudden infant death, focusing on genetic causes leading to lethal cardiac arrhythmias, considering both genes encoding ion channels as well as structural proteins due to recent association of channelopathies and desmosomal genes. We support a comprehensive analysis of all genes associated with sudden cardiac death in families suffering of infant death. It allows the identification of the most plausible cause of death but also of family members at risk, providing cardiologists with essential data to adopt therapeutic preventive measures in families affected with this lethal entity.

  10. 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

  11. Motivation to pursue genetic testing in individuals with a personal or family history of cardiac events or sudden cardiac death.

    PubMed

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

    2014-10-01

    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.

  12. [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.

  13. 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;…

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

    PubMed

    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.

  15. [Sudden cardiac death during sports due to coronariitis].

    PubMed

    Bilkenroth, B; Wegmann, W

    2000-07-01

    A case of sudden and unexpected death of a 29-year-old man during a basketball game is reported. Six years before death a transient ischemic attack and a membranous glomerulonephritis were diagnosed. The autopsy revealed as cause of death to be a severe lymphoplasmocytic coronariitis and, in addition, a small single focus of a lymphoplasmocytic aortitis, indicating a systemic disease. A suspected syphilitic vasculitis could not be confirmed. In the literature there are few cases of similar coronary arteriitis are described, such as Takayasu's type of arteriitis in men of young and middle age.

  16. Commodio cordis: an underappreciated cause of sudden cardiac death in young patients: assessment and management in the ED.

    PubMed

    Perron, A D; Brady, W J; Erling, B F

    2001-09-01

    Commotio cordis is the condition of sudden cardiac death or near sudden cardiac death after blunt, low-impact chest wall trauma in the absence of structural cardiac abnormality. Ventricular fibrillation is the most commonly reported induced arrhythmia in commotio cordis. Blunt impact injury to the chest with a baseball is the most common mechanism. Survival rates for commotio cordis are low, even with prompt CPR and defibrillation.

  17. [Morphological prerequisites of heart ventricles fibrillation in sudden cardiac death].

    PubMed

    Reznik, A G

    2009-01-01

    We studied morphological changes in the myocardium and content of glucose, magnesium, calcium, sodium in pericardial fluid of victims of out of hospital sudden death due to acute coronary insufficiency and prenecrotic stage of myocardial infarction. We established that both in regions of ischemic injury appearing as III degree contracture lesions of cardiomyocytes, zones of intracellular myocytolysis and primary breakdown of myofibrils, as will as in zones of relaxation myocardium loses its contractile properties. This in turn leads to asynchronous contraction of left and right ventricles. As fibrillation develops in both ventricles simultaneously there are all grounds to believe that morphological prerequisite (source of origin) of fibrillation is the presence of areas of ischemic injury and relaxation in the myocardium.

  18. 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

  19. Sports-Related Sudden Cardiac Injury or Death.

    PubMed

    Greene, Elizabeth Anne; Punnoose, Ann

    2015-12-01

    Symptoms such as syncope and chest pain, especially if they are accompanied by palpitations or occur with exercise in any combination, require cardiac evaluation before adolescent athletes are allowed to return to the sports field. Some life-threatening conditions will likely be associated with a family history of HCM or LQTS, but the family history may not be discovered at the first medical visit. A family history of CPVT, for example, is hard to elicit unless this diagnosis has already been established in an affected family member. The keys will be the timing of symptoms and the documentation of arrhythmia with exercise. The ECG at baseline in CPVT may be deceptively normal. Hypertrophic cardiomyopathy is progressive, so evaluation during early childhood may be negative. Long QT syndrome may not always result in an abnormal ECG, even in genetically positive individuals. A high index of suspicion is needed to make these diagnoses, especially if the family history is not available.

  20. Prevalence of HCM and long QT syndrome mutations in young sudden cardiac death-related cases.

    PubMed

    Allegue, Catarina; Gil, Rocio; Blanco-Verea, Alejandro; Santori, Montserrat; Rodríguez-Calvo, Marisol; Concheiro, Luis; Carracedo, Angel; Brion, María

    2011-07-01

    Cardiomyopathies and channelopathies are major causes of sudden cardiac death. The genetic study of these diseases is difficult because of their heterogenic nature not only in their genetic traits but also in their phenotypic expression. The purpose of the present study is the analysis of a wide spectrum of previously known genetic mutations in key genes related to hypertrophic cardiomyopathy (HCM), long QT syndrome (LQTS), and Brugada syndrome (BrS) development. The samples studied include cases of sudden cardiac death (SCD) in young adults and their relatives in order to identify the real impact of genetic screening of SCD in forensic cases. Genetic screening of described variation in 16 genes implicated in the development of HCM and three more genes implicated in LQTS and BrS was performed by using MassARRAY technology. In addition, direct sequencing of the two most prevalent genes implicated in the development of SQTL type 1 and 2 was also carried out. Genetic screening allowed us to unmask four possibly pathogenic mutation carriers in the 49 SCD cases considered; carriers of mutation represent 9% (2/23) of the probands with structural anomalies found after autopsy and 7% (1/14) of the probands with structurally normal hearts after in depth autopsy protocol. One mutation was found among 12 of the recovered SCD cases considered. In people with direct family history of sudden cardiac death, but not themselves, 11 additional mutation carriers were found. Three different mutations were found in six of the 19 LQTS patients, representing three families and two different mutations were found among six patients with previous syncope. Genetic analysis in sudden cardiac death cases could help to elucidate the cause of death, but it also can help in the prevention of future deaths in families at risk. The study presented here shows the importance and relevance of genetic screening in patients with signs of cardiac hypertrophy and in family cases with more than one

  1. 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.

  2. 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.

  3. 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

  4. 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

  5. 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

  6. 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.

  7. 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

  8. [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.

  9. 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

  10. 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

  11. [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

  12. 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.

  13. 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

  14. Abortion.

    PubMed

    Hume, K

    1979-04-21

    The review by Aileen F. Connon of Abortion by Potts, Diggory and Peel (Journal, February 10) made interesting reading, especially her quotation of the "facinating statistical information" that Australia has 11.5 million people and 45,000 to 90,000 criminal abortions a year. These are rather wide upper and lower confidence limits. One wonders what other information the authors have included that is of the same standard of accuracy. On the other hand, Malcolm Potts told me some years ago that the experience of his parent organization, the International Planned Parenthood Federation, with the IUD in India was a disaster. That I could well believe. Seeing some of the victims, the sight would indeed be enough to stir the stony heart of the most inhuman consultant gynaecologist. There is in Australia, and indeed in the world, an increasing number of doctors who are revolted by the activities of the International Planned Parenthood Federation and its affiliates which aggressively promote abortion as "an acceptable method of fertility control," and even as the primary method. These are a cross-section of the profession and include some of its most distinguished and erudite members who would be both competent and happy to review a book such as Abortion by Potts et alii from a pro-life point of view. Could I suggest that in future your book reviews and editorials include some well informed commentaries from doctors representing that heretofore silent group? I am holding a long and growing list of Australian doctors who have signed the "Declaration of Doctors," thus explicitly spelling out their respect for human life from the first moment of biological existence to that of natural death. Their services are available on request.

  15. Abortion.

    PubMed

    Churchill, M

    1979-09-15

    I would like to take issue with Dr Colin Brewer's statements concerning intrauterine contraceptive devices and abortion (11 August, p 389). I agree that logically there is no distinction between IUCDs, and other abortifacients used early in pregnancy, and abortion methods used later in pregnancy. However, I disagree with his statement that to make illegal IUCDs and similar methods out of an "obsessive concern for microscopic forms of life" would be "absurd." Firstly, size has never been a criterion for the presence or absence of life, or of its importance. Surely Dr Brewer, MPs, and the public would be outraged by anything less than obsessively careful handling of, say, rabies or smallpox viruses in laboratories. Do not the products of conception, with the full potential of a human being unless actively interfered with by other men (neglecting normal fetal wastage), deserve any less concern? Secondly, mortality should not be determined by practicalities; rather morality should determine one's actions. The question of whether IUCDs and other such procedures should remain legal or be made illegal should not be determined by their efficacy, popularity, or economy. I agree fully with Dr Brewer--abortion is a moral issue and it is a pity that the BMF has not raised the moral issues at stake. Particularly so, as Lord Denning put it "...without morality there can be no law." I personally subscribe to the Hippocratic Oath. PMID:497769

  16. Three sudden cardiac deaths associated with Lyme carditis - United States, November 2012-July 2013.

    PubMed

    2013-12-13

    Lyme disease is a multisystem illness caused by Borrelia burgdorferi, a spirochete transmitted by certain species of Ixodes ticks. Approximately 30,000 confirmed and probable cases of Lyme disease were reported in the United States in 2012, primarily from high-incidence states in the Northeast (Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont) and upper Midwest (Minnesota and Wisconsin). Common manifestations include cutaneous, neurologic, and rheumatologic signs and symptoms. Symptomatic infection of the heart is rare in recognized Lyme disease cases and usually resolves promptly with appropriate antibiotic therapy. Nonetheless, cardiac involvement occasionally can cause life-threatening cardiac conduction abnormalities. During November 2012-July 2013, one woman and two men (ranging in age from 26 to 38 years) from high-incidence Lyme disease states experienced sudden cardiac death and, on postmortem examination, were found to have evidence of Lyme carditis. The three deaths were investigated by the Connecticut Department of Public Health, Massachusetts Department of Public Health, New Hampshire Department of Public Health, New York State Department of Health, and CDC. Donated corneas from two decedents had been transplanted to three recipients before the diagnosis of Lyme disease was established, but no evidence of disease transmission was found. Although death from Lyme carditis is rare, it should be considered in cases of sudden cardiac death in patients from high-incidence Lyme disease regions. Reducing exposure to ticks is the best method for preventing Lyme disease and other tickborne infections.

  17. 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

  18. 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.

  19. 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

  20. 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

  1. 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

  2. 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.

  3. Active surveillance of sudden cardiac death in young athletes by periodic Internet searches.

    PubMed

    Choi, Kristal; Pan, Yann Ping; Pock, Michelle; Chang, Ruey-Kang R

    2013-01-01

    The authors hypothesized that prospective, systematic Internet searches could identify occurrences of sudden cardiac death (SCD) in athletes and would be useful for establishing a system of active surveillance. Weekly advanced Google searches of the Internet were conducted for cases of SCD in young athletes during a 12-month period (2007-2008). Athletes ages 11-30 years who collapsed during a game, practice, or within an hour of exercise were included in the study. Individuals with known histories of cardiac issues and events occurring outside the United States were excluded. Verification of SCD was by autopsy reports and death certificates from county coroner offices and vital record agencies. Initially, 71 events were identified. Verification for the cause of death by coroner reports was possible in 45 cases, 43 (96 %) of which were confirmed to be SCDs. A total of 69 individuals 11-30 years of age (mean 17 ± 5 years) died suddenly of cardiovascular causes while participating in 15 different organized sports and a variety of nonorganized physical activities. The most common cause of death was hypertrophic cardiomyopathy (30 %), followed by coronary artery anomalies (9 %), and myocarditis (9 %). The incidence of athlete SCD, the types of sports involved, and the cardiac causes of death in our study were comparable with those of previous reports. Readily available Internet searches have the potential to be a powerful tool for identifying occurrences of athlete SCD. An active surveillance system using Google searches followed by coroner report verification can provide important epidemiologic and clinical information.

  4. 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

  5. Active Surveillance of Sudden Cardiac Death in Young Athletes by Periodic Internet Searches

    PubMed Central

    Choi, Kristal; Pan, Yann Ping; Pock, Michelle; Chang, Ruey-Kang R.

    2013-01-01

    Objective We hypothesized that prospective, systematic Internet searches could identify occurrences of sudden cardiac death (SCD) in athletes, and would be useful to establish a system of active surveillance. Methods Weekly advanced Google searches of the Internet were conducted for cases of SCD in young athletes over a 12-month period (2007–8). Athletes aged 11 to 30 years who collapsed during a game, practice, or within an hour of exercise were included. Individuals with known histories of cardiac issues and events occurring outside the United States were excluded. Verification of SCD was by autopsy reports and death certificates from county coroner offices and vital record agencies. Results A total of 71 events were initially identified. Verification of the cause of death by coroner reports was possible in 45 cases, of which 43 (96%) were confirmed to be SCDs. Sixty-nine individuals, 11 to 30 years of age (mean 17 ± 5), died suddenly from cardiovascular causes while participating in 15 different organized sports and a variety of non-organized physical activities. The most common cause of death was hypertrophic cardiomyopathy (30%), followed by coronary artery anomalies (9%), and myocarditis (9%). The incidence of athlete SCD, types of sports involved, and cardiac causes of death in our study were comparable to previous reports. Conclusions Readily available Internet searches have the potential to be a powerful tool for identifying occurrences of athlete SCD. An active surveillance system using Google searches followed by coroner report verification can provide important epidemiologic and clinical information. PMID:23681420

  6. 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

  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. 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.

  9. 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

  10. [Sudden Cardiac Death of Young Persons: Risk Factors, Causes, Morphological Equivalents].

    PubMed

    Shilova, M A; Mamedov, M N

    2015-01-01

    The article contains literature review on the problem of causes of sudden cardiac death (SCD) among young people as well as results of author's own retrospective study of deaths of persons before 39 years based on forensic autopsies performed during 10 year period. The study of structure and dynamics of causes of death, its risk factors and the role of connective tissue dysplasia in development of terminal symptomocomlexes allowed to establish that main mechanism of SCD in young people was arrhythmogenic developing as a response to provoking factors--physical effort, psychoemotional stress, consumption of light alcoholic beverages. PMID:26688929

  11. Cardiac asystole following cannabis (marijuana) usage--additional mechanism for sudden death?

    PubMed

    Menahem, Samuel

    2013-12-10

    A 21 year old university student previously operated during infancy for an unobstructed total anomalous pulmonary venous drainage with an excellent result, was noted on a routine follow up 24 h Holter monitor to have multiple pauses related to cardiac asystole, the longest lasting 5.8 s and temporally related to marijuana inhalation. A repeat Holter was normal following a two week cessation of marijuana usage and again when carried out 3 months later. The documented periods of asystole may be a precursor of sudden death seen in addicts even without evidence of ischaemic heart disease. PMID:24200372

  12. Cardiac effects of anabolic steroids: hypertrophy, ischemia and electrical remodelling as potential triggers of sudden death.

    PubMed

    Nascimento, J H M; Medei, E

    2011-05-01

    Anabolic-androgenic steroids (AAS) are synthetic testosterone derivatives developed to maximise anabolic activity and minimise androgenic activity. AAS abuse is widespread among both athletes and non-athletes at fitness centres and is becoming a public health issue. In addition to their atherogenic, thrombogenic and spastic effects, AAS have direct cardiotoxic effects by causing hypertrophy, electrical and structural remodelling, and contractile dysfunction and by increasing the susceptibility to ischemic injuries. All of these factors contribute to an increased risk of ventricular arrhythmias and sudden cardiac death.

  13. 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

  14. 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

  15. 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.

  16. 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.

  17. [Updated ESC guideline: innovations for the treatment of ventricular arrhythmias and recommendations for prevention of sudden cardiac death].

    PubMed

    Eckardt, L; Deneke, T

    2016-09-01

    The 2015 European Society of Cardiology Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death is an update of the former 2006 European/American guidelines. This new consensus document gives a detailed overview on prevention and therapy of ventricular arrhythmias and sudden cardiac death. This includes detailed discussion of channelopathies and various cardiomyopathies. Gaps in evidence are identified and also discussed. DNA analysis and postmortem assessment in sudden cardiac death victims is for the first time part of these new recommendations. In addition, for the first time recommendations on subcutaneous implantable cardioverter-defibrillator (ICD) and the wearable defibrillator are given. The guidelines strengthen the role of ICD therapy in primary and secondary prevention of sudden cardiac death although data used as the basis for these recommendations are 10-15 years old and patients' characteristics including therapeutic options have changed during that time. Systematic reassessment of left ventricular function 6-12 weeks after infarction is also included as a new recommendation. The role of catheter ablation in electrical storm and for those presenting with a first episode of sustained ventricular tachycardia has also been upgraded in the new guidelines. Hopefully, the new guidelines will reach not only cardiologists and help to improve patient care, but also contribute to reducing the high number sudden cardiac deaths in Europe. PMID:27581243

  18. Sudden cardiac death in forensic medicine – Swiss recommendations for a multidisciplinary approach.

    PubMed

    Wilhelm, Matthias; Bolliger, Stephan A; Bartsch, Christine; Fokstuen, Siv; Gräni, Christoph; Martos, Viktor; Medeiros Domingo, Argelia; Osculati, Antonio; Rieubland, Claudine; Sabatasso, Sara; Saguner, Ardan M; Schyma, Christian; Tschui, Joelle; Wyler, Daniel; Bhuiyan, Zahurul A; Fellmann, Florence; Michaud, Katarzyna

    2015-01-01

    Sudden cardiac death (SCD) is by definition unexpected and cardiac in nature. The investigation is almost invariably performed by a forensic pathologist. Under these circumstances the role of the forensic pathologist is twofold: (1.) to determine rapidly and efficiently the cause and manner of death and (2.) to initiate a multidisciplinary process in order to prevent further deaths in existing family members. If the death is determined to be due to "natural" causes the district attorney in charge often refuses further examinations. However, additional examinations, i.e. extensive histopathological investigations and/or molecular genetic analyses, are necessary in many cases to clarify the cause of death. The Swiss Society of Legal Medicine created a multidisciplinary working group together with clinical and molecular geneticists and cardiologists in the hope of harmonising the approach to investigate SCD. The aim of this paper is to close the gap between the Swiss recommendations for routine forensic post-mortem cardiac examination and clinical recommendations for genetic testing of inherited cardiac diseases; this is in order to optimise the diagnostic procedures and preventive measures for living family members. The key points of the recommendations are (1.) the forensic autopsy procedure for all SCD victims under 40 years of age, (2.) the collection and storage of adequate samples for genetic testing, (3.) communication with the families, and (4.) a multidisciplinary approach including cardiogenetic counselling.

  19. Fetal loss in threatened abortion after demonstration of fetal cardiac activity in a low socioeconomic population.

    PubMed

    Dede, F S; Ulucay, U; Kose, M F; Dede, H; Dilbaz, S

    2010-01-01

    This study was conducted to determine the incidence and risk factors of fetal loss in threatened abortion after ultrasonographic detection of fetal cardiac activity in a low socioeconomic population. A total of 202 women with singleton pregnancies who presented with vaginal bleeding in which fetal heart activity was ultrasonographically demonstrated between 5 and 14 weeks' gestation were included. Pregnancies with fetal abnormalities were excluded from the study. All cases were followed-up with respect to pregnancy outcomes. A total of 54 of 202 pregnancies (26.7%) resulted in fetal loss before 20 weeks' gestation. The mean fetal heart rate (FHR) and cervical length values were lower in spontaneous abortions than in viable pregnancies (121.2 +/- 13.3 vs 143.5 +/- 12.4 and 41 +/- 6.0 vs. 34.8 +/- 6.1, respectively; p < 0.001). A receiver operating characteristic (ROC) curve analysis revealed an area under the curve of 0.88 for FHR and 0.77 for cervical length. A FHR value <130 b.p.m. was 81.4% sensitive, 85.1% specific and a cervical length value <40 mm was 80.8% sensitive, 54.7% specific for determination of fetal loss before 20 weeks' gestation. Fetal loss was observed in about one-quarter of pregnancies admitted with threatened abortion in a low socioeconomic population. Bradycardia and short cervix were found to be significant risk factors affecting the pregnancy outcome in women presenting with vaginal bleeding, in whom fetal cardiac activity was documented. PMID:20701515

  20. 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

  1. 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

  2. The Mikamo lecture. Role of higher nervous activity in sudden cardiac death.

    PubMed

    Lown, B

    1990-06-01

    The brain receives and catalogues myriads of information from within and without the organism. These inputs promote neural integration of bodily function through a multiplicity of cybernetic feedback loops. Higher nervous activity shapes the contours of perceived well-being and determines the course and progress of disease. Behavioral and neural factors play an important role in cardiovascular function and are especially relevant to the problem of sudden cardiac death (SCD). Clinical data attesting to the role of biobehavioral factors in SCD derive from a diversity of sources. It has long been known that bereavement increases the prevalence of cardiac fatality. Business failure rates are strongly related to increased mortality among persons aged 55 and over. Recession in economic activity, with increasing unemployment, is associated with augmented death rates from ischemic heart disease. In extensive surveys conducted among London civil servants, Rose and Marmot found not only the level but the type of employment to be a factor determining coronary heart disease mortality. Blue collar workers had a 3.6 times greater chance of dying from heart disease than an age-matched population in the higher ranks of civil service. A man's employment status was a stronger predictor of risk for dying from coronary heart disease than any of the usual risk factors, such as smoking, blood pressure, height-weight ratio, leisure time activities, glucose tolerance, or plasma cholesterol. Operation of behavioral factors is also suggested by the time of occurrence of sudden death. Among 3,983 men followed for more than 30 years, Rabkin and co-workers observed an excess proportion of fatalities on Mondays. No such pattern was noted for cancer mortality. Not only the day of the week but the time of day appears to be a factor. Muller and co-workers found a significant preponderance in the occurrence of myocardial infarction and sudden death from 6:00 AM to noon. They could not implicate

  3. Usefulness of Cardiac Sympathetic Nerve Imaging Using (123)Iodine-Metaiodobenzylguanidine Scintigraphy for Predicting Sudden Cardiac Death in Patients With Heart Failure.

    PubMed

    Kasama, Shu; Toyama, Takuji; Kurabayashi, Masahiko

    2016-01-01

    The autonomic nervous system plays an important role in the human heart. Activation of the cardiac sympathetic nervous system is a cardinal pathophysiological abnormality associated with the failing human heart. Myocardial imaging using (123)I-metaiodobenzylguanidine (MIBG), an analog of norepinephrine, can be used to investigate the activity of norepinephrine, the predominant neurotransmitter of the sympathetic nervous system. Many clinical trials have demonstrated that (123)I-MIBG scintigraphic parameters predict cardiac adverse events, especially sudden cardiac death, in patients with heart failure. In this review, we summarize results from published studies that have focused on the use of cardiac sympathetic nerve imaging using (123)I-MIBG scintigraphy for risk stratification of sudden cardiac death in patients with heart failure.

  4. Abortion.

    PubMed

    Rice-Oxley, C P

    1979-09-15

    Professor Peter Hungerford (25 August, p 496) says that he is fed up with semantic arguments about abortion which ignore reality. He then invokes two major fantasies of the last decade, those of sexual equality and the woman's right to choose. The second of these has become an article of faith to many pro-abortionists and its credentials should be examined. Whence does this right derive? A woman takes part in a more or less pleasurable activity with a man and then, without her volition, with no conscious effort on her part at all, the miraculous occurs and a new life comes into being. How does she have the right to destroy this new life? The argument is usually to the effect that it belongs to her and could not survive without her: "It's mine and I can do what I like with it." Of course, it is true that a fetus cannot survive without the support of its mother; no more could Professor Hungerford or I survive without the support of our fellow men who provide us with food, drink, and clothing, but that does not give them the right to kill us. The claim to possession, the assumption that the fetus is owned by its mother involves, I believe, a semantic error. In a sense, the fetus is "hers" in that it is growing inside her, even though she did not create it. Likewise, her husband is hers because joined to her by marriage and her country is hers because she lives there, although she does not own either of them and certainly has no right to destroy them. The life growing inside the mother is not hers in the same way that a cardigan she has bought or knitted for herself is hers. It is the consideration of semantics that protects us from the "realities" of such as Professor Hungerford.

  5. Preventing Sudden Cardiac Death: Automated External Defibrillators in Ohio High Schools

    PubMed Central

    Lear, Aaron; Hoang, Minh-Ha; Zyzanski, Stephen J.

    2015-01-01

    Context Ohio passed legislation in 2004 for optional public funding of automated external defibrillators (AEDs) in all Ohio high schools. Objective To report occurrences of sudden cardiac arrest in which AEDs were used in Ohio high schools and to evaluate the adherence of Ohio high schools with AEDs to state law and published guidelines on AEDs and emergency action plans (EAPs) in schools. Design Cross-sectional survey. Setting Web-based survey. Patients or Other Participants A total of 264 of 827 schools that were members of the Ohio High School Athletic Association. Main Outcome Measure(s) We surveyed schools on AED use, AED maintenance, and EAPs. Results Twenty-five episodes of AED deployment at 22 schools over an 11-year period were reported; 8 (32%) involved students and 17 (68%) involved adults. The reported survival rate was 60% (n = 15). Most events (n = 20, 80%) in both students and adults occurred at or near athletic facilities. The annual use rate of AEDs was 0.7%. Fifty-three percent (n = 140) of schools reported having an EAP in place for episodes of cardiac arrest. Of the schools with EAPs, 57% (n = 80) reported having rehearsed them. Conclusions Our data supported the placement of AEDs in high schools given the frequency of use for sudden cardiac arrest and the survival rate reported. They also suggested the need for increased awareness of recommendations for EAPs and the need to formulate and practice EAPs. School EAPs should emphasize planning for events in the vicinity of athletic facilities. PMID:26381367

  6. Pathophysiology of sudden cardiac death as demonstrated by molecular pathology of natriuretic peptides in the myocardium.

    PubMed

    Chen, Jian-Hua; Michiue, Tomomi; Ishikawa, Takaki; Maeda, Hitoshi

    2012-11-30

    Various heart diseases present with sudden death; however, it is difficult to interpret the severity of or difference in respective preexisting and terminal cardiac dysfunction based on conventional morphology. The present study investigated the cardiac pathophysiology employing quantitative mRNA measurement of atrial and brain natriuretic peptides (ANP and BNP) in the myocardium as markers of cardiac strain, using autopsy materials consisting of acute ischemic heart disease (AIHD, n=40) with/without the pathology of apparent myocardial necrosis (n=19/21), recurrent myocardial infarction (RMI, n=19), chronic congestive heart disease (CHD, n=11) and right ventricular cardiomyopathy (RVC, n=5), as well as hemopericardium (HP, n=11) due to myocardial infarction (n=5) and aortic rupture (n=6), and acute pulmonary thromboembolism (PTE, n=5). Cardiac death groups showed higher ANP and/or BNP mRNA expressions in the left ventricle than acute fatal bleeding (sharp instrumental injury; n=15) and/or mechanical asphyxiation (strangulation; n=10). AIHD and RMI cases had similar ANP and BNP mRNA expressions in bilateral ventricular walls, but their bilateral atrial levels were lower in RMI. RVC showed higher mRNA expressions of posterior left ventricular BNP, and right ventricular and bilateral atrial ANP and BNP. HP cases had lower BNP mRNA expression in the right ventricular wall, but PTE showed lower ANP and BNP mRNA expressions in the left ventricular wall; however, these mRNA expressions at other sites were similar to those of AIHD. CHD presented findings similar to those of AIHD, but the pericardial BNP level was significantly increased. These observations indicate characteristic molecular biological responses of myocardial natriuretic peptides in individual heart diseases and suggest the possible application of molecular pathology to demonstrate cardiac dysfunction even after death.

  7. 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.

  8. 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

  9. Integrated Omic Analysis of a Guinea Pig Model of Heart Failure and Sudden Cardiac Death.

    PubMed

    Foster, D Brian; Liu, Ting; Kammers, Kai; O'Meally, Robert; Yang, Ni; Papanicolaou, Kyriakos N; Talbot, C Conover; Cole, Robert N; O'Rourke, Brian

    2016-09-01

    Here, we examine key regulatory pathways underlying the transition from compensated hypertrophy (HYP) to decompensated heart failure (HF) and sudden cardiac death (SCD) in a guinea pig pressure-overload model by integrated multiome analysis. Relative protein abundances from sham-operated HYP and HF hearts were assessed by iTRAQ LC-MS/MS. Metabolites were quantified by LC-MS/MS or GC-MS. Transcriptome profiles were obtained using mRNA microarrays. The guinea pig HF proteome exhibited classic biosignatures of cardiac HYP, left ventricular dysfunction, fibrosis, inflammation, and extravasation. Fatty acid metabolism, mitochondrial transcription/translation factors, antioxidant enzymes, and other mitochondrial procsses, were downregulated in HF but not HYP. Proteins upregulated in HF implicate extracellular matrix remodeling, cytoskeletal remodeling, and acute phase inflammation markers. Among metabolites, acylcarnitines were downregulated in HYP and fatty acids accumulated in HF. The correlation of transcript and protein changes in HF was weak (R(2) = 0.23), suggesting post-transcriptional gene regulation in HF. Proteome/metabolome integration indicated metabolic bottlenecks in fatty acyl-CoA processing by carnitine palmitoyl transferase (CPT1B) as well as TCA cycle inhibition. On the basis of these findings, we present a model of cardiac decompensation involving impaired nuclear integration of Ca(2+) and cyclic nucleotide signals that are coupled to mitochondrial metabolic and antioxidant defects through the CREB/PGC1α transcriptional axis.

  10. Integrated Omic Analysis of a Guinea Pig Model of Heart Failure and Sudden Cardiac Death.

    PubMed

    Foster, D Brian; Liu, Ting; Kammers, Kai; O'Meally, Robert; Yang, Ni; Papanicolaou, Kyriakos N; Talbot, C Conover; Cole, Robert N; O'Rourke, Brian

    2016-09-01

    Here, we examine key regulatory pathways underlying the transition from compensated hypertrophy (HYP) to decompensated heart failure (HF) and sudden cardiac death (SCD) in a guinea pig pressure-overload model by integrated multiome analysis. Relative protein abundances from sham-operated HYP and HF hearts were assessed by iTRAQ LC-MS/MS. Metabolites were quantified by LC-MS/MS or GC-MS. Transcriptome profiles were obtained using mRNA microarrays. The guinea pig HF proteome exhibited classic biosignatures of cardiac HYP, left ventricular dysfunction, fibrosis, inflammation, and extravasation. Fatty acid metabolism, mitochondrial transcription/translation factors, antioxidant enzymes, and other mitochondrial procsses, were downregulated in HF but not HYP. Proteins upregulated in HF implicate extracellular matrix remodeling, cytoskeletal remodeling, and acute phase inflammation markers. Among metabolites, acylcarnitines were downregulated in HYP and fatty acids accumulated in HF. The correlation of transcript and protein changes in HF was weak (R(2) = 0.23), suggesting post-transcriptional gene regulation in HF. Proteome/metabolome integration indicated metabolic bottlenecks in fatty acyl-CoA processing by carnitine palmitoyl transferase (CPT1B) as well as TCA cycle inhibition. On the basis of these findings, we present a model of cardiac decompensation involving impaired nuclear integration of Ca(2+) and cyclic nucleotide signals that are coupled to mitochondrial metabolic and antioxidant defects through the CREB/PGC1α transcriptional axis. PMID:27399916

  11. 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

  12. [Preventive antifibrillatory treatment of sudden cardiac death in acute myocardial infarct].

    PubMed

    Thale, J; Gülker, H; Hindricks, G; Haverkamp, W; Pollock, B; Buchwalsky, R

    1988-01-01

    The pathophysiological basis of sudden cardiac death due to ventricular arrhythmias in acute myocardial infarction has been extensively investigated in experimental as well as in some clinical studies. Numerous clinical studies have been performed with the aim to establish the feasibility of antifibrillatory prophylaxis of sudden cardiac death by pretreatment with antiarrhythmic drugs. Using class I-antiarrhythmic drugs the reported findings were contradictory. While the antiarrhythmic efficacy of Lidocaine and other, newer class I-antiarrhythmic drugs is well established, the antifibrillatory effects of these drugs in the early phase of acute myocardial infarction remain uncertain. In clinical studies with the endpoint of mortality in patients at risk, longterm administration of orally effective class I-antiarrhythmic drugs did not prove to be superior to placebo. However, beta-sympatholytic agents have been shown to reduce mortality in patients at risk in several large clinical studies. The basic mechanism seems to be primarily a reduction in sudden cardiac death which is caused predominantly by ventricular fibrillation. The antifibrillatory properties of beta-blockers was demonstrated as well by a reduction in the number of episodes of ventricular fibrillation. The recognition of patients at risk who profit most from chronic beta-blocker therapy remains the main problem when treatment of numerous low-risk patients is avoided. In the ISIS I-study with Atenolol intravenous administration of a beta-blocker in the early phase of acute myocardial infarction has been shown to be beneficial if hemodynamic monitoring, for example using flow-directed heart catherization is performed. In general this does not apply to the treatment with calciumantagonists, especially with Verapamil and Nifedipine. These drugs do not improve prognosis of acute myocardial ischemia, obviously because of hemodynamic side effects. The antifibrillatory efficacy of Verapamil

  13. 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

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

    PubMed

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

    2016-02-01

    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.

  15. Implantable Defibrillators for Secondary Prevention of Sudden Cardiac Death in Cardiac Surgery Patients With Perioperative Ventricular Arrhythmias

    PubMed Central

    Nageh, Maged F.; Kim, John J.; Chen, Lie‐Hong; Yao, Janis F.

    2014-01-01

    Background Randomized studies of implantable cardioverter defibrillators (ICD) have excluded sudden cardiac death survivors who had revascularization before or after an arrhythmic event. To evaluate the role of ICD and the effects of clinical variables including degree of revascularization, we studied cardiac surgery patients who had an ICD implanted for sustained perioperative ventricular arrhythmias. Methods and Results The electronic database for Southern California Kaiser Foundation hospitals was searched for patients who had cardiac surgery between 1999 and 2005 and an ICD implanted within 3 months of surgery. One hundred sixty‐four patients were identified; 93/164 had an ICD for sustained pre‐ or postoperative ventricular tachycardia or fibrillation requiring resuscitation. Records were reviewed for the following: presenting arrhythmia, ejection fraction, and degree of revascularization. The primary end point was total mortality (TM) and/or appropriate ICD therapy (ICD‐T), and secondary end points are TM and ICD‐T. During the mean follow up of 49 months, the primary endpoint of TM+ICD‐T and individual end points of TM and ICD‐T were observed in 52 (56%), 35 (38%), and 28 (30%) patients, respectively, with 55% of TM, and 23% of ICD‐T occurring within 2 years of implant. In multivariate risk analysis, none of the following was associated with any of the end points: incomplete revascularization, presenting ventricular arrhythmia, and timing of arrhythmias. Conclusion Our data supports the recent guidelines for ICD in this cohort of patients, as the presence of irreversible substrate and triggers of ventricular arrhythmias, cannot be reliably excluded even with complete revascularization. Further studies are needed to understand this complex group of patients. PMID:25146702

  16. [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

  17. [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

  18. 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…

  19. Physical activity and sudden cardiac death in elders--a Croatian study.

    PubMed

    Duraković, Zijad; Duraković, Marjeta Misigoj; Skavić, Josip; Gojanović, Marija Definis

    2011-03-01

    The paper deals with the sudden cardiac death in elders due to physical activity in Croatia and to compare it to other population groups who practice physical activity. The data are a part of a retrospective study dealing with 59 sudden death due to physical activity in men in Croatia: from January 1, 1988 to December 31, 2008. Fifteen aged 65 to 82 years were recreationally engaged in physical activity: six in swimming, four in tennis, one in driving a bicycle, one in jogging, two in bowling and one died during sexual act. Only one had symptoms of pectoral angina, two suffered from arterial hypertension, and two had congestive heart failure. Eleven were without symptoms before exercise. At forensic autopsy, fourteen had coronary heart disease, seven had critical coronary artery stenosis, three had occluded left descendens anterior coronary artery and four critical coronary stenosis, four had a recent myocardial infarctions, and eleven had myocardial scars due to previous myocardial infarctions. Twelve of them had left ventricular hypertrophy: 15-25 mm. In Croatia, about 7per cent of the entire male population undertake recreational physical activity, while 13 per cent of them are elders. A sudden cardiac death due to recreational physical activity in elders reached 1.71/100 000 yearly, in the entire male population engaged in recreational physical exercise: 0.75/100 000 (p = 0.05730), in the total male population aged 15-40 engaged in sports and recreational physical exercise: 0.57/100.0000 (p = 0.00387), in young athletes: 0.15/100 000 (p = 0.00000). Medical examination of all elderly persons has to be done before starting of recreational physical activity: by clinical examination, searching for risk factors for atherosclerosis, performing ECG at rest, stress ECG, and echocardiography and to repeat the medical examination at least once a year Physical activity should start with a warm-up period and with a gradually increasing load, and usually not to exceed 6

  20. 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

  1. 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

  2. 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

  3. Impact of Denervated Myocardium on Improving Risk Stratification for Sudden Cardiac Death

    PubMed Central

    Cain, Michael E.

    2014-01-01

    Between 184,000 and 462,000 Americans die suddenly each year. Fifty percent to 70% of these deaths are due to ventricular tachycardia/fibrillation (VT/VF). We tested whether hibernating myocardium or myocardial sympathetic denervation identifies patients at high-risk for developing VT/VF independently of ejection fraction (EF). Positron emission tomography (PET) was used to quantify myocardial sympathetic denervation (11C-meta-hydroxyephedrine [11C-HED]), perfusion (13N-ammonia), and viability (insulin-stimulated 18F-2-deoxyglucose [18FDG]) in patients with ischemic cardiomyopathy (EF < 35%) eligible for a primary prevention implantable cardioverter defibrillator (ICD). The primary end-point was sudden cardiac arrest (SCA) defined as arrhythmic death or ICD discharge for VT/VF > 240 bpm. Volumes of total denervated (P = .001) and viable denervated myocardium (11C-HED-18FDG mismatch, P = .03) predicted SCA, whereas hibernating and infarcted myocardium did not. Multivariate analysis identified four independent predictors of SCA: denervated myocardium > 37.6% of left ventricule (LV), LV end-diastolic volume > 98 mL/m2, creatinine level > 1.49 mg/dL, and no angiotensin- inhibition therapy. Denervated myocardium had a hazard ratio of 3.5 for SCA (10.3%/year vs. 3.0%/year, p=0.001). Absence of all four factors predicted low risk (44% of cohort; SCA <1%/y) whereas two or more factors identified subjects at high-risk (20% of cohort; SCA 12%/y). Denervated myocardium quantified using PET strongly predicts risk of SCA, and is independent of EF, infarct volume, and other clinical variables. PMID:25125727

  4. Impact of denervated myocardium on improving risk stratification for sudden cardiac death.

    PubMed

    Cain, Michael E

    2014-01-01

    Between 184,000 and 462,000 Americans die suddenly each year. Fifty percent to 70% of these deaths are due to ventricular tachycardia/fibrillation (VT/VF). We tested whether hibernating myocardium or myocardial sympathetic denervation identifies patients at high-risk for developing VT/VF independently of ejection fraction (EF). Positron emission tomography (PET) was used to quantify myocardial sympathetic denervation ((11)C-meta-hydroxyephedrine [(11)C-HED]), perfusion ((13)N-ammonia), and viability (insulin-stimulated (18)F-2-deoxyglucose [(18)FDG]) in patients with ischemic cardiomyopathy (EF < 35%) eligible for a primary prevention implantable cardioverter defibrillator (ICD). The primary end-point was sudden cardiac arrest (SCA) defined as arrhythmic death or ICD discharge for VT/VF > 240 bpm. Volumes of total denervated (P = .001) and viable denervated myocardium ((11)C-HED-(18)FDG mismatch, P = .03) predicted SCA, whereas hibernating and infarcted myocardium did not. Multivariate analysis identified four independent predictors of SCA: denervated myocardium > 37.6% of left ventricule (LV), LV end-diastolic volume > 98 mL/m(2), creatinine level > 1.49 mg/dL, and no angiotensin- inhibition therapy. Denervated myocardium had a hazard ratio of 3.5 for SCA (10.3%/year vs. 3.0%/year, p=0.001). Absence of all four factors predicted low risk (44% of cohort; SCA <1%/y) whereas two or more factors identified subjects at high-risk (20% of cohort; SCA 12%/y). Denervated myocardium quantified using PET strongly predicts risk of SCA, and is independent of EF, infarct volume, and other clinical variables.

  5. Prevention of sudden cardiac death in the young and in athletes: dream or reality?

    PubMed

    Thiene, Gaetano; Carturan, Elisa; Corrado, Domenico; Basso, Cristina

    2010-01-01

    Cardiovascular diseases account for 40% of all deaths in the Western countries, and nearly two thirds of them occur suddenly. Young people (<35 years) are not spared from sudden death (SD) with a rate of 1/100,000 per year. Effort is a trigger with a threefold risk in athletes vs. nonathletes, and sports disqualification is by itself life-saving in people with underlying concealed cardiovascular diseases. Several culprits of cardiac SD may be identified at postmortem and atherosclerotic coronary artery disease is the leading cause (25% of SD cases in the young), mostly consisting of a single obstructive plaque with fibrocellular intimal proliferation. However, the spectrum of cardiovascular substrates is wide and include also congenital diseases of the coronary arteries (mainly anomalous origin), myocardium (arrhythmogenic and hypertrophic cardiomyopathies, myocarditis), valves (aortic stenosis and mitral valve prolapse), and conduction system (ventricular preexcitation, accelerated atrioventricular conduction and block). In up to 20% of cases, the heart is grossly and histologically normal at autopsy (unexplained SD or "mors sine materia"), and inherited ion channel diseases have been implicated (long and short QT syndromes, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia). Targets to treat and prevent SD in the young consist of the following: (a) avoid triggers like effort or emotion, (b) inhibit the onset of arrhythmias with drugs or ablation, (c) switch off arrhythmias with defibrillator, and (d) hinder the recurrence of the disease with genetic counseling and/or therapy. In vivo detection of cardiomyopathies is nowadays feasible by electrocardiogram and/or echocardiography, which resulted in a sharp decline of SD in the athletes in Italy, thanks to obligatory preparticipation screening for sport activity. Genetic screening could play a pivotal role in early detection of asymptomatic mutation carriers of cardiovascular diseases at risk

  6. Sudden cardiac death due to physical exercise in male competitive athletes. A report of six cases.

    PubMed

    Durakovic, Z; Misigoj-Durakovic, M; Vuori, I; Skavic, J; Belicza, M

    2005-12-01

    In the period of 30 years, i.e. from 1973 to 2002, we noticed in Croatia 6 sudden and unexpected cardiac deaths in male athletes during or after training. Two were soccer players, 2 athletic runners, one was a rugby player and one was a basketball player. All of them were without cardiovascular symptoms. At the forensic autopsy, the first athlete, aged 29, had chronic myocarditis and thickened left ventricular wall of 15 mm. The second, aged 21, had an acute myocardial infarction of the posterior wall with normal coronaries and thickened left ventricular wall of 15 mm. The third aged 17, had hypoplastic right coronary artery and narrowed ascending aorta, suppurant tonsillitis and subacute myocarditis. Two athletes, aged 29 and 15, had hypertrophic cardiomyopathy and normal coronaries, and one dilated aorta. The sixth, aged 24, had arrhythmogenic cardiomyopathy of the right ventricle. All the 6 athletes died suddenly, obviously because of malignant ventricular arrhythmias. In Croatia the death rate among athletes reached 0.15/100 000, in others who practice exercise reached 0.74/100,000 and the difference is highly significant (c2=14.487, Poisson rates=3.81, P=0.00014) and in physicians-specialists reached 33.6/100,000. Preventive medical examinations are essential, especially in athletes before physical exercise, as are other investigations in every case suspicious of heart disease, including electrocardiogram (ECG), stress ECG, echocardiography and stress-echocardiography and other findings if indicated. Physical exercise is contraindicated in acute respiratory infection: in 2 of those cases had been a cause of death as a trigger.

  7. 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.

  8. Hypertrophic cardiomyopathy and sudden cardiac death due to physical exercise in Croatia in a 27-year period.

    PubMed

    Duraković, Zijad; Duraković, Marjeta Misigoj; Skavić, Josip

    2011-12-01

    The paper deals with the sudden cardiac death during physical exercise in males in Croatia. The data are a part of a retrospective study dealing with 69 sudden death due to physical activity in men in Croatia during 27 years: from January 1, 1984 to December 31, 2010. Three of them suddenly died during training and two of them died during recreational physical exercise, probably because of malignant ventricular arrhythmia due to hyperthrophic cardiomyopathy. One had an obstructive form of hypertrophic cardiomyopathy with i.v. septum of 40 mm and four had a non-obstructive forms of hyperthrophic cardiomyopathy with left ventricular wall of 18-20-22-25 mm. First athlete was a short trails runner, aged 24, with no any previous physical discomforts, who suddenly collapsed and died during training. The second athlete was a soccer player aged 18, with no any previous physical discomfort, who suddenly collapsed and died during training. The third aged 15, was a school boy, basketball player, with no any previous physical discomfort, who collapsed and died during training. Two aged 25 and 34, were with no physical discomfort during exercise and died suddenly during recreational soccer games. A sudden cardiac death due to physical exercise in young athletes in Croatia suffered of hyperthropic cardiomyopathy reached 0.06/100 000 yearly (p = 0.00000) in 27 years, in teenagers 0.26/100 000 (p = 0.00226), in teenagers suffered of hypertrophic cardiomyopathy reached 0.10/100 000 (p = 0.00000), in all young athletes suffered of other heart diseases reached 0.19/100 000 (p = 0.00005), and in the total male population aged 15 or more, engaged in sports and recreational physical exercise: 0.71/100.0000 (p = 0.00001).

  9. [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.

  10. Chronic obstructive pulmonary disease and sudden cardiac death: A systematic review.

    PubMed

    van den Berg, Marten E; Stricker, Bruno H; Brusselle, Guy G; Lahousse, Lies

    2016-10-01

    Both chronic obstructive pulmonary disease (COPD) and sudden cardiac death (SCD) are major health burdens. A number of studies have addressed their interrelationship, but currently no systematic review has been published. Our objective is to give an overview of the literature of the association between COPD and SCD. A search on PubMed with both MeSH headings and free-text keywords was performed. We selected all original articles of studies in humans that assessed COPD on the one hand and SCD, electrocardiographic markers for SCD, ventricular arrhythmias, or asystole on the other. The electronic search yielded 251 articles, from which 27 full publications were selected after careful evaluation of the full-text articles. In these studies, COPD was associated with a prolonged and shortened QT interval. In patients with a myocardial infarction (MI), COPD was associated with an increased risk of ventricular arrhythmias and decreased survival. COPD was a risk factor for SCD both in cardiovascular patient groups and in community-based studies, independent from cardiovascular risk profile. Studies of the potential impact of respiratory treatment on the occurrence of SCD showed conflicting results. In conclusion, cumulating evidence associates COPD with an increased risk of SCD. Asystole and pulseless electric activity could be more common than VT/VF in deaths associated with COPD. Underlying mechanisms explaining this association require further investigation. PMID:27234353

  11. Sudden cardiac arrest risk stratification based on 24-hour Holter ECG statistics.

    PubMed

    Kasahara, Keisuke; Shiobara, Masahito; Nakamura, Saya; Yamashiro, Koichiro; Yana, Kazuo; Ono, Takuya

    2015-08-01

    This study examined the feasibility of using indices obtained from a long term Holter ECG record for sudden cardiac arrest (SCA) risk stratification. The ndices tested were the QT-RR interval co-variability and the alternans ratio percentile (ARP(θ)) which is defined as the θ(th) percentile of alternans ratios over a 24 hour period. The QT-RR interval co-variabilities are evaluated by the serial correlation coefficient between QT and RR trend sequences (QTRC). Previously reported Kalman filter technique and a simple smoothing spline method for the trend estimation are compared. Parameter θ in the alternans ratio percentile index was optimized to achieve the best classification accuracy. These indices were estimated from 26 cardiovascular outpatients for Holter ECG record. Patients were classified into high and low risk groups according to their clinical diagnosis, and the obtained indices were compared with those of 25 control subjects. A risk stratification using the two indices QTRC and ARP(θ) yielded an average sensitivity of 0.812 and a specificity of 0.925. The sensitivities and specificities of all three categories exceeded 0.8 except for the sensitivity to detect the high-risk patient group. Other short-term ECG parameters may need to be incorporated in order to improve the sensitivity.

  12. Chronic obstructive pulmonary disease and sudden cardiac death: A systematic review.

    PubMed

    van den Berg, Marten E; Stricker, Bruno H; Brusselle, Guy G; Lahousse, Lies

    2016-10-01

    Both chronic obstructive pulmonary disease (COPD) and sudden cardiac death (SCD) are major health burdens. A number of studies have addressed their interrelationship, but currently no systematic review has been published. Our objective is to give an overview of the literature of the association between COPD and SCD. A search on PubMed with both MeSH headings and free-text keywords was performed. We selected all original articles of studies in humans that assessed COPD on the one hand and SCD, electrocardiographic markers for SCD, ventricular arrhythmias, or asystole on the other. The electronic search yielded 251 articles, from which 27 full publications were selected after careful evaluation of the full-text articles. In these studies, COPD was associated with a prolonged and shortened QT interval. In patients with a myocardial infarction (MI), COPD was associated with an increased risk of ventricular arrhythmias and decreased survival. COPD was a risk factor for SCD both in cardiovascular patient groups and in community-based studies, independent from cardiovascular risk profile. Studies of the potential impact of respiratory treatment on the occurrence of SCD showed conflicting results. In conclusion, cumulating evidence associates COPD with an increased risk of SCD. Asystole and pulseless electric activity could be more common than VT/VF in deaths associated with COPD. Underlying mechanisms explaining this association require further investigation.

  13. Myocardial infarction, stroke, and sudden cardiac death may be prevented by influenza vaccination.

    PubMed

    Meyers, David G

    2003-03-01

    Acute myocardial infarction (AMI) and atherothrombotic stroke share a common pathogenesis involving disrupted atherosclerotic plaque and intravascular thrombosis. Both AMI and stroke have their peak incidence in winter months. Similarly, the incidence of upper respiratory infections (URIs), 38% of which are due to influenza, also peaks in winter (November and December). URIs result in many biochemical, cellular, and hemostatic changes that could predispose to plaque disruption and thrombosis. Infections, particularly URIs, frequently precede AMI and stroke. Up to 16% of persons older than 60 years of age experience a URI each year. Nineteen percent of those suffering an AMI recall a URI in the 2 weeks prior to their event. Three epidemiologic and one small clinical trial suggest that influenza vaccination is associated with a 50% reduction in incidence of sudden cardiac death, AMI, and ischemic stroke. Influenza vaccine is extremely safe and has a 50% efficacy. Theoretically, up to 104,500 AMIs and 192,000 nonembolic ischemic strokes could be prevented each year by influenza vaccination.

  14. 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

  15. Sudden cardiac death in hemodialysis patients: an in-depth review.

    PubMed

    Green, Darren; Roberts, Paul R; New, David I; Kalra, Philip A

    2011-06-01

    Sudden cardiac death (SCD) is the leading cause of death in hemodialysis patients, accounting for death in up to one-quarter of this population. Unlike in the general population, coronary artery disease and heart failure often are not the underlying pathologic processes for SCD; accordingly, current risk stratification tools are inadequate when assessing these patients. Factors assuming greater importance in hemodialysis patients may include left ventricular hypertrophy, electrolyte shift, and vascular calcification. Knowledge regarding SCD in hemodialysis patients is insufficient, in part reflecting the lack of an agreed-on definition of SCD in this population, although epidemiologic studies suggest the most common times for SCD to occur are toward the end of the long 72-hour weekend interval between dialysis sessions and in the 12 hours immediately after hemodialysis. Accordingly, it is hypothesized that the dialysis procedure itself may have important implications for SCD. Supporting this is recognition that hemodialysis is associated with both ventricular arrhythmias and dynamic electrocardiographic changes. Importantly, echocardiography and electrocardiography may show changes that are modifiable by alterations to dialysis prescription. The most effective preventative strategy in the general population, implanted cardioverter-defibrillator devices, are less effective in the presence of chronic kidney disease and have not been studied adequately in dialysis patients. Last, many dialysis patients experience SCD despite not fulfilling current criteria for implantation, making appropriate allocation of defibrillators uncertain.

  16. 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

  17. 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.

  18. 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

  19. Determinants of unfavorable prognosis for out-of-hospital sudden cardiac arrest in Bielsko-Biala district

    PubMed Central

    Nowak, Jolanta U.; Krzych, Łukasz J.

    2016-01-01

    Introduction The prognosis in out-of-hospital sudden cardiac arrest (OHCA) remains unfavorable and depends on a number of demographic and clinical variables, the reversibility of its causes and its mechanisms. Aim To investigate the risk factors of prehospital death in patients with OHCA in Bielsko County. Material and methods The study analyzed all dispatch cards of the National Emergency Medical Services (EMS) teams in Bielsko-Biala for the year 2013 (n = 23 400). Only the cards related to sudden cardiac arrest in adults were ultimately included in the study (n = 272; 190 men, 82 women; median age: 71 years). Results Sixty-seven victims (45 men, 22 women) were pronounced dead upon the arrival of the EMS team, and cardiopulmonary resuscitation (CPR) was not undertaken. In the remaining group of 205 subjects, CPR was commenced but was ineffective in 141 patients (97 male, 44 female). Although univariate analysis indicated 6 predictors of prehospital death, including OHCA without the presence of witnesses (odds ratio (OR) = 4.2), OHCA occurring in a public place (OR = 3.1), no bystander CPR (OR = 9.7), no bystander cardiac massage (OR = 13.1), initial diagnosis of non-shockable cardiac rhythm (OR = 7.0), and the amount of drugs used for CPR (OR = 0.4), logistic regression confirmed that only the lack of bystander cardiac massage (OR = 6.5) and non-shockable rhythm (OR = 4.6) were independent determinants of prehospital death (area under ROC curve = 0.801). Conclusions Non-shockable rhythm of cardiac arrest and lack of bystander cardiac massage are independent determinants of prehospital death in Bielsko-Biala inhabitants suffering from OHCA. PMID:27785135

  20. Regional Myocardial Sympathetic Denervation Predicts the Risk of Sudden Cardiac Arrest in Ischemic Cardiomyopathy

    PubMed Central

    Fallavollita, James A.; Heavey, Brendan M.; Luisi, Andrew J.; Michalek, Suzanne M.; Baldwa, Sunil; Mashtare, Terry L.; Hutson, Alan D.; deKemp, Robert A.; Haka, Michael S.; Sajjad, Munawwar; Cimato, Thomas R.; Curtis, Anne B.; Cain, Michael E.; Canty, John M.

    2014-01-01

    Objectives The PAREPET (Prediction of ARrhythmic Events with Positron Emission Tomography) study sought to test the hypothesis that quantifying inhomogeneity in myocardial sympathetic innervation could identify patients at highest risk for sudden cardiac arrest (SCA). Background Left ventricular ejection fraction (LVEF) is the only parameter identifying patients at risk of SCA who benefit from an implantable cardiac defibrillator (ICD). Methods We prospectively enrolled 204 subjects with ischemic cardiomyopathy (LVEF ≤35%) eligible for primary prevention ICDs. Positron emission tomography (PET) was used to quantify myocardial sympathetic denervation (11C-meta-hydroxyephedrine [11C-HED]), perfusion (13N-ammonia) and viability (insulin-stimulated 18F-2-deoxyglucose). The primary endpoint was SCA defined as arrhythmic death or ICD discharge for ventricular fibrillation or ventricular tachycardia >240 beats/min. Results After 4.1 years follow-up, cause-specific SCA was 16.2%. Infarct volume (22 ± 7% vs. 19 ± 9% of left ventricle [LV]) and LVEF (24 ± 8% vs. 28 ± 9%) were not predictors of SCA. In contrast, patients developing SCA had greater amounts of sympathetic denervation (33 ± 10% vs. 26 ± 11% of LV; p = 0.001) reflecting viable, denervated myocardium. The lower tertiles of sympathetic denervation had SCA rates of 1.2%/year and 2.2%/year, whereas the highest tertile had a rate of 6.7%/year. Multivariate predictors of SCA were PET sympathetic denervation, left ventricular end-diastolic volume index, creatinine, and no angiotensin inhibition. With optimized cut-points, the absence of all 4 risk factors identified low risk (44% of cohort; SCA <1%/year); whereas ≥2 factors identified high risk (20% of cohort; SCA ~12%/year). Conclusions In ischemic cardiomyopathy, sympathetic denervation assessed using 11C-HED PET predicts cause-specific mortality from SCA independently of LVEF and infarct volume. This may provide an improved approach for the identification

  1. Increased Risk of Sudden Cardiac Arrest in Obstructive Pulmonary Disease: A Case-Control Study

    PubMed Central

    Bardai, Abdennasser; Berdowksi, Jocelyn; Souverein, Patrick Cyriel; Hoes, Arno Wilhelmus; Rutten, Frans Hendrik; de Boer, Anthonius; Koster, Rudolph Willem; De Bruin, Marie Louise; Tan, Han Liong

    2013-01-01

    Background We aimed to determine whether (1) patients with obstructive pulmonary disease (OPD) have an increased risk of sudden cardiac arrest (SCA) due to ventricular tachycardia or fibrillation (VT/VF), and (2) the SCA risk is mediated by cardiovascular risk-profile and/or respiratory drug use. Methods A community-based case-control study was performed, with 1310 cases of SCA of the ARREST study and 5793 age, sex and SCA-date matched non-SCA controls from the PHARMO database. Only incident SCA cases, age older than 40 years, that resulted from unequivocal cardiac causes with electrocardiographic documentation of VT/VF were included. Conditional logistic regression analysis was used to assess the association between SCA and OPD. Pre-specified subgroup analyses were performed regarding age, sex, cardiovascular risk-profile, disease severity, and current use of respiratory drugs. Results A higher risk of SCA was observed in patients with OPD (n = 190 cases [15%], 622 controls [11%]) than in those without OPD (OR adjusted for cardiovascular risk-profile 1.4 [1.2–1.6]). In OPD patients with a high cardiovascular risk-profile (OR 3.5 [2.7–4.4]) a higher risk of SCA was observed than in those with a low cardiovascular risk-profile (OR 1.3 [0.9–1.9]) The observed SCA risk was highest among OPD patients who received short-acting β2-adrenoreceptor agonists (SABA) or anticholinergics (AC) at the time of SCA (SABA OR: 3.9 [1.7–8.8], AC OR: 2.7 [1.5–4.8] compared to those without OPD). Conclusions OPD is associated with an increased observed risk of SCA. The most increased risk was observed in patients with a high cardiovascular risk-profile, and in those who received SABA and, possibly, those who received AC at the time of SCA. PMID:23755262

  2. Remote Liver Ischemic Preconditioning Protects against Sudden Cardiac Death via an ERK/GSK-3β-Dependent Mechanism

    PubMed Central

    Hu, Zhaoyang; Hu, Sheng; Yang, Shuai; Chen, Mou; Zhang, Ping; Liu, Jin; Abbott, Geoffrey W.

    2016-01-01

    Background Preconditioning stimuli conducted in remote organs can protect the heart against subsequent ischemic injury, but effects on arrhythmogenesis and sudden cardiac death (SCD) are unclear. Here, we investigated the effect of remote liver ischemia preconditioning (RLIPC) on ischemia/reperfusion (I/R)-induced cardiac arrhythmia and sudden cardiac death (SCD) in vivo, and determined the potential role of ERK/GSK-3βsignaling. Methods/Results Male Sprague Dawley rats were randomized to sham-operated, control, or RLIPC groups. RLIPC was induced by alternating four 5-minute cycles of liver ischemia with 5-minute intermittent reperfusions. To investigate I/R-induced arrhythmogenesis, hearts in each group were subsequently subjected to 5-minute left main coronary artery ligation followed by 20-minute reperfusion. RLIPC reduced post-I/R ventricular arrhythmias, and decreased the incidence of SCD >threefold. RLIPC increased phosphorylation of cardiac ERK1/2, and GSK-3β Ser9 but not Tyr216 post-I/R injury. Inhibition of either GSK-3β (with SB216763) or ERK1/2 (with U0126) abolished RLIPC-induced antiarrhythmic activity and GSK-3β Ser9 and ERK1/2 phosphorylation, leaving GSK-3β Tyr216 phosphorylation unchanged. Conclusions RLIPC exerts a powerful antiarrhythmic effect and reduces predisposition to post-IR SCD. The underlying mechanism of RLIPC cardioprotection against I/R-induced early arrhythmogenesis may involve ERK1/2/GSK-3β Ser9-dependent pathways. PMID:27768739

  3. 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

  4. The clinical challenge of preventing sudden cardiac death immediately after acute ST-elevation myocardial infarction.

    PubMed

    Manolis, Antonis S

    2014-12-01

    Unfortunately, of all patients experiencing acute myocardial infarction (MI), usually in the form of ST-elevation MI, 25-35% will die of sudden cardiac death (SCD) before receiving medical attention, most often from ventricular fibrillation. For patients who reach the hospital, prognosis is considerably better and has improved over the years. Reperfusion therapy, best attained with primary percutaneous coronary intervention compared to thrombolysis, has made a big difference in reducing the risk of SCD early and late after ST-elevation MI. In-hospital SCD due to ventricular tachyarrhythmias is manageable, with either preventive measures or drugs or electrical cardioversion. There is general agreement for secondary prevention of SCD post-MI with implantation of a cardioverter defibrillator (ICD) when malignant ventricular arrhythmias occur late (>48 h) after an MI, and are not due to reversible or correctable causes. The major challenge remains that of primary prevention, that is, how to prevent SCD during the first 1-3 months after ST-elevation MI for patients who have low left ventricular ejection fraction and are not candidates for an ICD according to current guidelines, due to the results of two studies, which did not show any benefits of early (<40 days after an MI) ICD implantation. Two recent documents may provide direction as to how to bridge the gap for this early post-MI period. Both recommend an electrophysiology study to guide implantation of an ICD, at least for those developing syncope or non-sustained ventricular tachycardia, who have an inducible sustained ventricular tachycardia at the electrophysiology study. An ICD is also recommended for patients with indication for a permanent pacemaker due to bradyarrhythmias, who also meet primary prevention criteria for SCD.

  5. 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

  6. Incidence of sudden cardiac death in athletes: a state-of-the-art review.

    PubMed

    Harmon, Kimberly G; Drezner, Jonathan A; Wilson, Mathew G; Sharma, Sanjay

    2014-08-01

    Sudden cardiac death (SCD) is the leading medical cause of death in athletes; however, the precise incidence is unknown. The objectives of this review were to examine studies on the rate of SCD in athletes, assess the methodological strengths and weaknesses used to arrive at estimates, compare studies in athletes with estimates in similar populations and arrive at an approximation of the incidence of SCD based on the best available evidence. A comprehensive literature search was performed in PubMed using key terms related to SCD in athletes. Articles were reviewed for relevance and included if they contained information on the incidence of SCD in athletes or young persons up to the age of 40. The reference list from each manuscript was reviewed for additional relevant articles. The methods for case identification were examined, as well as the inclusion and exclusion criteria and the precision of the population denominator studied. Thirteen studies were found investigating the rate of SCD in athletes who ranged in age from 9 to 40. An additional 15 incidence studies were located examining the rate of SCD in other populations under the age of 40. Rates of SCD varied from 1:917,000 to 1:3000. Studies with higher methodological quality consistently yielded incidence rates in the range of 1:40,000 to 1:80,000. Some athlete subgroups, specifically men, African-American/black athletes and basketball players, appear to be at higher risk. The incidence of SCD in athletes is likely higher than traditional estimates which may impact the development of more effective prevention strategies.

  7. 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.

  8. 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

  9. Abortion - medical

    MedlinePlus

    ... womb (uterus). There are different types of medical abortions: Therapeutic medical abortion is done because the woman has ... Therapeutic medical abortion; Elective medical abortion; Induced abortion; Nonsurgical abortion

  10. 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

  11. 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.

  12. 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

  13. 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

  14. 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.

  15. 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

  16. 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

  17. 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…

  18. Congenital anomalies of coronary arteries: role in the pathogenesis of sudden cardiac death.

    PubMed

    Cheitlin, Melvin D; MacGregor, John

    2009-06-01

    After hypertrophic cardiomyopathy, coronary artery anomalies of origin from the wrong sinus of Valsalva are the second most common cause of sudden death on the athletic field in the USA. Although the right coronary artery arising from the left coronary sinus (ARCA) is four times as common as the left coronary artery arising from the anterior sinus (ALCA), it is the latter that is by far the more common cause of sudden death with or shortly after vigorous physical activity. Of the four types of ALCA, the interarterial type, where the left coronary artery passes anteriorly between the aorta and the right ventricular outflow tract, is the only type that places the patient at risk of sudden death. Another feature of this syndrome is the fact that sudden death occurs associated with or shortly after vigorous exercise and is very unusual after the patient is > 35 years of age. The mechanism by which there is sudden occlusion of the interarterial coronary artery is at present unknown, although there are a number of hypotheses involving the oblique passage of the vessel as it leaves the aorta. Sudden death is probably rare considering the number of people who have these anomalies. Symptoms premonitory to a fatal event such as exertional syncope, chest pain, or palpitations are probably common in patients at risk, and surgical correction is indicated in symptomatic patients at any age. In older asymptomatic patients, surgery is not recommended, since the incidence of sudden death in this age group is extremely small. In asymptomatic young patients, a stress test, preferably with radioisotope myocardial perfusion imaging or stress echocardiogram, should be done and surgical correction performed in those with ischemia provoked in the appropriate myocardial region. Since there is evidence that in patients who have survived a potentially fatal event, it is rare to be able to provoke ischemia with equal or greater exercise than had precipitated the malignant arrhythmia, the

  19. Sudden cardiac arrest due to a single sodium channel mutation producing a mixed phenotype of Brugada and Long QT3 syndromes.

    PubMed

    Lakshmanadoss, U; Mertens, A; Gallagher, M; Kutinsky, I; Williamson, B

    2016-01-01

    Inherited arrhythmia syndromes are a known, albeit rare, cause of sudden cardiac arrest which may present with characteristic electrocardiogram changes in patients with structurally normal heart. There are a variety of distinct arrhythmogenic syndromes that arise from mutations in voltage gated sodium channels, resulting in either gain or loss of function. We describe a patient with a primary inherited arrhythmia syndrome which presented as sudden cardiac arrest. Further workup revealed that her arrest was due to a combination of Brugada syndrome and Long QT3 syndrome secondary to a deleterious mutation of voltage-gated, sodium channel, type V alpha subunit (SCN5A Thr1709Met). PMID:27676163

  20. 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.

  1. Sudden cardiac death in the soccer field: a retrospective study in young soccer players from 2000 to 2013.

    PubMed

    Davogustto, Giovanni; Higgins, John

    2014-11-01

    Soccer is the most popular sport in the world, with over 200 million active players. Sudden cardiac death (SCD) represents the most striking as well as the most common cause of death in the soccer field. Underlying cardiovascular pathologies predispose to life threatening ventricular arrhythmias and SCD in soccer players. Up to thousands to hundred thousands players might have an underlying condition that predisposes them for SCD. After several media striking SCD events in soccer players the Fédération Internationale de Football Association (FIFA) has made screening recommendations that are more thorough than the ones recommended for the American Heart Association and the European Society of Cardiology. We present a retrospective search through Internet databases that resulted in 54 soccer players with SCD events from 2000 until 2013. In this article, we will describe and discuss the conditions of those cases of SCD in order to provide more knowledge of the factors that may precipitate SCD in young soccer players.

  2. Clinical Cosmobiology - Sudden Cardiac Death and Daily / Monthly Geomagnetic, Cosmic Ray and Solar Activity - the Baku Study (2003-2005)

    NASA Astrophysics Data System (ADS)

    Stoupel, E.; Babayev, E. S.; Mustafa, F. R.; Abramson, E.; Israelevich, P.; Sulkes, J.

    2006-12-01

    Part of results of collaborative studies for revealing an influence of the periodical changes of solar, geomagnetic and cosmic ray activities on the sudden cardiac death (SCD) mortality is described in this paper. The data covering daily and monthly temporal distribution of SCD (788 patients in 36 months in 2003-2005), taken from all of emergency and first medical aid stations of grand Baku area, were analyzed and compared with certain cosmophysical parameters. It was obtained that SCD is higher on the highest and lowest daily levels of geomagnetic activity. Days with SCD are accompanied by higher cosmic ray (neutron) activity. The monthly number of SCD was inversely related to solar and geomagnetic activities while was positively linked with cosmic ray activity level. It was concluded that cosmic ray activity could be considered as one of regulating external/environmental factors in human homeostasis.

  3. 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

  4. Serum 25(OH)D Is a 2-Year Predictor of All-Cause Mortality, Cardiac Death and Sudden Cardiac Death in Chest Pain Patients from Northern Argentina

    PubMed Central

    Naesgaard, Patrycja A.; León De La Fuente, Ricardo A.; Nilsen, Stein Tore; Woie, Leik; Aarsland, Torbjoern; Brede, Cato; Staines, Harry; Nilsen, Dennis W. T.

    2012-01-01

    Background Several studies have shown an association between vitamin D deficiency and cardiovascular risk. Vitamin D status is assessed by determination of 25-hydroxyvitamin D [25(OH)D] in serum. Methods We assessed the prognostic utility of 25(OH)D in 982 chest-pain patients with suspected acute coronary syndrome (ACS) from Salta, Northern Argentina. 2-year follow-up data including all-cause mortality, cardiac death and sudden cardiac death were analyzed in quartiles of 25(OH)D, applying univariate and multivariate analysis. Results There were statistically significant changes in seasonal 25(OH)D levels. At follow-up, 119 patients had died. The mean 25(OH)D levels were significantly lower among patients dying than in long-term survivors, both in the total population and in patients with a troponin T (TnT) release (n = 388). When comparing 25(OH)D in the highest quartile to the lowest quartile in a multivariable Cox regression model for all-cause mortality, the hazard ratio (HR) for cardiac death and sudden cardiac death in the total population was 0.37 (95% CI, 0.19–0.73), p = 0.004, 0.23 (95% CI, 0.08–0.67), p = 0.007, and 0.32 (95% CI, 0.11–0.94), p = 0.038, respectively. In patients with TnT release, the respective HR was 0.24 (95% CI, 0.10–0.54), p = 0.001, 0.18 (95% CI, 0.05–0.60), p = 0.006 and 0.25 (95% CI, 0.07–0.89), p = 0.033. 25(OH)D had no prognostic value in patients with no TnT release. Conclusion Vitamin D was shown to be a useful biomarker for prediction of mortality when obtained at admission in chest pain patients with suspected ACS. Trial registration ClinicalTrials.gov NCT01377402 PMID:22970121

  5. 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

  6. 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…

  7. Fulminant Peripartum myocarditis associated with sudden cardiac death: a case report.

    PubMed

    Ciccone, Marco Matteo; Dentamaro, Ilaria; Carbonara, Santa; Ricci, Gabriella; Vestito, Domenico; Marzullo, Andrea; Tunzi, Francesco; Solarino, Biagio

    2016-01-01

    Myocarditis is an inflammatory disease of myocardium, associated with nonischemic necrosis and degeneration of myocytes. Although the clinical course is rapid, myocarditis can lead to dilated cardiomyopathy with chambers dilatation and ventricular dysfunction. The pathophysiology of myocarditis in humans is not completely understood. There are several etiological agents implicated, mainly viral agents. The clinical presentation is extremely various, with nonspecific systemic symptoms until sudden death. The great variability of symptoms makes the diagnosis, therefore, extremely difficult. We report the case of a 40-year-old woman who developed, after childbirth, hyperthermia associated with neck and left arm pain; initially treated with acetaminophen, without any benefit, the young woman, after few days, died suddenly. The autopsy documented the presence of edematous lungs and enlarged and congested liver. The microbiological tests performed 4 days after death were negative. The heart was normal in shape and volume; a section of the left ventricle wall showed subendocardial discromic areas histologically characterized by multifocal perivascular and interstitial inflammatory infiltrates. These infiltrates consisted mainly of neutrophils with eosinophil component associated with myocyte necrosis and hemorrhagic interstitial infiltration.

  8. Sudden death while driving. Role of sinus perinodal degeneration and cardiac neural degeneration and ganglionitis.

    PubMed

    James, T N; Pearce, W N; Givhan, E G

    1980-05-01

    A young business executive was seen to slump over his steering wheel while driving, after which the automobile veered and turned over. Quickly taken unconscious to a nearby emergency room, he was pronounced dead on arrival. Because there was insufficient physical injury found to account for his death, and because atrial fibrillation had been detected for the first time on a routine physical examination 3 months previously, special examination of the cardiac conduction system was performed. A fibroma was present on the right side of the central fibrous body above the His bundle, similar to several fibromas on the mitral valve. Small foci of neuritis were present in the ventricular myocardium and the atrioventricular node. More extensive neural degeneration and ganglionitis were found near the sinus node, which also exhibited an encircling perinodal fibrosis. Ways in which these abnormalities could have caused a fatal electrical instability of the heart are discussed. Careful examination of the cardiac conduction system is warranted in other fatal automobile accidents under similar circumstances.

  9. SCD-HeFT: Use of RR Interval Statistics for Long-term Risk Stratification for Arrhythmic Sudden Cardiac Death

    PubMed Central

    Au-yeung, Wan-tai M.; Reinhall, Per; Poole, Jeanne E.; Anderson, Jill; Johnson, George; Fletcher, Ross D.; Moore, Hans J.; Mark, Daniel B.; Lee, Kerry L.; Bardy, Gust H.

    2015-01-01

    Background In the SCD-HeFT a significant fraction of the congestive heart failure (CHF) patients ultimately did not die suddenly from arrhythmic causes. CHF patients will benefit from better tools to identify if ICD therapy is needed. Objective To identify predictor variables from baseline SCD-HeFT patients’ RR intervals that correlate to arrhythmic sudden cardiac death (SCD) and mortality and to design an ICD therapy screening test. Methods Ten predictor variables were extracted from pre-randomization Holter data from 475 patients enrolled in the SCD-HeFT ICD arm using novel and traditional heart rate variability methods. All variables were correlated to SCD using Mann Whitney-Wilcoxon test and receiver operating characteristic analysis. ICD therapy screening tests were designed by minimizing the cost of false classifications. Survival analysis, including log-rank test and Cox models, was also performed. Results α1 and α2 from detrended fluctuation analysis, the ratio of low to high frequency power, the number of PVCs per hour and heart rate turbulence slope are all statistically significant for predicting the occurrences of SCD (p<0.001) and survival (log-rank p<0.01). The most powerful multivariate predictor tool using the Cox Proportional Hazards was α2 with a hazard ratio of 0.0465 (95% CI: 0.00528 – 0.409, p<0.01). Conclusion Predictor variables from RR intervals correlate to the occurrences of SCD and distinguish survival among SCD-HeFT ICD patients. We believe SCD prediction models should incorporate Holter based RR interval analysis to refine ICD patient selection especially in removing patients who are unlikely to benefit from ICD therapy. PMID:26096609

  10. 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

  11. Arrhythmias and sudden cardiac death in elite athletes. American College of Cardiology, 16th Bethesda Conference.

    PubMed

    Garson, A

    1998-01-01

    With the recent high visibility deaths of Hank Gathers and Reggie Lewis, two nationally recognized elite basketball players due to cardiovascular disease and arrhythmias, our awareness of the most optimal ways to manage athletes with known arrhythmias has become heightened. In making medical decisions we physicians come to rely in large measure on data, in addition to clinical acumen and experience. Unfortunately, we are at a disadvantage with respect to athletes since previously published data on the natural history and outcome of such individuals with known arrhythmias are sparse. Furthermore, the tragedies of Lewis, Gathers, Pete Maravich and others are also poignant reminders that the denominator of this equation is not defined and that we do not really know precisely how many athletes experience important arrhythmias, nor their relation to sports activity. In the decade since the 16th Bethesda Conference, an American College of Cardiology sponsored consensus panel that developed standards and recommendations for the disqualification from competition of athletes with known cardiovascular disease, little new data have been developed to make objective decisions in these areas (including arrhythmias) much easier. Nevertheless, while such decision-making in athletes involves situations that are relatively rare, the consequences of misjudgement are substantial. Unfortunately, to complicate matters, even if the precise likelihood of sudden death for a given athlete with arrhythmias were known, many (if not most) professional and elite college athletes might still regard any risk as acceptable and withdrawal from formal competition as highly unacceptable from a financial and psychological standpoint. In this review, consideration will be given to the state of our medical knowledge in these areas. Many controversies persist with regard to arrhythmias, most notably for the athlete who has Wolff-Parkinson-White, mitral valve prolapse, myocarditis, or complex ventricular

  12. 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

  13. A New Insight Into Sudden Cardiac Death in Young People: A Systematic Review of Cases of Takotsubo Cardiomyopathy.

    PubMed

    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

    2015-08-01

    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

  14. 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

  15. Improve the prevention of sudden cardiac arrest in emerging countries: the Improve SCA clinical study design

    PubMed Central

    Zhang, Shu; Singh, Balbir; Rodriguez, Diego A.; Chasnoits, Alexandr Robertovich; Hussin, Azlan; Ching, Chi-Keong; Huang, Dejia; Liu, Yen-Bin; Cerkvenik, Jeffrey; Willey, Sarah; Kim, Young-Hoon

    2015-01-01

    Aims This study aims to demonstrate that primary prevention (PP) patients with one or more additional risk factors are at a similar risk of life-threatening ventricular arrhythmias when compared with secondary prevention (SP) patients, and would receive similar benefit from an implantable cardioverter defibrillator (ICD), or cardiac resynchronization therapy-defibrillator (CRT-D) implant. The study evaluates the benefits of therapy for high-risk patients in countries where defibrillation therapy for PP of SCA is underutilized. Methods Enrolment will consist of 4800 ICD-eligible patients from Asia, Latin America, Eastern Europe, the Middle East, and Africa. Upon enrolment, patients will be categorized as SP or PP. Primary prevention patients will be assessed for additional risk factors: syncope/pre-syncope, non-sustained ventricular tachycardia, frequent premature ventricular contractions, and low left ventricular ejection fraction. Those PP patients with one or more risk factors will be categorized as ‘1.5’ patients. Implant of an ICD/CRT-D will be left to the patient and/or physician's discretion. The primary endpoint will compare the appropriate ICD therapy rate between SP and 1.5 patients. The secondary endpoint compares mortality between 1.5 implanted and non-implanted patients. Conclusion The Improve SCA study will investigate a subset of PP patients, believed to be at similar risk of life-threatening ventricular arrhythmias as SP patients. Results may help clinicians identify and refer the highest risk PP patients for ICDs, help local societies expand guidelines to include PP of SCA utilizing ICDs, and provide additional geographical-relevant evidence to allow patients to make an informed decision whether to receive an ICD. Trial registration NCT02099721. PMID:26037794

  16. Familial Atrial Septal Defect and Sudden Cardiac Death: Identification of a Novel NKX2‐5 Mutation and a Review of the Literature

    PubMed Central

    Ellesøe, Sabrina Gade; Johansen, Morten Munk; Bjerre, Jesper Vandborg; Hjortdal, Vibeke Elisabeth; Brunak, Søren

    2015-01-01

    Abstract Objective Atrial septal defect (ASD) is the second most common congenital heart defect (CHD) and is observed in families as an autosomal dominant trait as well as in nonfamilial CHD. Mutations in the NKX2‐5 gene, located on chromosome 5, are associated with ASD, often combined with conduction disturbances, cardiomyopathies, complex CHD, and sudden cardiac death as well. Here, we show that NKX2‐5 mutations primarily occur in ASD patients with conduction disturbances and heritable ASD. Furthermore, these families are at increased risk of sudden cardiac death. Results We screened 39 probands with familial CHD for mutations in NKX2‐5 and discovered a novel mutation in one family (2.5%) with ASD and atrioventricular block. A review of the literature revealed 59 different NKX2‐5 mutations in 202 patients. Mutations were significantly more common in familial cases compared to nonfamilial cases (P = 7.1 × 10−9). The majority of patients (74%) had ASD with conduction disturbance. Nineteen patients (15%) of 120 with familial ASD and conduction disturbance died from sudden cardiac death of which nine (8%) were confirmed mutation carriers, and 10 were possible carriers. Conclusions NKX2‐5 mutations mainly occur in familial CHD, the signature phenotype is ASD with conduction disturbances and mutation carriers are at increased risk of sudden cardiac death. We suggest that familial ASD patients should be screened for NKX2‐5 mutations and, if they are mutation carriers, implantation of an implantable cardioverter‐defibrillator should be considered in these patients. PMID:26679770

  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. 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.

  19. Effects of Mineralocorticoid Receptor Antagonists on the Risk of Sudden Cardiac Death in Patients With Left Ventricular Systolic Dysfunction

    PubMed Central

    Bapoje, Srinivas R.; Bahia, Amit; Hokanson, John E.; Peterson, Pamela N.; Heidenreich, Paul A.; Lindenfeld, JoAnn; Allen, Larry A.; Masoudi, Frederick A.

    2013-01-01

    Background Sudden cardiac death (SCD) is an important cause of death in patients with left ventricular systolic dysfunction. Mineralocorticoid receptor antagonists (MRAs) may attenuate this risk. The objective of this meta-analysis was to assess the impact of MRAs on SCD in patients with left ventricular systolic dysfunction. Methods and Results We systematically searched PubMed, EMBASE, Cochrane, and other databases through March 30, 2012, without language restrictions. We included trials that enrolled patients with left ventricular ejection fraction of ≤45%, randomized subjects to MRAs versus control and reported outcomes on SCD, total and cardiovascular mortality. Eight published trials that enrolled 11875 patients met inclusion criteria. Of these, 6 reported data on SCD and cardiovascular mortality, and 7 reported data on total mortality. No heterogeneity was observed among the trials. Patients treated with MRAs had 23% lower odds of experiencing SCD compared with controls (odds ratio, 0.77; 95% confidence interval, 0.66–0.89; P=0.001). Similar reductions were observed in cardiovascular (0.75; 95% confidence interval, 0.68– 0.84; P<0.001) and total mortality (odds ratio, 0.74; 95% confidence interval, 0.63–0.86; P<0.001). Although publication bias was observed, the results did not change after a trim and fill test, suggesting that the impact of this bias was likely insignificant. Conclusions MRAs reduce the risk of SCD in patients with left ventricular systolic dysfunction. Comparative effectiveness studies of MRAs on SCD in usual care as well as studies evaluating the efficacy of other therapies to prevent SCD in patients receiving optimal MRA therapy are needed to guide clinical decision-making. PMID:23403436

  20. 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. ...

  1. 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 ...

  2. A case-crossover analysis of fine particulate matter air pollution and out-of-hospital sudden cardiac arrest.

    PubMed

    Checkoway, H; Levy, D; Sheppard, L; Kaufman, J; Koenig, J; Siscovick, D

    2000-12-01

    Numerous recent epidemiologic studies report increases in the daily incidence of cardiovascular disease mortality and morbidity related to increases in daily levels of fine particulate matter (PM)* air pollution. This study sought to evaluate the possible association between the occurrence of out-of-hospital sudden cardiac arrest (SCA) and daily PM levels in the Seattle metropolitan area. The underlying hypothesis was that PM exposure may act as a cardiovascular trigger for SCA. A case-crossover study was conducted among 362 SCA cases identified by paramedics from October 1988 through June 1994. Cases were King County WA residents who were married, aged 25 to 74 years at the time of their SCA, with no prior history of clinically recognized heart disease or other life-threatening comorbid conditions. Daily averages of regional PM monitoring data for nephelometry measures of PM (reported in units of bsp, referred to as coefficient of light scattering) and PM10 (particulate matter 10 microm or smaller in aerodynamic diameter) from three monitoring sites were used as indicators of exposure. In the case-crossover analysis, PM levels during index times of cases within the five days preceding an SCA were compared with PM levels at referent days, defined as the same days of the week during the month of SCA occurrence. Lag periods for index days of 0 to 5 days were investigated. The estimated relative risk (RR) at a lag of 1 day for an interquartile range (IQR) change in nephelometry (0.51 bsp) was 0.893 (95% confidence interval [CI] 0.779-1.024). Varying the lag period had only minimal change on the observed association. The estimated relative risk at a lag of 1 day for an IQR change of PM10 (19.3 microg/m3) was 0.868 (95% CI 0.744-1.012). There was no evidence of confounding by ambient daily exposures to carbon monoxide or sulfur dioxide. Analysis of effect modification by individual-level variables, including age, cigarette smoke exposure, physical activity, and other

  3. Inter-Association Task Force Recommendations on Emergency Preparedness and Management of Sudden Cardiac Arrest in High School and College Athletic Programs: A Consensus Statement

    PubMed Central

    Drezner, Jonathan A; Courson, Ron W; Roberts, William O; Mosesso, Vincent N; Link, Mark S; Maron, Barry J

    2007-01-01

    Objective: To assist high school and college athletic programs prepare for and respond to a sudden cardiac arrest (SCA). This consensus statement summarizes our current understanding of SCA in young athletes, defines the necessary elements for emergency preparedness, and establishes uniform treatment protocols for the management of SCA. Background: Sudden cardiac arrest is the leading cause of death in young athletes. The increasing presence of and timely access to automated external defibrillators (AEDs) at sporting events provides a means of early defibrillation and the potential for effective secondary prevention of sudden cardiac death. An Inter-Association Task Force was sponsored by the National Athletic Trainers' Association to develop consensus recommendations on emergency preparedness and management of SCA in athletes. Recommendations: Comprehensive emergency planning is needed for high school and college athletic programs to ensure an efficient and structured response to SCA. Essential elements of an emergency action plan include establishment of an effective communication system, training of anticipated responders in cardiopulmonary resuscitation and AED use, access to an AED for early defibrillation, acquisition of necessary emergency equipment, coordination and integration of on-site responder and AED programs with the local emergency medical services system, and practice and review of the response plan. Prompt recognition of SCA, early activation of the emergency medical services system, the presence of a trained rescuer to initiate cardiopulmonary resuscitation, and access to early defibrillation are critical in the management of SCA. In any collapsed and unresponsive athlete, SCA should be suspected and an AED applied as soon as possible for rhythm analysis and defibrillation if indicated. PMID:17597956

  4. Risk of mortality (including sudden cardiac death) and major cardiovascular events in atypical and typical antipsychotic users: a study with the general practice research database.

    PubMed

    Murray-Thomas, Tarita; Jones, Meghan E; Patel, Deven; Brunner, Elizabeth; Shatapathy, Chetan C; Motsko, Stephen; Van Staa, Tjeerd P

    2013-01-01

    Objective. Antipsychotics have been associated with increased cardiac events including mortality. This study assessed cardiac events including mortality among antipsychotic users relative to nonusers. Methods. The General Practice Research Database (GPRD) was used to identify antipsychotic users, matched general population controls, and psychiatric diseased nonusers. Outcomes included cardiac mortality, sudden cardiac death (SCD), all-cause mortality (excluding suicide), coronary heart disease (CHD), and ventricular arrhythmias (VA). Sensitivity analyses were conducted for age, dose, duration, antipsychotic type, and psychiatric disease. Results. 183,392 antipsychotic users (115,491 typical and 67,901 atypical), 544,726 general population controls, and 193,920 psychiatric nonusers were identified. Nonusers with schizophrenia, dementia, or bipolar disorder had increased risks of all-cause mortality compared to general population controls, while nonusers with major depression had comparable risks. Relative to psychiatric nonusers, the adjusted relative ratios (aRR) of all-cause mortality in antipsychotic users was 1.75 (95% CI: 1.64-1.87); cardiac mortality 1.72 (95% CI: 1.42-2.07); SCD primary definition 5.76 (95% CI: 2.90-11.45); SCD secondary definition 2.15 (95% CI: 1.64-2.81); CHD 1.16 (95% CI: 0.94-1.44); and VA 1.16 (95% CI: 1.02-1.31). aRRs of the various outcomes were lower for atypical versus typical antipsychotics (all-cause mortality 0.83 (95% CI: 0.80-0.85); cardiac mortality 0.89 (95% CI: 0.82-0.97); and SCD secondary definition 0.76 (95% CI: 0.55-1.04). Conclusions. Antipsychotic users had an increased risk of cardiac mortality, all-cause mortality, and SCD compared to a psychiatric nonuser cohort.

  5. The FIFA medical emergency bag and FIFA 11 steps to prevent sudden cardiac death: setting a global standard and promoting consistent football field emergency care.

    PubMed

    Dvorak, Jiri; Kramer, Efraim B; Schmied, Christian M; Drezner, Jonathan A; Zideman, David; Patricios, Jon; Correia, Luis; Pedrinelli, André; Mandelbaum, Bert

    2013-12-01

    Life-threatening medical emergencies are an infrequent but regular occurrence on the football field. Proper prevention strategies, emergency medical planning and timely access to emergency equipment are required to prevent catastrophic outcomes. In a continuing commitment to player safety during football, this paper presents the FIFA Medical Emergency Bag and FIFA 11 Steps to prevent sudden cardiac death. These recommendations are intended to create a global standard for emergency preparedness and the medical response to serious or catastrophic on-field injuries in football.

  6. 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.

  7. 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.

  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. Next-generation sequencing of 34 genes in sudden unexplained death victims in forensics and in patients with channelopathic cardiac diseases.

    PubMed

    Hertz, C L; Christiansen, S L; Ferrero-Miliani, L; Fordyce, S L; Dahl, M; Holst, A G; Ottesen, G L; Frank-Hansen, R; Bundgaard, H; Morling, N

    2015-07-01

    Sudden cardiac death (SCD) is responsible for a large proportion of sudden deaths in young individuals. In forensic medicine, many cases remain unexplained after routine postmortem autopsy and conventional investigations. These cases are called sudden unexplained deaths (SUD). Genetic testing has been suggested useful in forensic medicine, although in general with a significantly lower success rate compared to the clinical setting. The purpose of the study was to estimate the frequency of pathogenic variants in the genes most frequently associated with SCD in SUD cases and compare the frequency to that in patients with inherited cardiac channelopathies. Fifteen forensic SUD cases and 29 patients with channelopathies were investigated. DNA from 34 of the genes most frequently associated with SCD were captured using NimbleGen SeqCap EZ library build and were sequenced with next-generation sequencing (NGS) on an Illumina MiSeq. Likely pathogenic variants were identified in three out of 15 (20%) forensic SUD cases compared to 12 out of 29 (41%) patients with channelopathies. The difference was not statistically significant (p = 0.1). Additionally, two larger deletions of entire exons were identified in two of the patients (7%). The frequency of likely pathogenic variants was >2-fold higher in the clinical setting as compared to SUD cases. However, the demonstration of likely pathogenic variants in three out of 15 forensic SUD cases indicates that NGS investigations will contribute to the clinical investigations. Hence, this has the potential to increase the diagnostic rate significantly in the forensic as well as in the clinical setting.

  10. 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 & ...

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

    PubMed

    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. PMID:26857994

  12. 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

  13. Furosemide and Potassium Chloride-induced Alteration in Protein Profile of Left Ventricle and its Associated Risk for Sudden Cardiac Death

    PubMed Central

    Murugan, Ponniah Senthil; Selvam, Govindan Sadasivam

    2014-01-01

    Background: Potassium ion (K+) plays an essential role in maintaining the electrical potential across the plasma membrane of cells. An abnormal serum K+ level is associated with increased risk of ventricular arrhythmia and sudden cardiac death (SCD) and these patients are generally prescribed with furosemide and potassium chloride (KCl). We explored the association between the use of these drugs and the risk of SCD by analyzing biochemical parameters and proteomic changes. Materials and Methods: The rats were administered with furosemide and KCl and their effect was analyzed by studying cardiac and oxidative markers, electrolyte content and histopathology. Two-dimensional gel electrophoresis (2-DE) and electrospray ionization-mass spectrometry were performed to investigate the LV proteomic changes. Results: Furosemide and KCl treatments showed significant effect on physiological and biochemical parameters, and LV histopathology of experimental rats. Proteomic analysis indicated 17 differentially expressed proteins. Among them, eight protein spots were identified using peptide mass fingerprinting. In furosemide-treated group, four proteins were upregulated and two proteins were downregulated when compared to 2-DE proteomic profile of control. While in KCl-treated rats, seven proteins were found downregulated. Conculsion: The present study revealed the differential expression of proteins by furosemide and KCl treatment. Thus, the results suggest that the use of these drugs leads to proteomic alteration, which involve in cardiac conductivity that might increase the risk of SCD. PMID:24748728

  14. 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.

  15. Prenatal Nicotine Exposure in Rhesus Monkeys Compromises Development of Brainstem and Cardiac Monoamine Pathways Involved in Perinatal Adaptation and Sudden Infant Death Syndrome: Amelioration by Vitamin C

    PubMed Central

    Slotkin, Theodore A.; Seidler, Frederic J.; Spindel, Eliot R.

    2011-01-01

    Maternal smoking during pregnancy greatly enhances perinatal morbidity/mortality and is the major risk factor for Sudden Infant Death Syndrome (SIDS). Studies in developing rodents indicate that nicotine is a neuroteratogen that targets monoamine pathways involved in the responses to hypoxia that are in turn, hypothesized to contribute to these adverse events. We administered nicotine to pregnant Rhesus monkeys from gestational day 30 through 160 by continuous infusion, achieving maternal plasma levels comparable to those in smokers; we examined neurochemical parameters immediately after Caesarean delivery at the end of the exposure period. Nicotine evoked elevations in brainstem serotonin levels and serotonin turnover, indicating hyperactivity of these pathways. The same treatment evoked a deficit in cardiac norepinephrine levels. Both effects were offset by coadministration of the antioxidant, Vitamin C. Brainstem serotonin hyperinnervation is a hallmark of SIDS, and the hyperactivity seen here can also account for the downregulation of serotonin receptors noted in this disorder. Deficient cardiac sympathetic innervation is also consistent with increased vulnerability to hypoxia during delivery or in the agonal event in SIDS. Our results thus indicate that nicotine exposure in a primate model produces brainstem and autonomic abnormalities of the key monoamine systems that govern the response to hypoxia, indicate an important role of oxidative stress in the adverse effects, and point to potential amelioration strategies that could offset these particular effects of nicotine. PMID:21320590

  16. 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

  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 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.

  19. 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.

  20. Ultra-long cardiopulmonary resuscitation with thrombolytic therapy for a sudden cardiac arrest patient with pulmonary embolism.

    PubMed

    Hsin, Tian; Chun, Fang Wei; Tao, Hsieh Lu

    2014-11-01

    The recovery of cardiac arrest patients with pulmonary embolism who are given an ultra-long duration of cardiopulmonary resuscitation(CPR) with manual chest compressions is very rare. We reported a 52-year-old woman who came to the hospital because of paroxysmal dyspnea. She experienced in hospital cardiac arrest and underwent prolonged CPR with manual chest compressions for 160 minutes. The patient presented with several episodes of cardiac electrical activity that lasted 10 to 20 seconds without consciousness. Blood gas analysis revealed pH 7.27, PaO2 51 mm Hg, and D-dimer 3723 ìg/mL. In addition,acute pulmonary embolism was considered due to the patient's symptoms. Thrombolytic therapy was given 100 minutes after the CPR was implemented. Sixty minutes later, her sinus rhythm was restored.After the continuous renal replacement therapy for renal failure was administered and other conservative treatments were given for the complications after the CPR with thrombolytic therapy, she finally recovered and was discharged. This case report supports the use of persistent ongoing CPR efforts and the use of thrombolytic therapy.

  1. 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

  2. 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

  3. 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

  4. 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

  5. Long-term efficacy of implantable cardiac resynchronization therapy plus defibrillator for primary prevention of sudden cardiac death in patients with mild heart failure: an updated meta-analysis.

    PubMed

    Sun, Wei-Ping; Li, Chun-Lei; Guo, Jin-Cheng; Zhang, Li-Xin; Liu, Ran; Zhang, Hai-Bin; Zhang, Ling

    2016-07-01

    Previous studies of implantable cardiac resynchronization therapy plus defibrillator (CRT-D) therapy used for primary prevention of sudden cardiac death have suggested that CRT-D therapy is less effective in patients with mild heart failure and a wide QRS complex. However, the long-term benefits are variable. We performed a meta-analysis of randomized trials identified in systematic searches of MEDLINE, EMBASE, and the Cochrane Database. Three studies (3858 patients) with a mean follow-up of 66 months were included. Overall, CRT-D therapy was associated with significantly lower all-cause mortality than was implantable cardioverter defibrillator (ICD) therapy (OR, 0.78; 95 % CI, 0.63-0.96; P = 0.02; I (2) = 19 %). However, the risk of cardiac mortality was comparable between two groups (OR, 0.74; 95 % CI, 0.53-1.01; P = 0.06). CRT-D treatment was associated with a significantly lower risk of hospitalization for heart failure (OR, 0.67; 95 % CI, 0.50-0.89; P = 0.005; I (2) = 55 %). The composite outcome of all-cause mortality and hospitalization for heart failure was also markedly lower with CRT-D therapy than with ICD treatment alone (OR, 0.67; 95 % CI, 0.57-0.77; P < 0.0001; I (2) = 0 %). CRT-D therapy decreased the long-term risk of mortality and heart failure events in patients with mild heart failure with a wide QRS complex. However, long-term risk of cardiac mortality was similar between two groups. More randomized studies are needed to confirm these findings, especially in patients with NYHA class I heart failure or patients without LBBB.

  6. Sudden Arrhythmia Death Syndromes (SADS) Foundation

    MedlinePlus

    ... SADS Foundation and John Hopkins Hospital Division of Cardiology are hosting a family support and educational meeting ... Baltimore/DC area families with cardiac arrhythmias. Sports Cardiology & Sudden Cardiac Arrest in the Young Conference 01/ ...

  7. Identification and Functional Characterization of a Novel CACNA1C-Mediated Cardiac Disorder Characterized by Prolonged QT Intervals with Hypertrophic Cardiomyopathy, Congenital Heart Defects, and Sudden Cardiac Death

    PubMed Central

    Boczek, Nicole J.; Ye, Dan; Jin, Fang; Tester, David J.; Huseby, April; Bos, J. Martijn; Johnson, Aaron J.; Kanter, Ronald; Ackerman, Michael J.

    2016-01-01

    Background A portion of sudden cardiac deaths (SCD) can be attributed to structural heart diseases such as hypertrophic cardiomyopathy (HCM) or cardiac channelopathies such as long QT syndrome (LQTS); however, the underlying molecular mechanisms are quite distinct. Here, we identify a novel CACNA1C missense mutation with mixed loss-of-function/gain-of-function responsible for a complex phenotype of LQTS, HCM, SCD, and congenital heart defects (CHDs). Methods and Results Whole exome sequencing (WES) in combination with Ingenuity Variant Analysis was completed on three affected individuals and one unaffected individual from a large pedigree with concomitant LQTS, HCM, and CHDs and identified a novel CACNA1C mutation, p.Arg518Cys, as the most likely candidate mutation. Mutational analysis of exon 12 of CACNA1C was completed on 5 additional patients with a similar phenotype of LQTS plus a personal or family history of HCM-like phenotypes, and identified two additional pedigrees with mutations at the same position, p.Arg518Cys/His. Whole cell patch clamp technique was used to assess the electrophysiological effects of the identified mutations in CaV1.2, and revealed a complex phenotype, including loss of current density and inactivation in combination with increased window and late current. Conclusions Through WES and expanded cohort screening, we identified a novel genetic substrate p.Arg518Cys/His-CACNA1C, in patients with a complex phenotype including LQTS, HCM, and CHDs annotated as cardiac-only Timothy syndrome. Our electrophysiological studies, identification of mutations at the same amino acid position in multiple pedigrees, and co-segregation with disease in these pedigrees provides evidence that p.Arg518Cys/His is the pathogenic substrate for the observed phenotype. PMID:26253506

  8. 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.

  9. 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

  10. Sudden cardiac death after repair of anomalous origin of left coronary artery from right sinus of Valsalva with an interarterial course : Case report and review of the literature.

    PubMed

    Nguyen, A L; Haas, F; Evens, J; Breur, J M P J

    2012-11-01

    Anomalous aortic origin of the coronary artery from the opposite sinus with interarterial course (AAOCA) is a rare condition with a high risk of sudden cardiac death (SCD) during or after strenuous exertion. SCD after repair of this anomaly is extremely rare. Here we present a 15-year-old athlete who collapsed on the basketball court in whom an anomalous origin of the left coronary artery from the right sinus of Valsalva with interarterial course (ALCA) was diagnosed. In spite of extensive pre-sport participation testing, SCD occurred shortly after surgical correction. We reviewed the literature to establish an evidence-based recommendation to aid physicians in conducting the optimal pre-sport participation management for the prevention of SCD in patients with a surgically corrected AAOCA/ALCA, especially for those who participate in strenuous exercise. Review of the literature (60 articles with 325 patients) reveals that post-surgical, pre-sport participation testing varies greatly but that mortality after surgical repair is extremely low (1.5 %). In conclusion, SCD can still rarely occur after repair of AAOCA despite extensive pre-sport participation testing. This should raise awareness among physicians treating these patients and raises the question whether or not return-to-play guidelines need to be revised. PMID:23055055

  11. Sudden cardiac death after repair of anomalous origin of left coronary artery from right sinus of Valsalva with an interarterial course : Case report and review of the literature.

    PubMed

    Nguyen, A L; Haas, F; Evens, J; Breur, J M P J

    2012-11-01

    Anomalous aortic origin of the coronary artery from the opposite sinus with interarterial course (AAOCA) is a rare condition with a high risk of sudden cardiac death (SCD) during or after strenuous exertion. SCD after repair of this anomaly is extremely rare. Here we present a 15-year-old athlete who collapsed on the basketball court in whom an anomalous origin of the left coronary artery from the right sinus of Valsalva with interarterial course (ALCA) was diagnosed. In spite of extensive pre-sport participation testing, SCD occurred shortly after surgical correction. We reviewed the literature to establish an evidence-based recommendation to aid physicians in conducting the optimal pre-sport participation management for the prevention of SCD in patients with a surgically corrected AAOCA/ALCA, especially for those who participate in strenuous exercise. Review of the literature (60 articles with 325 patients) reveals that post-surgical, pre-sport participation testing varies greatly but that mortality after surgical repair is extremely low (1.5 %). In conclusion, SCD can still rarely occur after repair of AAOCA despite extensive pre-sport participation testing. This should raise awareness among physicians treating these patients and raises the question whether or not return-to-play guidelines need to be revised.

  12. 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

  13. 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

  14. Circulating n-3 fatty acids and trans-fatty acids, PLA2G2A gene variation and sudden cardiac arrest.

    PubMed

    Lemaitre, Rozenn N; Bartz, Traci M; King, Irena B; Brody, Jennifer A; McKnight, Barbara; Sotoodehnia, Nona; Rea, Thomas D; Johnson, Catherine O; Mozaffarian, Dariush; Hesselson, Stephanie; Kwok, Pui-Yan; Siscovick, David S

    2016-01-01

    Whether genetic factors influence the associations of fatty acids with the risk of sudden cardiac arrest (SCA) is largely unknown. To investigate possible gene-fatty acid interactions on SCA risk, we used a case-only approach and measured fatty acids in erythrocyte samples from 1869 SCA cases in a population-based repository with genetic data. We selected 191 SNP in ENCODE-identified regulatory regions of fifty-five candidate genes in fatty acid metabolic pathways. Using linear regression and additive genetic models, we investigated the association of the selected SNP with erythrocyte levels of fatty acids, including DHA, EPA and trans-fatty acids among the SCA cases. The assumption of no association in non-cases was supported by analysis of publicly available datasets containing over 8000 samples. None of the SNP-fatty acid associations tested among the cases reached statistical significance after correction for multiple comparisons. One SNP, rs4654990 near PLA2G2A, with an allele frequency of 0·33, was nominally associated with lower levels of DHA and EPA and higher levels of trans-fatty acids. The strongest association was with DHA levels (exponentiated coefficient for one unit (1 % of total fatty acids), 0·90, 95 % CI 0·85, 0·97; P = 0·003), indicating that for subjects with a coded allele, the OR of SCA associated with one unit higher DHA is about 90 % what it is for subjects with one fewer coded allele. These findings suggest that the associations of circulating n-3 and trans-fatty acids with SCA risk may be more pronounced in carriers of the rs4654990 G allele. PMID:27313848

  15. 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.

  16. Abortion Counseling

    ERIC Educational Resources Information Center

    Brashear, Diane B.

    1973-01-01

    The author discusses the characteristics and feelings of women undergoing abortion. She mentions the decisions which counselors must help such women face, the information they must be given, and the types of support they need. Increased counseling services are needed, she feels, for the markedly increased number of women seeking abortions. (EK)

  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. 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

  19. 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

  20. 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. ...

  1. Abortion ethics.

    PubMed

    Fromer, M J

    1982-04-01

    Nurses have opinions about abortion, but because they are health professionals and their opinions are sought as such, they are obligated to understand why they hold certain views. Nurses need to be clear about why they believe as they do, and they must arrive at a point of view in a rational and logical manner. To assist nurses in this task, the ethical issues surrounding abortion are enumerated and clarified. To do this, some of the philosophic and historic approaches to abortion and how a position can be logically argued are examined. At the outset some emotion-laden terms are defined. Abortion is defined as the expulsion of a fetus from the uterus before 28 weeks' gestation, the arbitrarily established time of viability. This discussion is concerned only with induced abortion. Since the beginning of recorded history women have chosen to have abortions. Early Jews and Christians forbade abortion on practical and religious grounds. A human life was viewed as valuable, and there was also the practical consideration of the addition of another person to the population, i.e., more brute strength to do the necessary physical work, defend against enemies, and ensure the continuation of the people. These kinds of pragmatic reasons favoring or opposing abortion have little to do with the Western concept of abortion in genaeral and what is going on in the U.S. today in particular. Discussion of the ethics of abortion must rest on 1 or more of several foundations: whether or not the fetus is a human being; the rights of the pregnant woman as opposed to those of the fetus, and circumstances of horror and hardship that might surround a pregnancy. Viability is relative. Because viability is not a specific descriptive entity, value judgments become part of the determination, both of viability and the actions that might be taken based on that determination. The fetus does not become a full human being at viability. That occurs only at conception or birth, depending on one's view

  2. Sudden death associated with danon disease in women.

    PubMed

    Miani, Daniela; Taylor, Matthew; Mestroni, Luisa; D'Aurizio, Federica; Finato, Nicoletta; Fanin, Marina; Brigido, Silvana; Proclemer, Alessandro

    2012-02-01

    Danon disease is an X-linked systemic disorder characterized by left ventricular hypertrophy, mental retardation, and skeletal myopathy affecting young men. Electrocardiogram usually displays a Wolff-Parkinson-White preexcitation pattern. Less has been reported about the phenotype in women, although later-onset cardiac symptoms have been described. The aim of this study was to expand the knowledge of the phenotype of Danon disease in women. We clinically followed and evaluated with echocardiography, cardiac magnetic resonance imaging (cMRI), and genetic testing a family affected by Danon disease in which 2 men and 6 women showed a severe arrhythmogenic phenotype. Affected family members carried a nucleotide substitution at position 294 in exon 3 (c.294 G → A) that changed a tryptophan residue to a stop codon at position W98X in the lysosome-associated membrane protein 2 (LAMP2) gene. Four women died suddenly (1 aborted) at 37 to 54 years of age. Wolff-Parkinson-White pattern with atrioventricular block was detected in 2 of 6 women. Four had successful pregnancies without symptoms of heart failure. cMRI showed late gadolinium enhancement areas in a clinically healthy woman who was a mutation carrier. Two patients underwent heart transplantation; histology of explanted hearts demonstrated severe interstitial fibrosis, hypertrophic cardiomyocytes with cytoplasmic vacuoles, and myofibrillar disarray. In conclusion, LAMP2 mutation can cause a severe arrhythmogenic phenotype in women that includes a high risk of sudden death. cMRI may be useful in women harboring LAMP2 mutations to permit early detection of cardiac involvement and guide timely considerations of implantable cardioverter-defibrillator therapy. Heart transplantation should be considered at onset of heart failure symptoms owing to rapid progression of the disease.

  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. Comparison of U.S. and Italian experiences with sudden cardiac deaths in young competitive athletes and implications for preparticipation screening strategies.

    PubMed

    Maron, Barry J; Haas, Tammy S; Doerer, Joseph J; Thompson, Paul D; Hodges, James S

    2009-07-15

    Controversy has evolved over the most practical and effective strategy for preparticipation cardiovascular screening of competitive athletes to detect unsuspected cardiovascular disease and prevent sudden death on the athletic field. Athlete screening in the Veneto region of Italy is part of a national program (with 12-lead electrocardiography) that has reported the detection of previously undiagnosed hypertrophic cardiomyopathy and a decrease in the cardiovascular death rate in young athletes. In this study, over time periods of similar length, cardiovascular-related mortality rates in Veneto athletes were compared with those of a demographically similar region of the United States (Minnesota) in which screening is limited to history and physical examination. There were 55 sudden cardiovascular deaths reported in Veneto over 26 years (2.1/year), compared with 22 deaths in 23 years (0.96/year) in Minnesota. Over the recent and comparable 11-year period, 1993 to 2004, 12 deaths were reported in Veneto and 11 in Minnesota. When analyzed as deaths per 100,000 person-years, Veneto exceeded Minnesota for all years combined (1.87 for 1979 to 2004 vs 1.06 for 1985 to 2007, respectively, p = 0.006), although the 2 regions did not differ significantly for 1993 to 2004 (0.87 vs 0.93, respectively, p = 0.88) or most recently for 2001 to 2004 (0.43 vs 0.90, respectively, p = 0.38). In conclusion, sudden cardiovascular deaths in young competitive athletes occurred at a low rate in both Veneto and Minnesota. Despite different preparticipation screening strategies, athlete sudden death rates in these demographically similar regions of the United States and Italy have not differed significantly in recent years. These data do not support a lower mortality rate associated with preparticipation screening programs involving routine electrocardiography and examinations by specially trained personnel.

  5. Genetic and toxicologic investigation of Sudden Cardiac Death in a patient with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) under cocaine and alcohol effects.

    PubMed

    Cittadini, Francesca; De Giovanni, Nadia; Alcalde, Mireia; Partemi, Sara; Carbone, Arnaldo; Campuzano, Oscar; Brugada, Ramon; Oliva, Antonio

    2015-01-01

    Cocaine and alcohol toxicity is well known, especially when simultaneously abused. These drugs perform both acute and chronic harmfulness, with significant cardiac events such as ventricular arrhythmias, tachycardia, systemic hypertension, acute myocardial infarction, ventricular hypertrophy, and acute coronary syndrome. The present report refers about a patient who died after a documented episode of psychomotor agitation followed by cardiac arrest. At the autopsy investigation, arrhythmogenic right ventricular cardiomyopathy (ARVC) was diagnosed and confirmed by postmortem molecular analysis revealing a mutation in the DSG2 gene. Postmortem toxicological analysis demonstrated a recent intake of cocaine, and the death was attributed to cardiac arrhythmias. The detection of cocaine and cocaethylene in hair samples proved chronic simultaneous intake of cocaine and alcohol at least in the last month. The authors discuss the role of these drugs and genetic predisposition of the ARVC in causing the death of the patient. PMID:25399050

  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. [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

  8. 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

  9. Abortion before & after Roe.

    PubMed

    Joyce, Ted; Tan, Ruoding; Zhang, Yuxiu

    2013-09-01

    We use unique data on abortions performed in New York State from 1971 to 1975 to demonstrate that women traveled hundreds of miles for a legal abortion before Roe. A 100-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.

  10. 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

  11. 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

  12. Unsafe abortion in adolescents.

    PubMed

    Olukoya, A A; Kaya, A; Ferguson, B J; AbouZahr, C

    2001-11-01

    Every year, an estimated 2.0-4.4 million adolescents resort to abortion. In comparison with adults, adolescents are more likely to delay the abortion, resort to unskilled persons to perform it, use dangerous methods and present late when complications arise. Adolescents are also more likely to experience complications. Consequently, adolescents seeking abortion or presenting with complications of abortion should be considered as a medical emergency. Issues requiring special attention in the management of abortion complications in adolescents are identified. Approaches to adolescent abortion should involve all levels of the health care system, as well as the community, and should include not only management of the consequences of unsafe abortion, but also post-abortion contraception and counseling. Prevention of unwanted pregnancy by providing information on sexuality, ensuring that reproductive health services are adolescent-friendly, creating a supportive environment, building young people's social and decision-making skills, and offering counseling in times of crisis are highlighted.

  13. Post abortion contraception.

    PubMed

    Gemzell-Danielsson, Kristina; Kopp, Helena Kallner

    2015-11-01

    A safe induced abortion has no impact on future fertility. Ovulation may resume as early as 8 days after the abortion. There is no difference in return to fertility after medical or surgical abortion. Most women resume sexual activity soon after an abortion. Contraceptive counseling and provision should therefore be an integrated part of the abortion services to help women avoid another unintended pregnancy and risk, in many cases an unsafe, abortion. Long-acting reversible contraceptive methods that includes implants and intrauterine contraception have been shown to be the most effective contraceptive methods to help women prevent unintended pregnancy following an abortion. However, starting any method is better than starting no method at all. This Special Report will give a short guide to available methods and when they can be started after an induced abortion.

  14. Post abortion contraception.

    PubMed

    Gemzell-Danielsson, Kristina; Kopp, Helena Kallner

    2015-11-01

    A safe induced abortion has no impact on future fertility. Ovulation may resume as early as 8 days after the abortion. There is no difference in return to fertility after medical or surgical abortion. Most women resume sexual activity soon after an abortion. Contraceptive counseling and provision should therefore be an integrated part of the abortion services to help women avoid another unintended pregnancy and risk, in many cases an unsafe, abortion. Long-acting reversible contraceptive methods that includes implants and intrauterine contraception have been shown to be the most effective contraceptive methods to help women prevent unintended pregnancy following an abortion. However, starting any method is better than starting no method at all. This Special Report will give a short guide to available methods and when they can be started after an induced abortion. PMID:26619082

  15. 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 ...

  16. Conceptualising abortion stigma.

    PubMed

    Kumar, Anuradha; Hessini, Leila; Mitchell, Ellen M H

    2009-08-01

    Abortion stigma is widely acknowledged in many countries, but poorly theorised. Although media accounts often evoke abortion stigma as a universal social fact, we suggest that the social production of abortion stigma is profoundly local. Abortion stigma is neither natural nor 'essential' and relies upon power disparities and inequalities for its formation. In this paper, we identify social and political processes that favour the emergence, perpetuation and normalisation of abortion stigma. We hypothesise that abortion transgresses three cherished 'feminine' ideals: perpetual fecundity; the inevitability of motherhood; and instinctive nurturing. We offer examples of how abortion stigma is generated through popular and medical discourses, government and political structures, institutions, communities and via personal interactions. Finally, we propose a research agenda to reveal, measure and map the diverse manifestations of abortion stigma and its impact on women's health.

  17. 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.

  18. 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

  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.

  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. Abortion and religion.

    PubMed

    Howell, N R

    1997-01-01

    This paper argues that religious communities should pose new questions about abortion in an attempt to reinvigorate the abortion debate and make it more constructive. Such questions would break the current impasse, enlarge the global and ecological scope of abortion inquiry, and engage plural religious perspectives in an interreligious dialogue about justice and abortion. After an introduction, the paper discusses the first impasse in the abortion debate, which is caused by conflicting definitions of personhood that create a fetus/pregnant woman dualism and artificially separate the fetus from its interdependence with the mother. Section 2 looks at how the abortion impasse results from the assertions of competing fetal and maternal rights and from conflict over who controls nature and women's bodies. The third section seeks alternatives to the dichotomizing of individual and community in the abortion debate in Christian theology, such as the notion of the relational self that demands attention to the wider social implications of reproduction. By examining theories that presume that people are relational, section 4 locates the abortion debate in a wider ecological context with concerns about overpopulation and environmental degradation. Section 5 explores questions of what authority can be used to determine whether abortion is ever justifiable for Christians and what authority is relevant for determining a Christian theological ethic of abortion. This section also looks at Jewish, Muslim, Hindu, and Buddhist views of abortion in the belief that the complex ethical issues relating to abortion may be explored through religious ritual. PMID:12348325

  2. Three Ways to Die Suddenly: Do They All Require Calcium Calmodulin-Dependent Protein Kinase II?

    PubMed Central

    Anderson, Mark E.

    2014-01-01

    Sudden cardiac death occurs due to a limited number of pathological events. The heart can beat too fast or too slow to maintain adequate cardiac output or the heart can rupture. Here we survey recent evidence that excessive activation of calcium calmodulin-dependent protein kinase II by three core neurohumoral pathways or by oxidant stress can lead to sudden cardiac death due to sinus node dysfunction and bradycardia, ventricular tachycardia or fibrillation, and cardiac rupture. PMID:25125731

  3. 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 ...

  4. 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 ...

  5. Abortion: a reader's guide.

    PubMed

    Hisel, L M

    1996-01-01

    This review traces the discussion of abortion in the US through 10 of the best books published on the subject in the past 25 years. The first book considered is Daniel Callahan's "Abortion: Law, Choice and Morality," which was published in 1970. Next is book of essays also published in 1970: "The Morality of Abortion: Legal and Historical Perspectives," which was edited by John T. Noonan, Jr., who became a prominent opponent to the Roe decision. It is noted that Roman Catholics would find the essay by Bernard Haring especially interesting since Haring supported the Church's position on abortion but called for acceptance of contraception. Third on the list is historian James C. Mohr's review of "Abortion in America: The Origins and Evolution of National Policy," which was printed five years after the Roe decision. Selection four is "Enemies of Choice: The Right-to-Life Movement and Its Threat to Abortion" by Andrew Merton. This 1981 publication singled out a concern about sexuality as the overriding motivator for anti-abortion groups. Two years later, Beverly Wildung Harrison published a ground-breaking, feminist, moral analysis of abortion entitled "Our Right to Choose: Toward a New Ethic of Abortion. This was followed by a more empirical and sociopolitical feminist analysis in Kristin Luker's 1984 "Abortion and the Politics of Motherhood." The seventh book is by another feminist, Rosalind Pollack Petchesky, whose work "Abortion and Women's Choice: The State, Sexuality, and Reproductive Freedom" was first published in 1984 and reprinted in 1990. The eighth important book was "Abortion and Catholicism: The American Debate," edited by Thomas A. Shannon and Patricia Beattie Jung. Rounding out the list are the 1992 work "Life Itself: Abortion in the American Mind" by Roger Rosenblatt and Ronald Dworkin's 1993 "Life's Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom."

  6. Abortion: a reader's guide.

    PubMed

    Hisel, L M

    1996-01-01

    This review traces the discussion of abortion in the US through 10 of the best books published on the subject in the past 25 years. The first book considered is Daniel Callahan's "Abortion: Law, Choice and Morality," which was published in 1970. Next is book of essays also published in 1970: "The Morality of Abortion: Legal and Historical Perspectives," which was edited by John T. Noonan, Jr., who became a prominent opponent to the Roe decision. It is noted that Roman Catholics would find the essay by Bernard Haring especially interesting since Haring supported the Church's position on abortion but called for acceptance of contraception. Third on the list is historian James C. Mohr's review of "Abortion in America: The Origins and Evolution of National Policy," which was printed five years after the Roe decision. Selection four is "Enemies of Choice: The Right-to-Life Movement and Its Threat to Abortion" by Andrew Merton. This 1981 publication singled out a concern about sexuality as the overriding motivator for anti-abortion groups. Two years later, Beverly Wildung Harrison published a ground-breaking, feminist, moral analysis of abortion entitled "Our Right to Choose: Toward a New Ethic of Abortion. This was followed by a more empirical and sociopolitical feminist analysis in Kristin Luker's 1984 "Abortion and the Politics of Motherhood." The seventh book is by another feminist, Rosalind Pollack Petchesky, whose work "Abortion and Women's Choice: The State, Sexuality, and Reproductive Freedom" was first published in 1984 and reprinted in 1990. The eighth important book was "Abortion and Catholicism: The American Debate," edited by Thomas A. Shannon and Patricia Beattie Jung. Rounding out the list are the 1992 work "Life Itself: Abortion in the American Mind" by Roger Rosenblatt and Ronald Dworkin's 1993 "Life's Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom." PMID:12178914

  7. Abortion: the continuing controversy.

    PubMed

    Behrens, C E

    1972-08-01

    While most countries of the world practice abortion, government policy, medical opinion, private opinion and actual practice vary widely. Although mortality from legal abortions is quite low, complications rise sharply after 12 gestational weeks. No conclusive proof shows adverse postabortion psychological effects. Romania, Japan and the Soviet Union experienced declining birth rates when abortion was made available and New York City saw a decline in illegitimacy of approximately 12% from 1970 to 1971. Throughout the world abortion laws vary from restrictive to moderate to permissive. Where laws are restrictive, as in France and Latin America, illegal abortions are estimated in the millions. The controversy over abortion centers around the arguments of what constitutes a human life, and the rights of the fetus versus the right of a woman to control her reproductive life. A review of state abortion laws as of August 1972 shows pressure on state legislatures to change existing laws. The future of abortion depends upon technological advances in fertility control, development of substitutes like menstral extraction, prostaglandins and reversible sterilization. Development of these techniques will take time. At present only through education and improved delivery of contraceptives can dependence on abortion as a method of fertility control be eased. Citizen education in the United States, both sex education and education for responsbile parenthood, is in a poor state according to the Commission on Population Growth and the American Future. If recourse to abortion is to be moderated, it is the next generation of parents who will have to be educated.

  8. France: late abortion.

    PubMed

    Gaudry, D; Sadan, G

    1989-01-01

    In France, under the terms of a law passed by Parliament in 1975, a woman may have an abortion up to 12 weeks of pregnancy if she is a French resident and, in the event that she is a minor, she has parental consent. The woman must also have 2 medical consultations, a week apart. The woman is reimbursed by the state up to 70% of the cost of the abortion. After 12 weeks, abortion, except for therapeutic abortion, under the terms of Article 317 of the Criminal Code, is a crime, punishable by 6 months to 10 years in prison, a fine of between 1800 and 250,000 Francs, and loss of professional license. Moreover, Article 647 of the Health Code bans any advertising, incitement or propaganda for abortion or abortion-inducing products. Many French women go to Britain or Holland for abortions after 12 weeks, but they face the financial burden of traveling as well as the difficulties of getting help in a strange country and the stigma of having done something illegal. The Mouvement Francais pour le Planning Familial, which won the legalization of contraception in 1967, is now fighting for legal abortion as well as the distribution of information about sexuality, contraception, and abortion in the schools. 2 charges of incitement to abortion have been brought against the organization.

  9. Letter: The Canadian abortion law.

    PubMed

    Coffey, P G

    1976-08-01

    Removing abortion from the Criminal Code in Canada will mean that more and more abortions will be performed for nonmedical reasons which will result in an abortion-on-demand situation similar to that in Japan. Early complications of abortion include death, hemorrhage, shock, cervical injury, and infection. Later complications include premature births, spontaneous abortions, ectopic pregnancies, pelvic inflammation, and infertility. Legalized abortion does not seem to reduce the incidence of illegal abortion. There are also psychological, moral, and sociological consequences of legalized abortion. It would seem that liberal abortion makes bad medicine and leads to far-reaching consequences.

  10. 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.…

  11. 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 ...

  12. 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 ...

  13. 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

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

    PubMed Central

    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

  15. Abortion in early America.

    PubMed

    Acevedo, Z

    1979-01-01

    This piece describes abortion practices in use from the 1600s to the 19th century among the inhabitants of North America. The abortive techniques of women from different ethnic and racial groups as found in historical literature are revealed. Thus, the point is made that abortion is not simply a "now issue" that effects select women. Instead, it is demonstrated that it is a widespread practice as solidly rooted in our past as it is in the present.

  16. [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

  17. [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

  18. Partial-birth abortion: the final frontier of abortion jurisprudence.

    PubMed

    Bopp, J; Cook, C R

    1998-01-01

    Partial-birth abortion bans patterned after the federal bill passed by both houses of Congress are constitutional. The clear legislative definition can be easily distinguished from other abortion procedures. Abortion precedents do not apply to such bans because the abortion right pertains to unborn human beings, not to those partially delivered. Such bans are also rationally-related to legitimate state interests. Even if abortion jurisprudence is deemed to apply in the partial-birth abortion context, a ban is still constitutional under Casey because a ban on partial-birth abortions does not impose an undue burden on the abortion right.

  19. 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

  20. 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

  1. Abortion in Poland.

    PubMed

    Szawarski, Z

    1991-12-01

    As of July 1991 abortion is still legal in Poland. Currently the Polish Parliament has taken a break from the debate because the issue is so important that any decision must not be made in past. There is strong pressure from the Catholic Church to eliminate access to abortion. In the fall the Polish people will vote for and elect their first truly democratic Parliament. Abortion does not seem to be playing as important a role as other political issues. In 1956 a law was passed that allowed a woman to have an abortion for medical or social reasons. This law resulted in allowing women in Poland to use abortion as their primary form of contraception. The vast majority of the abortions were performed under the social justification. Then, when democracy same to Poland with the help of the Catholic Church, an unprecedented debate in the mass media, churches, and educational institutions was stirred up. The government attempted to stay out of the debate at first. But as people from different side of the debate saw that they had an opportunity to influence things in their favor, they began to politicize the issue. Currently there are 4 different drafts of the new Polish abortion law. 3 of them radically condemn abortion while the 4th condemns it as a method of family planning, but allows to terminate pregnancies in order to save the life of the mother. PMID:1777450

  2. [Abortion in Japan].

    PubMed

    Yamamoto, K; Yamamoto, Y; Hayase, T

    1993-01-01

    In Japan, the artificial abortion is a penal offence; only in the presence of certain conditions it is authorized under the provision of the Eugenic Protection Law which was promulgated in 1948. According to the law, the artificial abortion is restricted to the period, in which the fetus is not viable outside of the uterus. This period is prescribed by notification from the Ministry of Public Welfare; up to now it has been shortened twice (1976, 1991). Due to the introduction of economic reasons in the list of conditions and the simplification of the procedure the artificial abortion in Japan was virtually liberalized. Prosecution for illegal abortion is very rare in recent years. The number of reported artificial abortions decreases; in the about last 30 years it reduced by half. However, the increase in the number of abortions in women younger than 20 years of age is a problem. The abortion in teenagers is late compared with that in other age groups. Although the number of neonaticides does not seem to increase, the increase in the number of abortions in teenagers remains a serious problem in Japan. PMID:8352642

  3. 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

  4. CMA abortion survey.

    PubMed Central

    1983-01-01

    Responses to the question as to whether abortions should be performed at the woman's request during the first trimester of pregnancy were evenly divided. There was support for abortion on socioeconomic grounds, during the first trimester, from 61.5% of the respondents. Termination of pregnancy beyond the first trimester was supported by a majority of the respondents only in cases in which the woman's life is in danger (73.9%) or in which there is evidence of a severe physical abnormality in the fetus (70.6%) or in cases in which the woman's physical health is in danger (55.5%). Those who said they would not support abortion under any circumstances constitute, at most, 5.1% of the respondents. Support for the maintenance or the elimination of therapeutic abortion committees was addressed in two questions and in both cases the respondents were evenly divided. The responses to these two questions were compared and found to be logically consistent. Only physicians should perform abortions, and they should be performed in hospitals with the woman either as an inpatient or, during the first trimester, as an outpatient. The performance of first-trimester abortions in provincially approved abortion clinics was supported by 47.3% of the respondents. Of the 885 respondents who wished to see some amendment to the Criminal Code, 409 stated that the term "health" as used in the Criminal Code relative to the legal grounds for therapeutic abortion should be defined. PMID:6861064

  5. 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…

  6. Resolving the abortion controversy.

    PubMed

    Rosoff, J I

    1989-01-01

    This article addresses legislative attempts to reverse Roe v. Wade, U.S. abortion laws vis-á-vis those of other developed nations, socioeconomic factors figuring into the decision (or option) to abort, and the positive potential impact of improved contraceptive use.

  7. 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

  8. 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

  9. Walking the abortion tightrope.

    PubMed

    Simms, M

    1971-03-01

    The abortion controversy in England was partially resolved on February 23, 1971, when Sir Keith Joseph, Secretary of State for Social Services, announced that an inquiry into the 1967 Abortion Act would be established, but one which would be concerned with the way the Act was working rather than the principles underlying it. Regional inequalities exist in the implementation of the Act (as with substandard services in Birmingham, Liverpool and Sheffield) due to opposition of the local gynecological establishment and a genuine shortage of facilities. These can be eliminated only through time and retirement and with public finance for more equal abortion facilities. The addition of a consultant clause into the Act would probably reduce the number of abortions in smaller private nursing homes, flood the National Health Service with abortion requests, and drive women back to criminal abortionists.

  10. Sudden Unexplained Death – Treating the Family

    PubMed Central

    Mellor, Greg

    2014-01-01

    Sudden unexplained death in the context of a normal heart at post-mortem and negative toxicological analysis is termed sudden arrhythmic death syndrome (SADS). SADS is often due to cardiac genetic disease, particularly channelopathies. Assessment of family members of SADS victims will reveal at least one affected individual in up to half of families. Specialist evaluation begins with an expert cardiac autopsy that improves diagnostic accuracy and minimises erroneous interpretation of minor pathological findings. Retention of appropriate material for post-mortem genetic testing, ‘the molecular autopsy’, is recommended as this may provide a genetic diagnosis in up to a third of cases. Clinical assessment of families initially comprises 12-lead ECG with high right ventricular leads, echocardiogram and exercise testing. Additional investigations include sodium channel blocker and epinephrine provocation tests. Families with a diagnosis should be managed as per guidelines. Those with negative investigations can generally be discharged unless they are young and/or symptomatic. PMID:26835084

  11. 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…

  12. When Is an Abortion Not an Abortion?

    PubMed

    Mutcherson, Kimberly

    2015-01-01

    Discussion about the similarities and differences between abortion and multi-fetal pregnancy reduction, including the tug-of-war over naming, highlights ongoing contestation about the relationship between the law, ethics, and women's bodies. Ultimately, the law must root itself in the realities of pregnancy including the physical and social consequences that any pregnancy creates for the woman who carries it.

  13. Abortion and abortifacients.

    PubMed

    King, T M

    1978-01-01

    It is argued that abortion research is needed to improve existing techniques and to develop new ones to overcome logistical, financial, and political obstacles to wider availability. Such developments are reviewed, including early pregnancy tests, menstrual regulation, improved cervical dilatation methods, new second trimester abortifacients (e.g., urea and prostaglandins), and new first trimester abortifacients (e.g., injection of ethanol into the uterus and prostaglandin pills or vaginal suppositories). This last is quite promising because of the possibility of self-administration, removing much of the need for medical intervention. Further research is urged on 1) long-term side effects of abortion, particularly late or multiple abortions; and 2) ways to improve the delivery and integration of abortions into family planning programs. It is noted that because abortion seekers demonstrate by the fact itself a strong motivation to control fertility and are therefore enthusiastic acceptors of contraceptive methods, the widespread availability of early pregnancy tests and abortion could be the most effective way of increasing contraceptive practice and reducing abortion itself.

  14. Avoidance of late abortion.

    PubMed

    1979-11-24

    Induced abortion is now a common procedure in the United States and Britain. Methods for performing induced abortion are reviewed. Menstrual regulation, aspiration with a hand-held syringe and a flexible cannula within 6 weeks of the last period, is not often practiced in Britain. Several developing countries are using this simple technique to advantage. Vacuum aspiration in the 1st 12 weeks of pregnancy is the main method being used everywhere for 1st trimester procedures. Mortality rates with this method are low and, in well-organized clinics with experienced personnel, the rates can be reduced even further. It is agreed that 2nd trimester procedures are more complex, both physically and emotionally. In the last several years, dilatation and evacuation (D&E) has increased in popularity for 2nd trimester procedures. Dilation of the cervix is generally accomplished with laminaria, evacuation of the uterus with forceps, and then suction curettage applied. This procedure has replaced intraamniotic infusion, hysterotomy, and hysterectomy as the most commonly - practiced method, despite its need for special surgical skills and good clinical backup. Follow-up of abortions is difficult. Different long-term effects have been noted with different abortion procedures. Early abortion seems to have only a modest effect, if that. Whether late abortion has long-lasting effects remains open to question. Late abortion should be avoided.

  15. Abortion cases worrying.

    PubMed

    Mwanza, G

    1994-01-01

    The writer believes that life begins the instant that an human sperm cell and ovule fuse. This life must be respected and preserved. Abortion is shameful, but tolerated when either the mother or would-be baby's life is at stake. As the number of abortions continue to increase, the controversy over a woman's right to abortion rages on. The author wonders whether questions about abortion will ever be resolved and considers some possible solutions with reference to Zambia. There are many early pregnancies among Zambian youths. A 1993 study found 207 abortions per year in the country among 15-19 year olds; this includes illegal, incomplete, and induced abortions. The Coordinator for the Young Women Christian Association in Lusaka thinks that inadequate sex education is one of the factors contributing to the ever-rising number of abortions today. Youths have sexual intercourse without understanding the possible consequences. Parents, community leaders, and school authorities should instead become more involved and teach children about sex to lessen the incidence of abortion. Specifically, parents should talk to their children about sex as they mature, teaching them about their biological reproductive features and functions. The author is convinced that once children and youths understand their bodies, it will be very easy for them to control their desires. Most male and female teens do, however, cite love and sexual desire as the primary motives for their first relationships. The writer also mentions how pregnant girls get expelled from school and that women experience mental and physical side effects from induced abortion.

  16. 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

  17. Cardiac catheterization

    MedlinePlus

    Catheterization - cardiac; Heart catheterization; Angina - cardiac catheterization; CAD - cardiac catheterization; Coronary artery disease - cardiac catheterization; Heart valve - cardiac catheterization; Heart failure - ...

  18. Abortion: pro and contra.

    PubMed

    Jebereanu, Laura; Jebereanu, Diana; Alaman, Roxana; Tofan, Andra; Jebereanu, Sorin; Pauncu, Sebastian

    2006-01-01

    To kill a new life before it's born, to do an abortion. This is a problem of many generations. In the evolution of human civilization, the attitude concerning abortion was different in different cultures, periods, societies. The aim of our study is to evaluate the actual opinion and attitude of young persons, students, and residents in medicine in Timisoara city, and the situation of the whole country. We performed a questionnaire for 400 people, between the ages of 19 and 28 with superior studies. The group is composed of 320 (80%) women and 80 (20%) men. We accepted for recording and analyzing all the the completed questionnaires. The questions referred to the topic of abortion in the antecedents, and asked if they had had one, how it affected the life of the women and her family, the circumstances of acceptance of abortion today, religious aspects and different other aspects. PMID:17146907

  19. 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

  20. Moderate views of abortion.

    PubMed

    Sumner, L W

    1997-01-01

    This essay offers a moderate view of abortion that imposes a time limit for unrestricted abortion and specific indications for later abortions. The introduction notes that the discussion will provide a defense for this policy based on a moral analysis but that other options for moderates, especially options provided by freestanding views (the defense of which does not rest on any prior commitment about the morality of abortion), will also be considered. The next section considers the moral status of the fetus grounded in a criterion of moral standing that stipulates the necessary characteristics to achieve moral standing. This discussion concludes that a fetus acquires moral standing only when it becomes sentient. Section 3 moves the argument from ethics to politics to prove that a moderate policy must place no limitations on abortion before the time the fetus becomes sentient because before that time the fetus has no interest for the state to protect. The final section notes that some pro-choice advocates may be happier with the moderate policy proposed than with its controversial defense based on the moral status of the fetus and that another defense of a moderate policy could be based on a finding that the ethical issue can not be decided and that no view about abortion ethics is more reasonable than any other. The essay concludes that the ethical debate is ultimately unavoidable. PMID:12348328

  1. Abortion and regret.

    PubMed

    Greasley, Kate

    2012-12-01

    The article considers three theses about postabortion regret which seek to illustrate its pertinence to reasoning about abortion, and which are often deployed, either explicitly or implicitly, to dissuade women out of that reproductive choice. The first is that postabortion regret renders an abortion morally unjustified. The second is that that a relatively high incidence of postabortion regret-compared with a lower incidence of postnatal regret in the relevant comparator field-is good evidence for the moral impermissibility of abortion choice. The third is that high rates of postabortion regret suggest that abortion is not the most prudent or welfare-maximising choice for the woman concerned. All three theses argue for the compellingness of knowledge about postabortion regret in moral and practical reasoning about abortion, especially from the pregnant woman's point of view. This article argues that all three theses are flawed. In particular, it seeks to remind readers that feelings of regret directed at past decisions are often decoupled from the fact of the matter about their moral or rational justification. Moreover, certain features of reproductive decisions in particular make regret an especially unsuitable yardstick for actual justification in this context, and even less epistemically reliable as evidence for a lack of justification than it may be in other fields of decision-making. The implication is that rates of postabortion regret, even if they can be presumed to be higher than rates of postnatal regret, are not as pertinent to moral and practical reasoning about abortion as is sometimes suggested.

  2. Politics and abortion.

    PubMed

    Rosoff, J I

    1985-01-01

    The legalization of abortion in the United States by the Supreme Court in 1973 bypassed the political process in the majority of the states. Since then, however, political controversy and agitation in relation to abortion has become nationwide. From largely Catholic-based opposition, it has grown to encompass religious fundamentalists and to be a major part of the New Right's agenda. Abortion is now, pro and con, part of the platform of both political parties. The sweeping nature of the Supreme Court's decisions leaves the opposition with very little room to restrict abortion, short of overturning the decisions through a constitutional amendment. Such an amendment requires a two-thirds majority of Congress and passage is unlikely. However, funding bans on scores of federal programmes have succeeded in restricting access to abortion for the poor, the young and minorities. These restrictions are part of a long-term strategy to educate the public as to the evils of abortion with the aim of making it illegal again, either through the adoption of a constitutional amendment or by obtaining a reversal by a hoped-for change in membership of the Supreme Court.

  3. [Psychosomatic aspects of cardiac arrhythmias].

    PubMed

    Siepmann, Martin; Kirch, Wilhelm

    2010-07-01

    Emotional stress facilitates the occurrence of cardiac arrhythmias including sudden cardiac death. The prevalence of anxiety and depression is increased in cardiac patients as compared to the normal population. The risk of cardiovascular mortality is enhanced in patients suffering from depression. Comorbid anxiety disorders worsen the course of cardiac arrhythmias. Disturbance of neurocardiac regulation with predominance of the sympathetic tone is hypothesized to be causative for this. The emotional reaction to cardiac arrhythmias is differing to a large extent between individuals. Emotional stress may result from coping with treatment of cardiac arrhythmias. Emotional stress and cardiac arrhythmias may influence each other in the sense of a vicious circle. Somatoform cardiac arrhythmias are predominantly of psychogenic origin. Instrumental measures and frequent contacts between physicians and patients may facilitate disease chronification. The present review is dealing with the multifaceted relationships between cardiac arrhythmias and emotional stress. The underlying mechanisms and corresponding treatment modalities are discussed.

  4. Abortion and rape.

    PubMed

    Barry-Martin, P

    1977-10-26

    The letter is an answer to a previous letter which appeared in the same journal and which was discrediting, according to the author of this letter, the Royal Commission on Contraception, Sterilization, and Abortion. The earlier letter refutes a quote from "Abortion and Social Justice" used by the Commission, regarding the situation in Colorado after rape became an indication for abortion. The quote reports that although between 1967-1971 the number of abortions for rape totalled 290, no rapist was charged or convicted for the crime. However, according to the author of this letter, the actual quote reads somewhat differently, and states that, during the same period, "no rapist was ever charged with his crime, much less convicted of it, which casts some real doubts on the reality of the alleged rapes." The meaning of this passage is that none of the alleged rapists had actually caused the 290 pregnancies. From records and government statistics it is possible to count about 3300 cases of rape known to the police in Colorado for the years 1967-1971. To suggest that none of these cases were charged or convicted is ridiculous. The author also states that rape as an indication for abortion will lead to abuse of the law, and that pregnancy for actual rape is rare.

  5. 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…

  6. Addressing barriers to safe abortion.

    PubMed

    Culwell, Kelly R; Hurwitz, Manuelle

    2013-05-01

    The latest World Health Organization data estimate that the total number of unsafe abortions globally has increased to 21.6 million in 2008. There is increasing recognition by the international community of the importance of the contribution of unsafe abortion to maternal mortality. However, the barriers to delivery of safe abortion services are many. In 68 countries, home to 26% of the world's population, abortion is prohibited altogether or only permitted to save a woman's life. Even in countries with more liberal abortion legal frameworks, additional social, economic, and health systems barriers and the stigma surrounding abortion prevent adequate access to safe abortion services and postabortion care. While much has been achieved to reduce the barriers to comprehensive abortion care, much remains to be done. Only through the concerted action of public, private, and civil society partners can we ensure that women have access to services that are safe, affordable, confidential, and stigma free. PMID:23477700

  7. 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

  8. 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

  9. Connecticut's new abortion statute.

    PubMed

    Healey, J M

    1990-08-01

    Amid the raging controversy on whether minors should have the same access to abortion as adults, the Connecticut legislature has passed a compromise statues that recognizes a minor's right seek an abortion, while imposing certain requirements. Those who seek to regulate access argue that because minors may lack the maturity to make a valid decision, parental notification is necessary; advocates of minors' right to access hold that it should be the minor who makes such personal decision. In an effort to resolve the conflict, Connecticut's law says that young women under the age of 16 must receive pregnancy-related information before an abortion can take place. Specifically., a physician or counselor is required to: 1) explain to the minor that the information provided is not intended to coerce or persuade her into making a particular choice; 2) explain that she may consider her decision any time prior to the operation or during the time period when abortion is legally permitted; 3) explain the alternatives of either carrying out the pregnancy or getting an abortion, including information on public and private agencies that may assist in carrying out the decision; 4) inform her that pubic and private agencies provide information on birth control; 5) discuss the possibility of involving the minor's parents(s), guardian(s), or other adult family member in the decision; and 6) allow the minor to ask questions and to obtain useful information. After the completion of the process, the minor must sign a form that attests that the requirements have been met, and -- if applicable -- that the minor has decided to involve a parent or relative. In cases where the health or safety of a minor requires and abortion, the Connecticut statute allows for the provisions to be waived.

  10. 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

  11. 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.

  12. Multiple Induced Abortions: Danish Experience.

    ERIC Educational Resources Information Center

    Osler, Mogens; David, Henry P.; Morgall, Janine M.

    1997-01-01

    Women having an induced abortion in an urban clinic were studied. First, second, and third time aborters (N=150) were interviewed. Variables including reasons for choosing abortion, life situations, contraceptive risk-taking, and ease of becoming pregnant were examined. Related studies and suggestions for postabortion counseling are discussed.…

  13. 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

  14. 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.

  15. 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.

  16. Sudden Hearing Loss.

    ERIC Educational Resources Information Center

    Vaughan, John C.

    1997-01-01

    Patients with a sudden dramatic decline in hearing usually require rapid diagnosis and treatment. Unfortunately, the treatment of this condition continues to be controversial and an exact etiology in most cases has been inconclusive. Nevertheless, physicians have reached a consensus regarding several broad principles, which are presented in this…

  17. Horses and Zebras: complex cardiac anatomy in a patient with out-of-hospital cardiac arrest.

    PubMed

    Brown, Samuel M; Miller, Dylan V; Vezina, Daniel; Dean, Nathan C; Grissom, Colin K

    2011-04-01

    This case report describes a woman presenting after out-of-hospital cardiac arrest with several cardiac anomalies, including a form fruste of Ebstein's anomaly complicated by a large tricuspid valve vegetation. On autopsy, she proved to have unstable plaques in epicardial vessels that likely caused arrhythmic sudden cardiac death, a reminder that even in the presence of rare anomalies, common things are common.

  18. 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.…

  19. [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.

  20. 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.

  1. 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

  2. [Recurrent spontaneous abortions].

    PubMed

    Salat-Baroux, J

    1988-01-01

    The process of fertilization in humans, is remarkably inefficient. Spontaneous abortion is estimated to be between 15 and 20% of all clinical pregnancies, and the early spontaneous abortion rate is closer to 30-50% of fertilized ova. Not all authors agree on the definition of "recurrent spontaneous abortion" (RSA), so the frequency of repeated pregnancy wastage is difficult to determine; from empirically derived data, it has been estimated to range between 0.4 and 0.8%. Because of the various etiologies of RSA, their association in determining an abortive event, it is difficult to evaluate their exact incidence. Moreover, their is no prospective study on this subject, so it is advisable to distinguish between the admitted causes, the likely factors, and the etiologies to be evaluated. In the first group, the congenital or acquired müllerian anomalies (especially the septate uterus), represent about 25% of the RSA, but a lot of problems concerning the physiopathology are still debated, even if the rate of pregnancies after surgery ranges around 50% in certain series. On the other hand, the genetic factors, identified especially with the banding technique, are undeniable: however, although the rate of chromosomal aberrations in the offspring (Monosomy X, Trisony 16, Triploidy) is very high (50 to 60% of spontaneous abortions in the first trimester of pregnancy), when couples with usual abortions are subjected to karyotypic analysis, genetic anomalies (especially translocations) are been noted in only 6.2% of the women and 2.6% of the men. In the second group, the infective factors (chlamydiae, toxoplasma and mycoplasma) are difficult to analyse since the serology is not sufficient without a real proof of an endometrial colonization. Among the endocrinological causes, the classical luteal phase deficiency remains a subject of controversy (estimated between 3 and 30%) not only for the establishment of the diagnosis, but also for the efficiency of progesterone

  3. Abortion (Amendment) Bill.

    PubMed

    Dundon, S

    1980-02-23

    Your editorial of Jan. 26 and the multi-signatory letter in your issue of Feb. 2 support the 1967 Abortion Act and suggest that Mr. Corrie's Bill is a retrograde step. The implication is that our professional knowledge should lead us to that conclusion. To take the opposite view risks being regarded as a member of a pressure group or a conscientious objector, but to remain silent might be construed as being in agreement. As I see it the great majority of people of varying ethnic groups, including those adhering to the Jewish, Muslim, and Christian faiths, subscribe to a behavioral code which regards human life as sacred: to take a life is to be countenanced only to save another. Abortion should be regarded as taking human life and morally wrong; making abortion legal does not make it morally right. Doctors are in a very difficult position, and cannot, no more than politicians can, make moral decisions for other people. Traditionally, however, the profession has a role in the responsibility for protection of life, and perhaps the public have a right to expect this protection. Human life begins at conception and some human rights begin at this time. Life (and its protection) seems to be a most basic right. The World Medical Association, in the Declaration of Oslo (1970), stated: "1. The first moral principle imposed upon the doctor is respect for human life as expressed in a clause of the Declaration of Geneva: 'I will maintain the utmost respect for human life from the time of conception.'" The 1967 Abortion Act did not result from a general referendum, much less a medical referendum. If the Corrie Bill is passed and abortions are cut by 2/3 as you suggest, this would, in my view, be a step, not back, but in the right direction.

  4. Manual Snow Removal and Sudden Death.

    PubMed

    Skavić, Petar; Stemberga, Valter; Duraković, Din

    2015-06-01

    The aim was to analyze the causes of sudden death in middle-aged and elderly men during manual snow removal. During snowy winter months in Zagreb, from January 2013 to January 2014, four males aged 52, 65, 72 and 81, died suddenly while manually removing snow. They were all autopsied. All of them have suffered from arterial hypertension and coronary heart disease, and one suffered from metabolic syndrome. The cause of death in two was probable malignant ventricular arrhythmia. In the third who fell down on the icy surface, consequences were cerebral contusion and neck vertebral luxation. In the fourth who fell down from the top of a 15 m tall building during snow removal, the cause of death were multiple injuries: fractures of both clavicles, ribs and vertebrae's Th5, Th6, hematothorax, cardiac contusion, hematopericardium, thoracic aorta rupture, contusions and ruptures of both lungs, rupture of the diaphragm, liver rupture, hematoperitoneum and cerebral edema. The estimated death rate in the City of Zagreb for males aged 30-64 years is 5.44/1,000,000 inhabitants, which is less than in those aged 65-85 years (40.03/1,000,000; p = 0.2269). Sudden strenuous physical effort due to manual snow removal in two non-trained persons, who have suffered from arterial hypertension and coronary heart disease, was the cause of sudden death. Manual snow removal is an important cause of sudden death, as it is a very arduous effort in non-adapted middle-aged and elderly persons. PMID:26753462

  5. Manual Snow Removal and Sudden Death.

    PubMed

    Skavić, Petar; Stemberga, Valter; Duraković, Din

    2015-06-01

    The aim was to analyze the causes of sudden death in middle-aged and elderly men during manual snow removal. During snowy winter months in Zagreb, from January 2013 to January 2014, four males aged 52, 65, 72 and 81, died suddenly while manually removing snow. They were all autopsied. All of them have suffered from arterial hypertension and coronary heart disease, and one suffered from metabolic syndrome. The cause of death in two was probable malignant ventricular arrhythmia. In the third who fell down on the icy surface, consequences were cerebral contusion and neck vertebral luxation. In the fourth who fell down from the top of a 15 m tall building during snow removal, the cause of death were multiple injuries: fractures of both clavicles, ribs and vertebrae's Th5, Th6, hematothorax, cardiac contusion, hematopericardium, thoracic aorta rupture, contusions and ruptures of both lungs, rupture of the diaphragm, liver rupture, hematoperitoneum and cerebral edema. The estimated death rate in the City of Zagreb for males aged 30-64 years is 5.44/1,000,000 inhabitants, which is less than in those aged 65-85 years (40.03/1,000,000; p = 0.2269). Sudden strenuous physical effort due to manual snow removal in two non-trained persons, who have suffered from arterial hypertension and coronary heart disease, was the cause of sudden death. Manual snow removal is an important cause of sudden death, as it is a very arduous effort in non-adapted middle-aged and elderly persons.

  6. 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 . ...

  7. 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

  8. 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 ...

  9. Immunohistochemical marker for Na+ CP type Valpha (C-20) and heterozygous nonsense SCN5A mutation W822X in a sudden cardiac death induced by mild anaphylactic reaction.

    PubMed

    Turillazzi, Emanuela; Pomara, Cristoforo; La Rocca, Giampiero; Neri, Margherita; Riezzo, Irene; Karch, Steven B; Anzalone, Rita; Lo Iacono, Melania; Fineschi, Vittorio

    2009-07-01

    A sudden death likely due to mild anaphylactic reaction in a young man is described. Autoptic, histologic, immunohistochemical, and laboratory findings were strongly consistent with the diagnosis of a mild anaphylactic reaction. Genetic molecular analysis, performed on formalin-fixed, paraffin-embedded tissues, showed a mutation described as W822X in a family with electrocardiographic pattern typical of Brugada Syndrome. It results in a nonsense mutation generating a truncated form of the channel protein. The mutation is due to a point substitution of a guanine with an adenine residue (G2466A). Immunohistochemistry and laser scanning confocal microscopy on sections from heart formalin-fixed, paraffin-embedded tissues led us to confirm the cellular localization of the Na+ CP type Valpha (C-20) at the intercalated disks of ventricular myocytes and nearly 50% reduction in Na+ channels expression in ventricular myocytes when compared with control cases. We suggest that the anaphylactic reaction that occurred in the young man could serve as a trigger mechanism, responsible for his sudden death with a SCN5A mutation associated with the Brugada syndrome.

  10. [Sudden infant death syndrome].

    PubMed

    Espinosa Morett, A; Shkurovich, M; Carlos Ugartechea, J; Mallet Arelano, A; Salmón Rodríguez, L E

    1976-01-01

    This report is based on a review of the present situation of the sudden infant death syndrome through the presentation of four cases studied at the Unidad de Pediatría, Hospital General de México, S.S.A. All cases were in apparent good health before death. All babies were less than ten months of age. In three cases, necropsy was not performed, and the other one did not show significant abnormalities at the post-mortem examination. A complete review of the literature was made including: historical, epidemiological, genetic, clinical and pathological aspects. Special emphasis is made on the pathophysiology of the syndrome during MOR phase of sleep and muscular hypertrophy of the lungs arteriolae suggesting chronic hypoxia which are the most relevant theories in the sudden infant death syndrome. Psychological aspects and the family management by the physician and detection of possible future victims of the syndrome are finally discussed. PMID:973858

  11. Structural imaging biomarkers of sudden unexpected death in epilepsy.

    PubMed

    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; Diehl, Beate

    2015-10-01

    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.

  12. 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

  13. [Acute complications of abortion].

    PubMed

    Obel, E

    1976-02-01

    The complications accompanying the various methods of abortion as studied in different surveys are reported. In studies of dilation and curettage (D and C) and vaccuum aspiration (VA), lethality ranges from .5 to 2.9 deaths/100,000 cases. Metrorrhagia occurred in 2.5-6% of the D and C cases studied and in 2.9-3.5% of the VA cases. The bleeding was accompanied by infection in most cases where abortive tissue remained in the uterus, which occured in .4-.8% of the D and C cases and in .6-.9% of the VA cases studied. Postabortive bleeding occurred through the 10th day in up to 25% of the patients and was related to the length of the gestation period before abortion. Pelvic infection, mostly of the endometrium, occurred in about 1.4% of the D and C patients and in .3-1.2% of the VA patients. 1.4% of the D and C patients and .6% of the VA patients experienced a rise in body temperature as the only complication of abortion. Perforation of the uterus occurred in about .8% of the D and C patients and in .1-.6% of VA patients. Lesions of the cervix had to be sutured in .1% of the D and C group and .3% of the VA group. Saline instillation, used for abortions in the second trimest er, had a mortality rate of about 20/100,000 cases. Since the success rate of saline instillation is 90-98%, complications are more frequent, often requiring treatment with oxytocin or curettage. Extensive bleeding occurred in 2.3-4%. Curettage of the placenta was required in about 2.1-16.9% of the cases. Pelvic inflammation occurred in about 2.5% and temperature elevation in 1-3.4%. Abdominal hysterotomies had a lethality of 208/100,000. Pelvic hemorrhage occurred in 31%, inflammation in 4.7%, temperature elevation in 13%, and febrile reactions in 31% of the abdominal hysterotomies studied. It is necessary to establish international definitions of abortion complications for better documentation, and postoperative observations should be recorded more conscientiously. PMID:1251502

  14. Abortion research in Latin America.

    PubMed

    Gaslonde Sainz, S

    1976-08-01

    Surveys dealing with abortion in Latin America have provided useful information despite problems in the collection and use of the data. Considerations that should be taken into account in designing abortion surveys and using the resultant information have been discussed here. Special attention has been paid to the need for a broad definition of "abortion" in order to overcome difficulties in gathering information about abortion in Latin America. Surveys have shown increasing incidence of abortion throughout Latin America in the recent past. In examining changes over time it is crucial to interpret clearly and carefully the summary measures of proportion of pregnancies ending in abortion and abortion rates per 1,000 women. It is also important to realize that the level and direction of change of the abortion rate depends on both the rate at which women are becoming pregnant and the proportion of pregnancies ending in abortion. Better survey design and techniques and more careful use of the resulting information will aid in the planning and evaluation of programs aimed at reducing abortion in Latin America. PMID:960180

  15. Abortion: taking the debate seriously.

    PubMed

    Kottow Lang, Miguel Hugo

    2015-05-19

    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.

  16. Religion and attitudes toward abortion and abortion policy in Brazil.

    PubMed

    Ogland, Curtis P; Verona, Ana Paula

    2011-01-01

    This study examines the association between religion and attitudes toward the practice of abortion and abortion policy in Brazil. Drawing upon data from the 2002 Brazilian Social Research Survey (BSRS), we test a number of hypotheses with regard to the role of religion on opposition to the practice of abortion and its legalization. Findings indicate that frequently attending Pentecostals demonstrate the strongest opposition to the practice of abortion and both frequently attending Pentecostals and Catholics demonstrate the strongest opposition to its legalization. Additional religious factors, such as a commitment to biblical literalism, were also found to be significantly associated with opposition to both abortion issues. Ultimately, the findings have implications for the future of public policy on abortion and other contentious social issues in Brazil.

  17. 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

  18. Psychiatric aspects of therapeutic abortion.

    PubMed

    Doane, B K; Quigley, B G

    1981-09-01

    A search of the literature on the psychiatric aspects of abortion revealed poor study design, a lack of clear criteria for decisions for or against abortion, poor definition of psychologic symptoms experienced by patients, absence of control groups in clinical studies, and indecisiveness and uncritical attitudes in writers from various disciplines. A review of the sequelae of therapeutic abortion revealed that although the data are vague, symptoms of depression were reported most frequently, whereas those of psychosis were rare. Positive emotional responses and a favourable attitude toward therapeutic abortion were often reported, although again the statistical bases for these reports were inadequate. There was a lack of evidence that the reported effects were due to having an abortion rather than to other variables.Other areas dealt with inadequately in most of the articles reviewed included analyses of symptoms and of the evidence on the duration of sequelae, descriptions of the criteria for approving abortions, investigation of the psychiatric histories of the patients, presentation of data on the effects of refusing abortion requests, systematic study of a number of epidemiologic factors, and analyses of the circumstances leading to pregnancy in patients having abortions. The evidence was found to be sparse on the effects of supportive relationships, different abortion techniques and the length of gestation on the psychologic status of patients. Little attention was paid to the consequences of psychiatric labelling of patients, or to the effect of having an abortion on factors that may influence future pregnancies.The potential roles of health care professionals appear to deserve more study, and little research seems to have been done to compare the psychologic factors associated with abortion and those associated with live birth. As well, there is little evidence that differences in abortion legislation account for significant differences in the psychologic

  19. Late abortion meeting, Paris / France.

    PubMed

    Spinelli, A

    1989-01-01

    On January 27 and 28, 1989 a workshop and a meeting were organized in Paris by Mouvement Francais pour le Planning Familial (MFPF/France) and the IPPF Europe Region. The workshop was held on the first day. 24 staff and volunteers from Planned Parenthood Associations of 15 countries attended, reviewing abortion laws, the definition of therapeutic abortion, and the incidence and problems of second trimester abortion. Second trimester abortion is available in only a few European countries. Second trimester abortions are rare in France (about 2000 per annum), and in 1986 1717 French women travelled to England in order to seek an abortion. All late abortions are performed for serious reasons. Older women may mistake signs of pregnancy for the onset of the menopause; and women fearful of social or familial punishment, especially teenagers, may be reluctant to consult a doctor. The experiences of Denmark and Sweden, where the problem is partially solved, suggest some strategies: optimize accessibility of contraceptive services, particularly for women at higher risk of late abortion; diminish the taboo surrounding abortion, so that women are less frightened to seek help at an early stage of pregnancy; make abortion services available in all regions of the country; avert time-consuming enforced waiting periods or consent for minors; and stimulate public information campaigns on the importance of seeking help early. On January 28 a meeting involving about 200 participants took place at the Universite Paris Dauphine, Salle Raymond Aron. Speakers at the meeting discussed the issue of late abortion in Europe, the difficulties of obtaining late abortions, counseling, medical problems, the woman's point of view, and possible solutions. At the close of the meeting, the MFPF called on the French government to modify some of the articles in the Penal Code that restrict women's access to safe and legal abortion.

  20. 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

  1. [Chemical methods of abortion].

    PubMed

    Schmidt-Matthiesen, H

    1979-07-20

    Medicaments are used to prepare for instrument abortions in the 1st trimester and as inducers of abortion in the 2nd trimester. The effects, side effects, and dangers depend on the substances used and the route of application, which can be vaginal, cervical, injection, instillation, extraamniotic, intraamniotic, intravenous, or intramuscular. In the past, intraamniotic instillation of a 20% salt solution was the most common 2nd trimester method in Japan, the US, and Eastern Europe, giving a success rate of 90%. Serious side effects prompted substitution of extraamniotic instillation, which rarely produces serious side effects. Instillation of a 60% urea solution into the amniotic fluid in combination with oxytocin or prostaglandin produces an abortion in 13-21 hours, with a failure rate of 3% and a frequency of cervical laceration of under 1%. Extraamniotic use of a .1% solution of rivanol yields a success rate of about 85%, with a relatively long average time to explusion of 24-41 hours. In case of failure the procedure can be repeated. The advantage of the Rivanol method is the rarity of infectious complications. Alcohol is not used as a human abortifacient because it produces necrosis in the decidua and placenta. Prostaglandins are used in most 2nd trimester abortions. Research is underway to identify derivatives that will have an extended uterine impact without serious side effects. Different routes of administration have different effectiveness rates and dangers. All prostaglandins cause side effects including pain during uterine contractions, gastro-intestinal reactions, nausea, vomiting, fever, and headaches. Specific preparations are associated with other effects, some of them life-threatening. Emergency treatment should be available when these substances are used. Adjuvant measures may be employed before adminstration of an abortifacient agent to soften the cervix, or after administration to hasten the procedure. The choice of procedure depends upon the

  2. Abortion for fetal abnormality.

    PubMed

    Maclean, N E

    1979-07-25

    I wish to thank Dr. Pauline Bennett for her reply (NZ Med J, 13 June). She has demonstrated well that in dealing with sensitive difficult issues such as abortion for fetal abnormality, the one thing the doctor is not recommended to do is to speak the truth] I am prompted to write this letter for 2 reasons. Firstly, the excellent letter written by Dr. A. M. Rutherford (NZ Med J, 13 June) on the subject of abortion stated, "The most disturbing feature about the whole controversy is the 'blunting of our conscience'." When the doctors are not encouraged to be honest with patients then indeed our conscience has been blunted. Secondly, I watched Holocaust last night, and cannot refrain from stating that I see frightening parallels between our liberal abortion policy and the activities of the Nazis. As I watched the "mental patients" being herded into the shed for gassing by the polite, tidy, white coated medical staff, and then heard the compassionate, sensitive, letter of the hospital authorities to the relatives of the deceased, the parallel became obvious. The mental patients were weak, defenseless, burdensome, and uneconomic; the unborn are weak, defenseless, burdensome, and uneconomic. The hospital authority's letter was acceptable in many ways, acceptable except that its words bore no relation to the truth. It is said that the "first casualty of war is the truth". Whether that war involves the Jews, or the insane, or the unborn, the statement would seem correct.

  3. Public funding of abortions and abortion counseling for poor women.

    PubMed

    Edwards, R B

    1997-01-01

    This essay seeks to reveal the weakness in arguments against public funding of abortions and abortion counseling in the US based on economic, ethico-religious, anti-racist, and logical-consistency objections and to show that public funding of abortion is strongly supported by appeals to basic human rights, to freedom of speech, to informed consent, to protection from great harm, to justice, and to equal protection under the law. The first part of the article presents the case against public funding with detailed considerations of the economic argument, the ethico/religious argument, the argument that such funding supports racist genocide or eugenic quality control, and arguments that a logical inconsistency exists between the principles used to justify the legalization of abortions and arguments for public funding. The second part of the article presents the case for public funding by discussing the spending of public funds on morally offensive programs, arguments for public funding of abortion counseling for the poor, and arguments for public funding of abortions for the poor. It is concluded that it is morally unacceptable and rationally unjustifiable to refuse to expend public funds for abortions for low income women, because after all most money for legal abortions for the poor comes from welfare payments made to women. If conservative forces want to insure that no public funds pay for abortions, they must stop all welfare payments to pregnant women. PMID:12348330

  4. 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

  5. Planning for scholastic cardiac emergencies: the Ripley project.

    PubMed

    Kyle, J M; Leaman, J; Elkins, G A

    1999-01-01

    Fatalities during sports participation are usually cardiac in origin. Sudden Cardiac Arrest (SCA) from ventricular fibrillation has been reported in several sporting venues over the last decade. Successful treatment of stadium SCA requires a rapid response team equipped with defibrillator capabilities. The use of automated external defibrillators (AED) by responders in sports arenas is critical to help prevent catastrophic scholastic athlete and spectator cases of unexpected sudden cardiac death.

  6. 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.

  7. Abortion in a just society.

    PubMed

    Hunt, M E

    1993-01-01

    A female Catholic theologian imagines a just society that does not judge women who decide to undergo an abortion. The Church, practitioners, and the courts must trust that women do make person-enhancing choices about the quality of life. In the last 15 years most progress in securing a woman's right to abortion has been limited to white, well-educated, and middle or upper middle class women. A just society would consider reproductive options a human right. Abortion providers are examples of a move to a just society; they are committed to women's well-being. There are some facts that make one pessimistic about achieving abortion in a just society. The US Supreme Court plans to review important decisions establishing abortion as a civil right. Further, some men insist on suing women who want to make their own reproductive decisions--an anti-choice tactic to wear away women's right to reproductive choice. Bombings of abortion clinics and harassment campaigns by anti-choice groups are common. These behaviors strain pro-choice proponents emotionally, psychically, and spiritually. Their tactics often lead to theologians practicing self-censorship because they fear backlash. Abortion providers also do this. Further, the reaction to AIDS is that sex is bad. Anti-abortion groups use AIDS to further their campaigns, claiming that AIDS is a punishment for sex. Strategies working towards abortion in a just society should be education and persuasion of policymakers and citizens about women's right to choose, since they are the ones most affected by abortion. Moreover, only women can secure their rights to abortion. In a just society, every health maintenance organization, insurance company, and group practice would consider abortion a normal service. A just society provides for the survival needs of the most marginalized.

  8. 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

  9. Sudden sensorineural hearing loss.

    PubMed

    Stew, B T; Fishpool, S J C; Williams, H

    2012-02-01

    Sudden onset sensorineural hearing loss is a medical emergency that continues to be poorly understood despite being recognized in the literature since 1944 (De Kleyn, 1944). A commonly used criterion to qualify for this diagnosis is a sensorineural hearing loss over three contiguous pure-tone frequencies of 30 dB or more that develops within 72 hours. The vast majority of cases are unilateral and the estimated annual incidence is 20 per 100 000 persons (Nosrati-Zarenoe et al, 2007). A cause for the hearing loss is only identified in up to 10% of cases but 50% of patients will improve spontaneously (Penido et al, 2009).

  10. Sudden sensorineural hearing loss.

    PubMed

    Stew, B T; Fishpool, S J C; Williams, H

    2012-02-01

    Sudden onset sensorineural hearing loss is a medical emergency that continues to be poorly understood despite being recognized in the literature since 1944 (De Kleyn, 1944). A commonly used criterion to qualify for this diagnosis is a sensorineural hearing loss over three contiguous pure-tone frequencies of 30 dB or more that develops within 72 hours. The vast majority of cases are unilateral and the estimated annual incidence is 20 per 100 000 persons (Nosrati-Zarenoe et al, 2007). A cause for the hearing loss is only identified in up to 10% of cases but 50% of patients will improve spontaneously (Penido et al, 2009). PMID:22504750

  11. Sudden death of entanglement.

    PubMed

    Yu, Ting; Eberly, J H

    2009-01-30

    A new development in the dynamical behavior of elementary quantum systems is the surprising discovery that correlation between two quantum units of information called qubits can be degraded by environmental noise in a way not seen previously in studies of dissipation. This new route for dissipation attacks quantum entanglement, the essential resource for quantum information as well as the central feature in the Einstein-Podolsky-Rosen so-called paradox and in discussions of the fate of Schrödinger's cat. The effect has been labeled ESD, which stands for early-stage disentanglement or, more frequently, entanglement sudden death. We review recent progress in studies focused on this phenomenon.

  12. The abortion struggle in America.

    PubMed

    Warren, Mary Anne

    1989-10-01

    The U.S. Supreme Court's July 1989 decision in Webster v. Reproductive Health Services, while not overturning Roe v. Wade, extended the power of state and local governments to regulate abortion. Warren situates the Webster decision in a larger context of 19th and 20th century American anti-abortion legislation, the Court's 1973 Roe decision and its predecessors, and the anti-abortion campaign that followed Roe. She then discusses Webster and its legal, practical, and political implications, concluding that the future of legal abortion in the United States is radically uncertain.

  13. God's bullies: attacks on abortion.

    PubMed

    Hadley, J

    1994-01-01

    National politics in the US, Poland, and Ireland have in recent years been afire with debate over abortion. Conflicting abortion laws almost scuttled the reunification of Germany. This paper describes how the abortion debate took hold in post-Communist Poland and how the issue came to be so entrenched in US politics in the wake of the US Supreme Court's 1973 decision on abortion in the case of Roe vs. Wade. It focuses upon abortion mainly as a method of birth control which women have always sought when needed regardless of the procedure's legal status. The controversies and campaigns recorded and the ideas offered focus upon women's access to affordable, safe, and legal abortion. The author argues that Poland is no place to be a woman and presents sections on the country's church, government, and medical profession; Roe vs. Wade; who opposes abortion rights and their broad success; the 1992 US presidential election; Bill Clinton's presidency; why the abortion debate has been different in Britain; and new issues on abortion.

  14. Prophylactic antibiotics for curettage abortion.

    PubMed

    Grimes, D A; Schulz, K F; Cates, W

    1984-11-15

    Opinion is divided as to the advisability of routine use of prophylactic antibiotics for curettage abortion. Six studies, including three randomized clinical trials, suggest that prophylaxis reduces infectious morbidity associated with curettage abortions by about one half. Three other studies, two involving prophylaxis for instillation abortions and one involving a vaginal antiseptic for curettage abortion, support the hypothesis that antimicrobial prophylaxis reduces morbidity. Tetracyclines are commonly used for this purpose. The cost of routine prophylaxis even with an expensive tetracycline would appear to be offset by the savings in direct and indirect costs. Prophylaxis may help prevent both short-term morbidity and potential late sequelae, such as ectopic pregnancy and infertility.

  15. Controversy over abortion funding increases.

    PubMed

    1980-03-01

    The controversy surrounding the question of public financing of Medicaid abortions in the U.S. was fanned through 5 separate court decisions in January 1980. In 3 of the decisions--directed against the Connecticut, Minnesota, and Missouri Medicaid abortion programs--the courts invalidated the state laws on the grounds that they limited federal funding of abortions for poor women too narrowly. Another decision stated that the Missouri law violated the equal protection clause of th Constitution. A decision in the U.S. District Court in Brooklyn, New York, stated that the 1976 Hyde amendment's restrictions on federal payment for abortions under Medicaid are unconstitutional. Each case is briefly analyzed.

  16. 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.

  17. [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.

  18. 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

  19. The medicolegal aspects of abortion.

    PubMed

    Hall, R E

    1972-01-01

    There was little demand for abortion in the 19th century. There was no population explosion and large families were needed to tend the farm. People were more religious; women were 2nd class citizens; and abortions in those days were medically unsafe. The movement to reform abortion laws in the United States stemmed largely from 3 events in the early 1960s: 1) the request in 1963 of Sherri Finkbine for an abortion after she had taken thalidomide and then learned of its teratogenic potential; 2) a rubella epidemic in 1964 and 1965; and 3) the 1965 Supreme Court decision declaring the Connecticut birth control law to be unconstitutional. In 1970 abortion was completely legalized in the states of Hawaii, Alaska, New York and Washington -- the first 3 by legislation and the last by popular referendum. With 4 states operating under repeal laws, 12 under reform laws, and 34 under restrictive laws, the current practice of abortion in the U.S. at this time is chaotic. In order to cope with the tremendous new demand for abortions, doctors have had to learn new techniques and hospitals have had to modify their procedures and adapt their facilities. An obstacle in the transition to universally available abortion has been the resistance of attending physicians, house staff, paramedical personnel, and hospital administrators and trustees. The legal future of abortion lies more in the courts than in the legislatures. With the impetus provided by the 4 new repeal laws, other states will now revise their abortion statutes at an accelerated pace, but it will not be possible to achieve universal repeal by this state-by-state route. Medical practitioners need to prepare for the eventuality of legalized abortion on a national scale.

  20. Contraception following abortion and the treatment of incomplete abortion.

    PubMed

    Gemzell-Danielsson, Kristina; Kopp Kallner, Helena; Faúndes, Anibal

    2014-07-01

    Family planning counseling and the provision of postabortion contraception should be an integrated part of abortion and postabortion care to help women avoid another unplanned pregnancy and a repeat abortion. Postabortion contraception is significantly more effective in preventing repeat unintended pregnancy and abortion when it is provided before women leave the healthcare facility where they received abortion care, and when the chosen method is a long-acting reversible contraceptive (LARC) method. This article provides evidence supporting these two critical aspects of postabortion contraception. It suggests that gynecologists and obstetricians have an ethical obligation to do everything necessary to ensure that postabortion contraception, with a focus on LARC methods, becomes an integral part of abortion and postabortion care, in line with the recommendations of the International Federation of Gynecology and Obstetrics and of several other organizations.

  1. 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

  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. Abortion Information: A Guidance Viewpoint

    ERIC Educational Resources Information Center

    Wolleat, Patricia L.

    1975-01-01

    A number of questions relating to providing abortion information to teenagers can be raised from legal, ethical and philosophical standpoints. The purpose of this article is to examine abortion information-giving from the perspective of counseling and guidance theory and practice. (Author)

  4. Abortion, Birthright and the Counselor.

    ERIC Educational Resources Information Center

    Fadale, Vincent E.; And Others

    This transcript is the result of panel presentation given on the implications of liberalized abortion laws for counselors. A new law which went into effect in July, 1970, in New York State presented women with the option of obtaining a legal abortion up to the 24th week of pregnancy. Counselors in New York State were, therefore, presented with new…

  5. Advice in the Abortion Decision

    ERIC Educational Resources Information Center

    Luscutoff, Sidney A.; Elms, Alan C.

    1975-01-01

    Subjects in this study were asked to report the number of contacts-for-advice they had made when forming decisions to have a therapeutic abortion, or to carry a pregnancy to term. As predicted, the abortion group differed strongly from both other groups on most questions. (Author)

  6. 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

  7. 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 ...

  8. 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.

  9. 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

  10. 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

  11. 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

  12. 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.

  13. [Induced abortion: a world perspective].

    PubMed

    Henshaw, S K

    1987-01-01

    This article presents current estimates of the number, rate, and proportion of abortions for all countries which make such data available. 76% of the world's population lives in countries where induced abortion is legal at least for health reasons. Abortion is legal in almost all developed countries. Most developing countries have some laws against abortion, but it is permitted at least for health reasons in the countries of 67% of the developing world's population. The other 33%--over 1 billion persons--reside mainly in subSaharan Africa, Latin America, and the most orthodox Muslim countries. By the beginning of the 20th century, abortion had been made illegal in most of the world, with rules in Africa, Asia, and Latin America similar to those in Europe and North America. Abortion legislation began to change first in a few industrialized countries prior to World War II and in Japan in 1948. Socialist European countries made abortion legal in the first trimester in the 1950s, and most of the industrialized world followed suit in the 1960s and 1970s. The worldwide trend toward relaxed abortion restrictions continues today, with governments giving varying reasons for the changes. Nearly 33 million legal abortions are estimated to be performed annually in the world, with 14 million of them in China and 11 million in the USSR. The estimated total rises to 40-60 million when illegal abortions added. On a worldwide basis some 37-55 abortions are estimated to occur for each 1000 women aged 15-44 years. There are probably 24-32 abortions per 100 pregnancies. The USSR has the highest abortion rate among developed countries, 181/1000 women aged 15-44, followed by Rumania with 91/1000, many of them illegal. The large number of abortions in some countries is due to scarcity of modern contraception. Among developing countries, China apparently has the highest rate, 62/1000 women aged 15-44. Cuba's rate is 59/1000. It is very difficult to calculate abortion rates in countries

  14. 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

  15. Abortion in Croatia and Slovenia.

    PubMed

    1992-01-01

    In Slovenia abortion will continue to be available during the first 10 weeks of pregnancy as it has been since 1978. The Slovenian Constitutional Court passed this decision in December, 1991 calling the right to abortion a basic human right. T he ruling was a setback both for the government's conservative parties and the Catholic church. In Croatia, where the Catholic church is campaigning against abortion, the situation is quite different. Zagreb is full of stickers and posters with anti-abortion messages branding abortion murder and spreading inaccurate information in announcements. In 1990, there were 56,000 abortions. For every child that was born, one was aborted. The largest Croatian newspaper publicizes the Catholic view. They want pro-choice women of the volunteer group Tresnjevka to stop their struggle. The church and conservative women's groups press for inclusion of abortion in the Constitution. They are very powerful, and the fear is that might soon succeed in restricting or outlawing abortion. Tresnjevka is making efforts to organize a coordination and information center for women in Zagreb where there are 350,000 women and children refugees. Informative brochures are printed on natural healing methods in gynecology, as drugs are very scarce, and addresses for gynecological emergency care are also provided. Abortion has been legally available on demand during the 1st 10 weeks of pregnancy since 1978. Fore year Tresnjevka has worked for women, trying to raise funds from personal donations and from the government for their activities. Funds from foreign countries have never been received. At present many of the group's activities are on hold because of lack of funds, nevertheless the determination to continue fighting is alive. PMID:12285925

  16. 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

  17. 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 ...

  18. 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

  19. 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;…

  20. A Mutation in TNNC1-encoded Cardiac Troponin C, TNNC1-A31S, Predisposes to Hypertrophic Cardiomyopathy and Ventricular Fibrillation*

    PubMed Central

    Parvatiyar, Michelle S.; Landstrom, Andrew P.; Figueiredo-Freitas, Cicero; Potter, James D.; Ackerman, Michael J.; Pinto, Jose Renato

    2012-01-01

    Defined as clinically unexplained hypertrophy of the left ventricle, hypertrophic cardiomyopathy (HCM) is traditionally understood as a disease of the cardiac sarcomere. Mutations in TNNC1-encoded cardiac troponin C (cTnC) are a relatively rare cause of HCM. Here, we report clinical and functional characterization of a novel TNNC1 mutation, A31S, identified in a pediatric HCM proband with multiple episodes of ventricular fibrillation and aborted sudden cardiac death. Diagnosed at age 5, the proband is family history-negative for HCM or sudden cardiac death, suggesting a de novo mutation. TnC-extracted cardiac skinned fibers were reconstituted with the cTnC-A31S mutant, which increased Ca2+ sensitivity with no effect on the maximal contractile force generation. Reconstituted actomyosin ATPase assays with 50% cTnC-A31S:50% cTnC-WT demonstrated Ca2+ sensitivity that was intermediate between 100% cTnC-A31S and 100% cTnC-WT, whereas the mutant increased the activation of the actomyosin ATPase without affecting the inhibitory qualities of the ATPase. The secondary structure of the cTnC mutant was evaluated by circular dichroism, which did not indicate global changes in structure. Fluorescence studies demonstrated increased Ca2+ affinity in isolated cTnC, the troponin complex, thin filament, and to a lesser degree, thin filament with myosin subfragment 1. These results suggest that this mutation has a direct effect on the Ca2+ sensitivity of the myofilament, which may alter Ca2+ handling and contribute to the arrhythmogenesis observed in the proband. In summary, we report a novel mutation in the TNNC1 gene that is associated with HCM pathogenesis and may predispose to the pathogenesis of a fatal arrhythmogenic subtype of HCM. PMID:22815480

  1. Smoking habits and spontaneous abortion.

    PubMed

    Sandahl, B

    1989-04-01

    Smoking habits have been compared in three samples of pregnancies: (1) spontaneous abortions (n = 610); (2) induced abortions (n = 800); and (3) deliveries (n = 1337). The variables studied were, besides smoking habits, day of LMP, outcome of earlier pregnancies, maternal age, and, for the delivery sample, also diagnoses of mother and child, gestational length, sex, and birthweight. A statistical analysis of the association between smoking and the risk of having a spontaneous abortion was made. The comparisons were made with all types of intra-uterine pregnancies but spontaneous abortions, e.g., deliveries and induced abortions. The effects and consequences of that are discussed. The smoking rates according to pregnancy outcome differ among the samples. In the induced abortion sample 58% smoked compared with 50% in the spontaneous abortion sample and 44% in the delivery sample. The well-known effect of smoking on gestational length and birthweight was shown. No significant effect of smoking on the miscarriage risk was seen. The only trend was the opposite. Possible explanations for this are discussed.

  2. 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.

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. Fathers and abortion.

    PubMed

    Di Nucci, Ezio

    2014-08-01

    I argue that it is possible for prospective mothers to wrong prospective fathers by bearing their child; and that lifting paternal liability for child support does not correct the wrong inflicted to fathers. It is therefore sometimes wrong for prospective mothers to bear a child, or so I argue here. I show that my argument for considering the legitimate interests of prospective fathers is not a unique exception to an obvious right to procreate. It is, rather, part of a growing consensus that procreation can be morally problematic and that generally talking of rights in this context might not be warranted. Finally, I argue that giving up a right to procreate does not imply nor suggest giving up on women's absolute right to abort, which I defend.

  9. [Umberto Eco and abortion].

    PubMed

    1997-09-01

    The Cardinal of Milan and the linguist and writer Umberto Eco maintained a correspondence in the mid-1990s in connection with the Italian magazine ¿Liberal¿. One of the issues discussed was the conflict between belief in the value of human life and existing abortion legislation. Umberto Eco stated that he would do all in his power to dissuade a woman pregnant with his child from having an abortion, regardless of the personal cost to the parents, because the birth of a child is a miracle. He would not, however, feel capable of imposing his ethical position on anyone else. Terrible moments occur in which women have a right to make autonomous decisions concerning their bodies, their feelings, their futures. Those who disagree cite the right to life, a rather vague concept about which even atheists can be enthusiastic. The moment at which a new human being is formed has been brought to the center of Catholic theology, despite its uncertainty; the beginning of a new life may always need to be understood as a process whose end result is the newborn. Only the mother should decide at what moment the process may be interrupted. The cardinal¿s response distinguished between psychic and physical life, on the one hand, and life participating in the life of God on the other. The threshold is the moment of conception, reflecting a continuity of identity. The new being is worthy of respect. Any violation of the affection and care owed to the being can only be experienced as a profound suffering and painful laceration that may never heal. The response of Eco is unknown. PMID:12349541

  10. [Umberto Eco and abortion].

    PubMed

    1997-09-01

    The Cardinal of Milan and the linguist and writer Umberto Eco maintained a correspondence in the mid-1990s in connection with the Italian magazine ¿Liberal¿. One of the issues discussed was the conflict between belief in the value of human life and existing abortion legislation. Umberto Eco stated that he would do all in his power to dissuade a woman pregnant with his child from having an abortion, regardless of the personal cost to the parents, because the birth of a child is a miracle. He would not, however, feel capable of imposing his ethical position on anyone else. Terrible moments occur in which women have a right to make autonomous decisions concerning their bodies, their feelings, their futures. Those who disagree cite the right to life, a rather vague concept about which even atheists can be enthusiastic. The moment at which a new human being is formed has been brought to the center of Catholic theology, despite its uncertainty; the beginning of a new life may always need to be understood as a process whose end result is the newborn. Only the mother should decide at what moment the process may be interrupted. The cardinal¿s response distinguished between psychic and physical life, on the one hand, and life participating in the life of God on the other. The threshold is the moment of conception, reflecting a continuity of identity. The new being is worthy of respect. Any violation of the affection and care owed to the being can only be experienced as a profound suffering and painful laceration that may never heal. The response of Eco is unknown.

  11. Psychological sequelae of induced abortion.

    PubMed

    Romans-Clarkson, S E

    1989-12-01

    This article reviews the scientific literature on the psychological sequelae of induced abortion. The methodology and results of studies carried out over the last twenty-two years are examined critically. The unanimous consensus is that abortion does not cause deleterious psychological effects. Women most likely to show subsequent problems are those who were pressured into the operation against their own wishes, either by relatives or because their pregnancy had medical or foetal contraindications. Legislation which restricts abortion causes problems for women with unwanted pregnancies and their doctors. It is also unjust, as it adversely most affects lower socio-economic class women.

  12. 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.

  13. Abortion incidence in Cambodia, 2005 and 2010.

    PubMed

    Fetters, Tamara; Samandari, Ghazaleh

    2015-01-01

    Although Cambodia now permits elective abortion, scarcity of research on this topic means that information on abortion incidence is limited to regional estimates. This estimation model combines national survey data from Demographic and Health Surveys (DHS) with national prospective data of abortion procedures from government health facilities, collected in 2005 and 2010, to calculate the national incidence of safe and unsafe abortion. According to DHS, the proportion of all induced abortions that took place in a health facility in the five years preceding each survey increased from almost 52% to 60%. Projecting from facility-based abortions to national estimates, the national abortion rate increased from 21 to 28 per 1000 women aged 15-44. The abortion ratio also increased from 19 to 28 per 100 live births. This research quantifies an increase in safely induced abortions in Cambodia and provides a deeper understanding of induced abortion trends in Cambodia.

  14. 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

  15. 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...

  16. Abortion: the antithesis of womanhood?

    PubMed

    Timpson, J

    1996-04-01

    The debate regarding the practice and role of abortion has been an enduring and problematic area of discourse within the nursing literature, with a tendency towards a polarized and inevitably simplistic analysis of what, for many practitioners, women and families, remains a highly complex and morally fraught concept. This paper attempts to explore the concept of abortion from within a feminist epistemology, to present a review of the literature as regards women's reproductive health and responsibilities, and thereby to contribute to the process of better understanding the role of abortion within contemporary health care practice. In order to facilitate the study it has been necessary to explore the wide spectrum of historical, philosophical, legal, moral and political imperatives pertaining to the meaning of abortion as represented within contemporary society, not only in relation to women and their reproductive health, but to feminism, women's well-being and self-determinism per se. PMID:8675897

  17. Abortion and the human animal.

    PubMed

    Tollefsen, Christopher

    2004-01-01

    I discuss three topics. First, there is a philosophical connecting thread between several recent trends in the abortion discussion, namely, the issue of our animal nature, and physical embodiment. The philosophical name given to the position that you and I are essentially human animals is "animalism." In Section II of this paper, I argue that animalism provides a unifying theme to recent discussions of abortion. In Section III, I discuss what we do not find among recent trends in the abortion discussion, namely "the right to privacy." I suggest some reasons why the right to privacy is conspicuous by its absence. Finally, I address Patrick Lee's claim that the evil of abortion involves "the moral deterioration that the act brings to those who are complicit in it, and to the culture that fosters it."

  18. [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.

  19. [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

  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. Sudden transition and sudden change from open spin environments

    SciTech Connect

    Hu, Zheng-Da; Xu, Jing-Bo; Yao, Dao-Xin

    2014-11-15

    We investigate the necessary conditions for the existence of sudden transition or sudden change phenomenon for appropriate initial states under dephasing. As illustrative examples, we study the behaviors of quantum correlation dynamics of two noninteracting qubits in independent and common open spin environments, respectively. For the independent environments case, we find that the quantum correlation dynamics is closely related to the Loschmidt echo and the dynamics exhibits a sudden transition from classical to quantum correlation decay. It is also shown that the sudden change phenomenon may occur for the common environment case and stationary quantum discord is found at the high temperature region of the environment. Finally, we investigate the quantum criticality of the open spin environment by exploring the probability distribution of the Loschmidt echo and the scaling transformation behavior of quantum discord, respectively. - Highlights: • Sudden transition or sudden change from open spin baths are studied. • Quantum discord is related to the Loschmidt echo in independent open spin baths. • Steady quantum discord is found in a common open spin bath. • The probability distribution of the Loschmidt echo is analyzed. • The scaling transformation behavior of quantum discord is displayed.

  2. 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

  3. [Induced abortion: pro and con].

    PubMed

    Balić, Adem; Balić, Devleta; Habibović, A; Adzajlić, A

    2003-01-01

    Induced abortion like a method of birth control is the most unpopular method but it is a choice of great deal women especially in our environment. In connection with very loud demands for sharpened the low of pregnancy interrupting, many authors analyse methods, complications and risk groups of women, its acceptability like a method of family planning. At the end they give conclusion with some concrete suggestions and the aim to reduce the number of induced abortions. PMID:14528715

  4. Genetics, amniocentesis, and abortion.

    PubMed

    Hirschhorn, K

    1984-01-01

    At this time a rather large number of congenital abnormalities still occur. About 2-3% of pregnancies will result in children with major congenital abnormalities that cannot be detected prenatally. Yet, with the availability of prenatal diagnosis for an ever increasing number of genetic problems and, more recently, for developmental problems as well, a new option was offered to couples at risk when they took the risk of pregnancy: finding out whether the fetus was abnormal. An early argument regarding the ethics of this option was formulated by Dan Callahan, director of the Hastings Institute for Ethics, Society and the Life Sciences, when he indicated the need to be careful about the term "option." A need exists to be careful about societal pressures in favor of the new medical options--on, for example, a pregnant woman who is over 35 and does not get a prenatal diagnosis; or on a woman carrying a Down's syndrome child identified by prenatal diagnosis not to have an abortion. This was the 1st specter raised when prenatal diagnosis was introduced. The most common indication for amniocentesis is the risk of chromosomal abnormalities. The risk of discovering a chromosomal abnormality by amniocentesis is about double the risk at birth because a number of chromosomally abnormal fetuses are lost late in the 2nd trimester by spontaneous abortion. The age cutoff at 35 raises an immediate ethical question: since the total number of births to women over age 35 seems to be increasing, and at the same time a greater and greater percentage of children with Down's syndrome are born to women under age 35, the question arises as to whether amniocentesis should be done on all pregnancies, and whether all births with Down's syndrome should be selectively aborted or avoided. Amniocentesis in all pregnancies is impractical at this time from the technological and the cost perspective, but the ethical question should be raised. Among the X-linked disorders, 1 group cannot be

  5. Safe abortion: a woman's right.

    PubMed

    Sangala, Vanessa

    2005-07-01

    Complications of induced abortion sadly remain significant causes of maternal mortality and morbidity around the world, but only in countries that do not provide access to safe abortion services. This article presents a brief account of how high maternal mortality from induced abortion became history in the UK and the dire consequences to women's health that unsafe abortion still has in many countries of the world. It gives a brief overview of the methods available to evacuate the uterus, with particular reference to manual vacuum aspiration. The status of the law in different countries is discussed, together with the need for health professionals to interpret repressive laws in ways that enables them to care for women who seek their help. Safe abortion services are cost effective, essential services for women. Men are part and parcel of the reason women resort to terminating a pregnancy, and, together with the countless children whose lives are dependent on a healthy caring mother, are also beneficiaries of safe abortion services. There can be no excuse for continuing to deny these services to so many women around the world.

  6. Abortion and infertility in Russia.

    PubMed

    Kulakov, V I

    1995-03-01

    The exceptionally high rate of induced abortion in Russia (204/100 live births in 1991) and of abortion-related genital tract infection and infertility implies an urgent need for both the prevention of unwanted pregnancy and less invasive abortion techniques. Vacuum aspiration is gradually replacing curettage as the abortion method of choice for first-trimester abortions, and research is being conducted on pharmacologic abortion involving prostaglandins in combination with RU-486. Infertility, which affects 10-15% of married Russian couples, accounts for 50% of visits to the largest gynecologic hospitals. 92% of women and 49% of men in couples with impaired fertility exhibit pathology of the reproductive system, primarily prior inflammatory morbidity of the genitalia. The use of surgery to correct these impairments is largely unsuccessful, especially when there has been prior treatment with the hydroturbation method. The Federal Family Planning Program for 1993-97 reflects increased awareness of the problem; among its goals are the creation of state and social structures for a family planning service, mass media campaigns, the preparation of educational materials on the avoidance of unwanted pregnancy, and staff training in sex education and family planning.

  7. Cardiac rehabilitation

    MedlinePlus

    ... Coronary artery disease - cardiac rehab; Angina - cardiac rehab; Heart failure - cardiac rehab ... have had: Heart attack Coronary heart disease (CHD) Heart failure Angina (chest pain) Heart or heart valve surgery ...

  8. 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.

  9. 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

  10. 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

  11. Europe's abortion wars: womb for debate.

    PubMed

    Blinken, A J

    1991-01-01

    As Europe edges toward some sort of unity, the volatile abortion debate has begun to spill across national boundaries. Reflecting the continent's religious and cultural diversity, abortion laws throughout Europe vary widely. Holland and Sweden have the most liberal abortion laws. The former allows abortion on demand, while the later permits abortion until the 18th week -- and possibly up until term, if the National Health Bureau gives permission. Britain, France, and Belgium have also adopted liberal abortion laws. Other nations, however, have more conservative laws. Since 1983, Ireland has banned abortion entirely. Spain allows abortion only in cases of rape, malformed fetuses, or when the mother's life is in danger. Many countries are also experiencing bitter debates over abortion. Czechoslovakia's liberal abortion law has come under increasing pressure, and in Poland, bishops and legislators have feuded over the legality of abortion. The move towards unification has only intensified these debates. Germany is currently without a national abortion law, as the former East Germany still enjoys a more liberal abortion law than West Germany. Differences over abortion laws have led to what is know in Europe as abortion shipping. Every year, an estimated 15,000 Irish women travel to England, some 7,000 German women go to Holland, and some 3,000 French women travel to England -- all seeking to take advantage of another country's abortion law. Some Europeans have begun to look for continent-wide laws on abortion. Recently, an Irish group argued against its country's law before the European court of Justice. Right-to-life groups have also fought to establish continent-wide restrictions. So far, it seems unlikely that Europe will reach an agreement on the issue of abortion.

  12. Contemporary issues for spontaneous abortion. Does recurrent abortion exist?

    PubMed

    Reindollar, R H

    2000-09-01

    Most of the time, spontaneous abortion is a random event and represents the natural selection process. Although a recurrent factor may be present and may cause one or more abortions for a given couple, such instances are rare. Well-substantiated causes include parental chromosomal abnormalities (e.g., translocation), antiphospholipid syndrome, PCOD, and maternal age greater than 40 years. Müllerian duplication defects are most likely a cause of pregnancy loss for some women. A growing body of evidence refutes the role of corpus luteum defect as a common cause of recurrent abortion. Other causes are numerically infrequent in occurrence. It is likely that cigarette smoking and alcohol consumption contribute to pregnancy wastage. Although some therapies for the causes listed herein have been proven effective by randomized controlled trials, most have not. Given the excellent outcome demonstrated for most couples with unexplained recurrent abortion in the absence of treatment, it is difficult to recommend unproven therapies, especially if they are invasive and expensive. Instead of examining the environment in which pregnancy has occurred or been planned, clinicians have simply counted the number of spontaneous abortions among couples in an attempt to determine who should be evaluated. The former approach would seem most appropriate and proactive.

  13. Abortion epidemic in Latin America.

    PubMed

    Viel, B

    1983-05-01

    Recent surveys have shown that 3.4 million illegal abortions may be taking place in the Latin American countries every year, with a rate of around 45/1000 women of childbearing age. Yet only in Cuba can women have abortion on demand. In the other countries the penalty for the abortionist and the client is a prison sentence. The only way of measuring the frequency of abortion is through the numbers of women entering hospitals for treatment of postabortion complication, but not all countries publish hospitals statistics that are reliable. Surveys in Chile and Colombia for 1974 show a rate of 11.7-17.9/1000 women of fertile age undergoing illegal abortions, with only 1/3 resulting in complications. The law is not strictly enforced in these countries because the number of people that will have to be prosecuted is too large and because there is no place to care for the young children of women who will be prosecuted. Yet the abortion death rate (38% of total maternal deaths) is so high that a new policy must be drawn up, especially since women who have normal deliveries are sent home earlier to make room for those with abortion complications, resulting in a high infant mortality rate. In addition the rate of pregnancies among adolescents is very high due to the permissive social atmosphere combined with a lack of sex education in the schools. Studies that would allow international comparisons to show ways to prevent the consequences of illegal abortions are needed.

  14. [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

  15. [Induced abortion in China: problems and interventions].

    PubMed

    Wu, Shang-chun; Qiu, Hong-yan

    2010-10-01

    Pooled literatures showed that the induced abortion in China faces many problems:the number of induced abortion remains large; most cases are young and nulliparity women; the frequency of abortion is high; and the interval between one and another abortion is short. Health promotion strategies should be applied to address these problems. It is important to increase the population's awareness of contraception,especially among nulliparity and migrant populations. Routine and effective contraceptive methods should be recommended and emphasized during induced abortion and delivery to lower the rate of induced abortion.

  16. Abortion applicants in Arkansas.

    PubMed

    Henker, F O

    1973-03-01

    The article reports upon the characteristics of 300 abortion applicants in Arkansas manifesting significant stress from unwanted pregnancy between May 1, 1970 and June 30, 1971. The sample is limited by the fact that all of these women had been willing to seek medical aid. Patients ranged from ages 13-47, 131 of them ages 17-21. 35% had had some college education; another 29% were high school graduates. 50.6%, 20.6%, and 27.3% were single, divorced, and married, respectively. 59.6% of the patients were primiparas. 18.3%, 9.6%, and 12.3% were classified as being neurotic, having psychophysiologic tendencies (gastrointestinal problems, obesity, chronic headaches), and having sociopathic features (passive-aggressive, frankly rebellious, delinquent, antisocial, alcoholic), respectively. 12 women had noticeable schizoid features; 4 women had mildly active schizophrenia. Fathers of the women were usually blue-collar workers (55.3%) or white-collar workers (24.6%). The most frequent ordinal sibling position among the women was oldest child (38%). Parental instability (1 or both parents lost through death, divorce, father usually away working, chronic alcoholism, etc.) was reported by 39.6% of the patients. Patients' attitudes toward the unwanted pregnancy included dislike of inexpediency of the situation (82.6%), self-depreciation (55.6%), and aversion (28.6%). Precipitated psychiatric disorders were for the greatest part mild. Manifesting symptoms included depression (66.7%), anxiety (21%), and mixed anxiety and depression (12.2%). Suicidal threats and gestures were made by 22 and 8 patients, respectively. In summary, the study reveals a group of predominantly Caucasian women from unstable, middle-class urban families who were going through an adjustment reaction to adolescence or adult life.

  17. 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.

  18. Commotio cordis: an underappreciated cause of sudden death in athletes.

    PubMed

    Lateef, F

    2000-10-01

    Over the last few years, the recognised cardiovascular risks of sporting activities have been extended to include cardiac arrest resulting from low-energy precordial chest impact produced by projectiles (e.g. baseball) or bodily contact, in the young, healthy and active athlete [also known as commotio cordis (CC)]. However, case reports of CC in European medical literature can be traced back for at least 130 years. CC accounts for a small, but important, subset of sudden death during sporting activities. It is a devastating electrophysiological event in the young athlete, and one which has generated considerable concern, both in the medical profession as well as in the public. The mechanism of sudden death appears to be caused by ventricular fibrillation, which occurs when the chest impact is delivered within a narrow, electrically vulnerable portion of the cardiac cycle, that is, during repolarisation, just before the peak of the T wave. Resuscitation of these victims is possible with prompt cardiopulmonary resuscitation and defibrillation. Preventive measures, such as the use of age-appropriate safety baseballs and suitably designed chest wall protection, may reduce the risk of sudden death and, thus, make the athletic field a safer place for young athletes.

  19. [Current concepts on sudden death].

    PubMed

    Asensio, Enrique; Narváez, René; Dorantes, Joel; Oseguera, Jorge; Orea, Arturo; Hernández, PabloR; Rebollar, Verónica; Mont, Lluís; Brugada, Josep

    2005-01-01

    Sudden death is defined as the death occurring less than one hour before the onset of the patient's symptoms. It is a severe condition considered a public health issue in several countries and in ours, it accounts for 33 000 to 53 000 annual deaths mainly related to ischemic heart disease. The main cause of sudden death are severe ventricular arrhythmias, but determining what patients are at risk for such an episode is complex, that is why risk stratification is usually a low cost-effective intervention. In the present study, we describe different sudden death risk-stratification strategies. Different sudden death treatment strategies regarding general population have different success rates in different countries, nevertheless, among select high risk populations; the best therapy currently available is the automatic implantable cardioverter-defibrillator. We also discuss other treatment options. In Mexico it is deemed necessary to do an important effort for the early detection, prevention and treatment of sudden death in order to limit the consequences of this problem. PMID:15892455

  20. 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...

  1. Abortion: the right to an argument.

    PubMed

    Meilaender, G

    1989-01-01

    Our moral puzzles about abortion will not be resolved by resort to compromise positions and adoption of middle ground, for abortion concerns how we understand ourselves as a people and how we define membership in this community. PMID:2606652

  2. Defining Sudden Infant Death and Sudden Intrauterine Unexpected Death Syndromes with Regard to Anatomo-Pathological Examination

    PubMed Central

    Ottaviani, Giulia

    2016-01-01

    Crib death, or sudden infant death syndrome (SIDS), is the most frequent form of death in the first year of life, striking one baby in every 1,700–2,000. Yet, despite advances in maternal–infant care, sudden intrauterine unexplained/unexpected death syndrome (SIUDS) has a sixfold to eightfold greater incidence than that of SIDS. Frequent congenital abnormalities, likely morphological substrates for SIDS–SIUDS, were detected, mainly represented by alterations of the cardiac conduction system, such as accessory pathways and abnormal resorptive degeneration, and hypoplasia/agenesis of the vital brainstem structures. On the basis of these considerations, the new common definition of the SIDS–SIUDS complex is “The sudden death of a fetus after the 25th gestational week or infant under one year of age which is unexpected by history and remains unexplained after a thorough case investigation, including examination of the death scene, performance of a general autopsy and examination of the fetal adnexa”. Therefore, given that the general autopsy does not disclose any cause of death, a more in-depth histopathological analysis of the cardiac conduction system and autonomic nervous system by specialized pathologists is necessary. PMID:27709109

  3. Roe v. Wade. On abortion.

    PubMed

    French, M

    1998-01-01

    In ancient Assyria, fathers held the right of life or death over their newborn infants, but women found to have performed an abortion on themselves or others were impaled and denied burial. This punishment was otherwise reserved for crimes against the state such as high treason or assault on the king. Likewise, in Babylon if a wife arranged her husband's death so that she could marry another man, she was convicted of treason and impaled or crucified. Thus, ancient thought paralleled the husband-wife relationship with that of the state-subject. The small group of men who generally dominate institutions such as the state, the church, or a corporation have a primary demand for obedience and deference to their supreme authority from their underlings. These groups did not condemn abortion because it involved questions of life or death. After all, many states have permitted infanticide, many still sanction execution, and all are willing to sacrifice the lives of their soldiers in war. Patriarchs condemn abortion because they consider it treasonous for a woman to assert the right to use her own judgement and to treat her body as if it were her own and not the property of her husband. This denies the supremacy of the male, which is the first principle of patriarchs. Because patriarchal institutions depend upon the subjection of women, women's bodies become important markers in the struggle for human freedom. This explains why patriarchal institutions in the US have continuously attacked women's right to abortion by fragmenting the statute allowing abortion and attempting to render the fragments illegal. While US women have won other rights that can be protected legally, women require the right to abortion in order to possess the right to physical integrity and to be able to undo what men have done to them. Otherwise, men would be able to create a set-back in women's human rights by forcing women into motherhood.

  4. 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.

  5. Heart-brain interactions in cardiac arrhythmia.

    PubMed

    Taggart, P; Critchley, H; Lambiase, P D

    2011-05-01

    This review examines current knowledge of the effects of higher brain centres and autonomic control loops on the heart with particular relevance to arrhythmogenesis. There is now substantial evidence that higher brain function (cortex), the brain stem and autonomic nerves affect cardiac electrophysiology and arrhythmia, and that these may function as an interactive system. The roles of mental stress and emotion in arrhythmogenesis and sudden cardiac death are no longer confined to the realms of anecdote. Advances in molecular cardiology have identified cardiac cellular ion channel mutations conferring vulnerability to arrhythmic death at the myocardial level. Indeed, specific channelopathies such as long QT syndrome and Brugada syndrome are selectively sensitive to either sympathetic or vagal stimulation. There is increasing evidence that afferent feedback from the heart to the higher centres may affect efferent input to the heart and modulate the cardiac electrophysiology. The new era of functional neuroimaging has identified the central neural circuitry in this brain-heart axis. Since precipitants of sudden fatal arrhythmia are frequently environmental and behavioural, central pathways translating stress into autonomic effects on the heart might be considered as therapeutic targets. These brain-heart interactions help explain the apparent randomness of sudden cardiac events and provide new insights into future novel therapies to prevent sudden death.

  6. SUICIDE, PSYCHIATRISTS AND THERAPEUTIC ABORTION.

    PubMed

    ROSENBERG, A J; SILVER, E

    1965-06-01

    Pressures for interruption of pregnancy by therapeutic abortion constantly increase, both for liberalization of laws and for interpreting existing law more broadly. There are wide variations and inconsistencies in psychiatric attitudes and practices about therapeutic abortion. Follow-up patient data are scant, but necessary. Results of questionnaires indicate that such data can be obtained, and convey the impression that patients seem to manage after pregnancy, regardless of outcome, much as they had before pregnancy. This study indicates that the incidence of suicide in pregnant women is approximately one-sixth that of the rate for non-pregnant women in comparable age groups, implying that perhaps pregnancy has a psychically protective role.

  7. Improving abortion care in Zambia.

    PubMed

    Bradley, J; Sikazwe, N; Healy, J

    1991-01-01

    In this commentary, the impact of the introduction of manual vacuum aspiration (MVA) for incomplete abortion patients and for early uterine evacuation is discussed for the University Teaching Hospital in Lusaka, Zambia. This 3-year training and service delivery program was begun in 1988 after it was clear that 15% of maternal deaths were due to illegally induced abortion. The prior procedure of dilation and curettage (D and C) required use of the main operating room and general anesthesia, which resulted in severe congestion and treatment delays. As a result of the new MVA procedure, congestion has decreased substantially, treatment is safer and more timely, and the staff's ability to provide abortions has increased. Family planning counseling is provided to postabortion patients in a more thorough fashion, and the savings in time has improved the quality of patient-staff interactions. Specifically, the patient flow has improved from a 12-hour wait to a 4-6 hour wait and rarely requires overnight hospitalization. The demand for the main operating room had decreased which frees space, time, and commodities for other gynecological treatment. The shorter procedure and release time means a minimal loss of earnings and productivity, and allows for greater privacy in explaining absences to families, schools, or employers. The improved quality of are is reflected in the figures for number treated, i.e., in 1989, 74% were treated with MVA for incomplete abortion 12 weeks and pregnancy termination 8 weeks compared with 26% treated with D and C. In 1990, the figures were 86% with MVA and 14% with D and C. The likelihood of complications from hemorrhage and sepsis have also been reduced. The MVA procedure is also less traumatic for the patient. The increased access to safe legal abortion services is reflected in the ratio of induced to incomplete abortions between 1988-1990 (1:25 to 1:5). Family planning counseling is provided by a full-time counselor who counsels preabortion

  8. Combatting the "partial-birth abortion" myth.

    PubMed

    1998-11-01

    Despite the efforts of pro-choice activists in the US to point out the critical differences between so-called "partial-birth abortions" and late-term abortions, the public remains confused about the issue. Proposed federal legislation banning "partial-birth abortions" excludes any language defining late-term abortions (time period or fetal viability). Thus, such a ban would apply to any abortion at any stage of pregnancy. Only the states of Kansas and Utah have passed legislation that limit the ban to late-term abortions. The term "partial-birth abortion" also has no independent meaning: it is not a medical term nor does it refer to a medical procedure. The correct term, "intact dilation and extraction," is never mentioned in most proposed legislation, much of which is written in broad enough language to outlaw all abortions. Most states that passed bans on "partial-birth abortions," in fact, had previously banned late-term abortions. In Georgia, a court order revised a "partial-birth abortion" law by limiting it to post-viability dilation and extraction and insisting on exceptions to protect the pregnant women's life and health. The courts have severely limited or enjoined "partial-birth abortion" legislation in 19 of the 20 states where challenges were mounted. Because an educated public overwhelmingly rejects the bans, reproductive rights activists are attempting to educate the public despite the inability or unwillingness of the media to make the crucial distinction. PMID:12294330

  9. Combatting the "partial-birth abortion" myth.

    PubMed

    1998-11-01

    Despite the efforts of pro-choice activists in the US to point out the critical differences between so-called "partial-birth abortions" and late-term abortions, the public remains confused about the issue. Proposed federal legislation banning "partial-birth abortions" excludes any language defining late-term abortions (time period or fetal viability). Thus, such a ban would apply to any abortion at any stage of pregnancy. Only the states of Kansas and Utah have passed legislation that limit the ban to late-term abortions. The term "partial-birth abortion" also has no independent meaning: it is not a medical term nor does it refer to a medical procedure. The correct term, "intact dilation and extraction," is never mentioned in most proposed legislation, much of which is written in broad enough language to outlaw all abortions. Most states that passed bans on "partial-birth abortions," in fact, had previously banned late-term abortions. In Georgia, a court order revised a "partial-birth abortion" law by limiting it to post-viability dilation and extraction and insisting on exceptions to protect the pregnant women's life and health. The courts have severely limited or enjoined "partial-birth abortion" legislation in 19 of the 20 states where challenges were mounted. Because an educated public overwhelmingly rejects the bans, reproductive rights activists are attempting to educate the public despite the inability or unwillingness of the media to make the crucial distinction.

  10. 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…

  11. [[Prevalence of induced abortion in Korea

    PubMed

    Lim, J; Lee, S; Bae, H

    1989-07-01

    The authors analyze recent trends in the prevalence of induced abortions in South Korea. They attempt to determine motivations for abortion, examine its side effects, and investigate the impact of induced abortions on infertility. The focus is on creating recommendations for population policy and maternal and child health care. Data are from the 1988 Korean National Fertility and Family Health Survey. (SUMMARY IN ENG)

  12. Abortion in Adolescence: The Ethical Dimension.

    ERIC Educational Resources Information Center

    Silber, Thomas

    1980-01-01

    This essay, addressed to medical personnel and counselors, presents a bioethical approach to adolescent abortion. Topics include an overview of abortion in the U.S., related medical issues, data pertinent to adolescent abortions, ethical theory, adolescent moral development, and moral aspects of treatment of adolescents. (Author/DB)

  13. 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…

  14. 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)

  15. Abortion: a legal and public health perspective.

    PubMed

    Kunins, H; Rosenfield, A

    1991-01-01

    Abortion is an issue of great public concern and debate. The majority of US citizens support a woman's right to choose, but it has not always been that way. Abortion was made legal in 1973 but women have been abortions for hundreds of years before that. The history of abortion is therefore a history of women breaking the law and subjecting themselves to great physical and social risk. Abortion law in the US has been changed mostly by the Supreme Court. After Roe v Wade (1973) there were many other cases brought before the Court involving federal and state funding of abortion, father's rights, parental consent for minors, and many other finer points of law and policy regarding abortion. Abortion is commonly practiced in many developing countries including the ones where it is illegal. The data collected from these countries gives researchers here a great deal of information on the clinical and sociological aspects of abortion. Medical technology has broadened the scope of abortion by introducing medication to induce abortion such as RU486. Abortion is no longer an exclusively surgical procedure. Since it can performed now with a pill it will be almost impossible to regulate it as strictly as before.

  16. Sociology and abortion: legacies and strategies.

    PubMed

    Imber, J B

    1979-11-01

    A survey essay sees the sociological view of abortion practice in 1979 appearing as a dense web of philosophical conundrums and at times violent political strategies; with abortion still not typically seen as 1 form of birth control among others. Attention is called to the variety of approaches to abortion in books and articles about its medical, demographic, religious, historical, political, philosophical, psychological, practical, and personal aspects. These include: James C. Mohr's Abortion in America: The Origins and Evolution of National Policy 1800-1900; Abortion, by Potts, Diggory, and Peel; Abortion in Psychosocial Perspective: Trends in Transnational Research, edited by Davis, Friedman, Van der Tak, and Seville; Linda Francke's The Ambivalence of Abortion; Mary K. Zimmerman's Passage Through Abortion: The Personal and Social Reality of Women's Experiences; Abortion Politics: The Hawaii Experience, by Steinhoff and Diamond; John Connery's Abortion: the Development of the Roman Catholic Perspective; Abortion: New Directions for Policy Studies, by Manier, Liu, and Solomon; and Harry Harris' Prenatal Diagnosis and Selective Abortion.

  17. 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 ...

  18. 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

  19. Sudden cardiac death in marathons: a systematic review.

    PubMed

    Waite, Oliver; Smith, Andy; Madge, Luke; Spring, Hannah; Noret, Nathalie

    2016-01-01

    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

  20. Benign cardiac tumours, malignant arrhythmias

    PubMed Central

    Myers, Kimberley A; Wong, Kenny K; Tipple, Marion; Sanatani, Shubhayan

    2010-01-01

    Four cases of pediatric cardiac tumours (PCTs) associated with ventricular arrhythmias are reported. Sudden cardiac death attributable to the tumour occurred in two children. A third child received an implantable cardioverter defibrillator and the fourth had persistent ventricular arrhythmia despite medical therapy. Most PCTs are considered benign; however, the development of malignant arrhythmias may complicate the management of these tumours in some patients. The literature regarding the arrhythmogenic potential of PCTs and the use of implantable cardioverter defibrillators in these patients is reviewed. The series highlights the deficiency of prognostic information for this cohort. PMID:20151061

  1. 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

  2. [The clinical condition and treatment of diseases associated with sudden death].

    PubMed

    Sawamura, Atsushi; Katabami, Ken-ichi; Ishimori, Naoki; Singu, Yasuei; Nakayama, Naoki

    2016-05-01

    The Hokkaido Medical Society is a group of doctors and medical researchers in Hokkaido. Its purpose is to contribute to medicine and to the improvement of medical treatment. This symposium was carried out in order to inform citizens about the condition known as sudden death. We hypothesize that the incidence of sudden death tends to increase in line with the incidence of metabolic syndrome. Approximately four hundred patients were transported to our hospital by ambulance in a state of cardiopulmonary arrest (CPA) last year. The number of CPA patients who are treated in our hospital has increased in comparison to the previous decade. The theme of this year is "The clinical condition and treatment of diseases associated with sudden death" in view of the above mentioned situation. In 2015, it was reported that sudden death occurred in an American pilot and that the co-pilot was forced to make an emergency landing. Interestingly, sudden death can ever sometimes occur in pilots who undergo regular physical examinations. Numerous diseases and conditions are associated with sudden death, including: acute myocardial infarction, irregular pulse, cardiac insufficiency, cerebrovascular disease, aortic dissection and choking. We are of the opinion that the frequency of sudden death is very high in the fields of emergency medicine, cardiovascular medicine, cardiovascular surgery and neurosurgery. In this symposium, we presented and explained the condition that is known as sudden death and the current state of treatment of sudden death in emergency medicine, cardiovascular medicine, cardiovascular surgery and neurosurgery departments of the Hokkaido University Graduate School of Medicine in October, 2015. We hope that the symposium will help the citizen audience to understand the condition and treatment of sudden death, and also to help prevent sudden death.

  3. 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…

  4. Investigating Insight as Sudden Learning

    ERIC Educational Resources Information Center

    Ash, Ivan K.; Jee, Benjamin D.; Wiley, Jennifer

    2012-01-01

    Gestalt psychologists proposed two distinct learning mechanisms. Associative learning occurs gradually through the repeated co-occurrence of external stimuli or memories. Insight learning occurs suddenly when people discover new relationships within their prior knowledge as a result of reasoning or problem solving processes that re-organize or…

  5. A request for an abortion.

    PubMed

    Walker, A; Marsden, S; Rubin, P

    1990-12-01

    How to manage to abortion request by a hypothetical 30-year old married woman who states the she fears a deformed child because of taking an antibiotic combination, cotrimoxazole, containing trimethoprim is discussed by 3 physicians. The 1st doctor would confirm pregnancy with an exam and a laboratory test, schedule another consultation for counseling, and schedule a pelvic ultrasound if she decides to carry the pregnancy. If she wants an abortion, the physician would counsel her at length about her marriage and the emotional consequences of abortion. The 2nd physician would advise her that fetal abnormality from trimethoprim has not been reported in women. Since this doctor is personally opposed to abortion, she would refer the patient to another doctor to make the arrangements, and counsel her again afterward. The 3rd physician added the advice that 1-2% of all U.K. births are abnormal in some way. He would take steps to establish the precise gestational date, recommend an ultrasound scan at 18 weeks to cover himself legally and suggest that the patient's husband join in the counseling session to help bring out feelings about the marriage and the pregnancy.

  6. Abortion, infanticide and moral context.

    PubMed

    Porter, Lindsey

    2013-05-01

    In 'After-birth abortion: why should the baby live?', Giubilini and Minerva argue that infanticide should be permitted for the same reasons as abortion. In particular, they argue that infanticide should be permitted even for reasons that do not primarily serve the interests (or would-be best interests) of the newborn. They claim that abortion is permissible for reasons that do not primarily serve the interests (or would-be interests) of the fetus because fetuses lack a right to life. They argue that newborns also lack a right to life, and they conclude that therefore, the same reasons that justify abortion can justify infanticide. This conclusion does not follow. The lack of a right to life is not decisive. Furthermore, the justificatory power of a given reason is a function of moral context. Generalisations about reasons across dissimilar moral contexts are invalid. However, a similar conclusion does follow-that fetus-killing and newborn-killing are morally identical in identical moral contexts-but this conclusion is trivial, since fetuses and newborns are never in identical moral contexts.

  7. Abortion, infanticide and moral context.

    PubMed

    Porter, Lindsey

    2013-05-01

    In 'After-birth abortion: why should the baby live?', Giubilini and Minerva argue that infanticide should be permitted for the same reasons as abortion. In particular, they argue that infanticide should be permitted even for reasons that do not primarily serve the interests (or would-be best interests) of the newborn. They claim that abortion is permissible for reasons that do not primarily serve the interests (or would-be interests) of the fetus because fetuses lack a right to life. They argue that newborns also lack a right to life, and they conclude that therefore, the same reasons that justify abortion can justify infanticide. This conclusion does not follow. The lack of a right to life is not decisive. Furthermore, the justificatory power of a given reason is a function of moral context. Generalisations about reasons across dissimilar moral contexts are invalid. However, a similar conclusion does follow-that fetus-killing and newborn-killing are morally identical in identical moral contexts-but this conclusion is trivial, since fetuses and newborns are never in identical moral contexts. PMID:23637451

  8. Mifepristone and first trimester abortion.

    PubMed

    Murray, S; Muse, K

    1996-06-01

    The development of safe, effective, nonsurgical methods of pregnancy termination has the potential to avert significant maternal mortality and morbidity, especially in developing countries. RU-486 blocks the action of progesterone and cortisol, leading to structural changes in the endothelium of decidual capillaries, decidual necrosis, and subsequent detachment of the products of conception. When RU-486 is administered in conjunction with a low dose of a prostaglandin such as misoprostol, the abortion rate is comparable to that for vacuum aspiration (e.g., 94-96%). This regimen is contraindicated, however, in women aged 35 years and older, smokers, and those with medical problems such as diabetes, hypertension, clotting disorders, or anemia. In countries with strict abortion laws, RU-486 has been used to induce menstrual bleeding in women whose periods are delayed up to 10 days. An obstacle to more widespread acceptance of RU-486 has been its medicalization through national guidelines that stipulate waiting periods or require multiple visits to an approved abortion clinic. Women are likely to prefer RU-486 over surgical abortion because it allows the patient more control over her pregnancy termination and is less invasive. As political controversy continues to delay RU-486's introduction to the US and most developing countries, there are concerns that the drug will become a black market commodity used for self-induction.

  9. 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

  10. 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.

  11. 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.

  12. 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

  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.

  14. 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

  15. Sudden sensorineural hearing loss after non-otologic surgery.

    PubMed

    Page, Joshua Cody; Peters, Bob

    2015-01-01

    Sudden sensorineural hearing loss following non-otologic surgery is a rare event described in the medical literature. Cardiopulmonary bypass surgery is most commonly associated with this type of hearing loss. Our case report and review of the literature describe two cases with postoperative hearing loss - neither of which are cardiac surgeries - making them exceedingly rare in the medical literature. Regardless of the rarity of this unfortunate event, the possibility for permanent hearing loss is a potentially devastating unanticipated complication and one that all surgeons should be aware.

  16. Living after sudden death: A case report of Naxos disease.

    PubMed

    Noain, Jose Alberto Garcia; Golet, Amparo Cantin; Calzada, Jorge Navarro; Mellado, Ascension Muñoz; Duarte, Julian Mozota

    2012-10-01

    Naxos disease is a recessive inherited condition with arrhythmogenic right ventricular dysplasia (ARVD) and a peculiar cutaneous phenotype (woolly hair and a palmoplantar keratoderma). Woolly hair appears from birth, palmoplantar keratoderma develops during childhood and cardiomyopathy is clinically manifested by adolescence. Patients present with syncope, sustained ventricular tachycardia or sudden death. We report a case of a 14 year old boy from Spain, who was admitted into our emergency room after being resuscitated from cardiac arrest, secondary to malignant ventricular tachycardia that developed while he was playing basketball.

  17. 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

  18. [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

  19. Orientations toward abortion: guilty or knowledge?

    PubMed

    Allgeier, A R; Allgeier, E R; Rywick, T

    1981-01-01

    Students (N = 118) were classified as pro-choice, anti-abortion, or mixed on the basis of their responses to ten fictitious case histories of females who requested abortion. The distribution of participants on the abortion issue was quite similar to the results of a 1979 national survey. As expected, these groups differed on attitudes toward abortion as murder, the legalization of abortion, and the morality of premarital sex. The groups differed significantly in levels of sex guilt, but did not exhibit significant differences in levels of sexual knowledge. The results were discussed within the context of the public controversy over abortion. It was suggested that the affective messages accompanying the sexual socialization of children and adolescents may be more predictive of orientations toward abortion than the weight of intellectual arguments regarding the rights of the fetus, the point at which a fetus becomes viable, or a woman's right to have control over her own body.

  20. Induced abortion--a global health problem.

    PubMed

    Odlind, V

    1997-01-01

    Every year around 500,000 women are estimated to die from pregnancy-related causes, the majority in the developing world and many as a consequence of unsafe abortion. Around 25 per cent of maternal deaths in Asia and 30-50 per cent of maternal deaths in Africa and Latin America occur as a result of induced abortion. Data on abortion related maternal morbidity is less reliable than mortality but suggests that for every maternal death 10-15 women suffer significant pregnancy-related morbidity, i.e. infertility, genito-urinary problems and/or chronic pain. Induced abortion occurs in practically every society in the world but only 40 per cent of the women in the world live in countries where abortion is legally free. A permissive legislation is an important prerequisite for medically safe and early abortion. Oppositely, with a restrictive law, abortion is difficult to obtain, costly and possibly unsafe, in particular to the least affluent women in the society. Induced abortion in a developed country with legal and easy access to services is a safe procedure with hardly any mortality and very low morbidity. The best strategy to reduce the number of unsafe abortions is prevention of unwanted pregnancy. The consequences of unsafe abortion on women's health need to be acknowledged by everybody in the society in order to improve abortion care. It is necessary to adjust legal and other barriers to medically safe abortion in order to follow the declaration at the UN conference on population in Cairo, 1994, which stated that abortion, wherever legal, should be safe. It is also necessary to introduce preventive measures where abortions are performed, i.e. good and easily accessible family planning services.

  1. Serotonin in the sudden infant death syndrome.

    PubMed

    Waters, Karen

    2010-11-01

    It seems likely that some infants who die from sudden infant death syndrome (SIDS) have a brainstem abnormality of the serotonergic system. Evidence suggests that infants who died from SIDS had defective respiratory and/or autonomic responses that led to death instead of recovery after an acute insult. The serotonergic neuromodulator system has roles in the control of cardiac autonomic and respiratory function, as well as now being identified as abnormal in infants with SIDS. This manuscript reviews the multiple roles of serotonin with reference to the functional aspects of the relevant brain regions. Correlations with pre- or postnatal exposure to stressors, or an underlying genetic process are also reviewed. Together, these studies indicate that perturbed function of the serotonin system will have significant physiological impact during early development. Understanding the functional importance of these systems assists understanding of the pathogenesis of SIDS. In conclusion, whether an infant inherits serotonergic defects and is therefore "inherently vulnerable", or whether postnatal stressors can induce the abnormalities, any functional abnormalities of the serotonergic system that result are likely to be subclinical in the majority of cases and not easily detected with current medical tools. PMID:21152449

  2. [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

  3. Cardiac arrest

    MedlinePlus

    ... Article.jsp. Accessed June 16, 2014. Myerburg RJ, Castellanos A. Approach to cardiac arrest and life-threatening ... PA: Elsevier Saunders; 2011:chap 63. Myerburg RJ, Castellanos A. Cardiac arrest and audden aardiac death. In: ...

  4. Sudden gains in behavioural activation for depression.

    PubMed

    Masterson, Ciara; Ekers, David; Gilbody, Simon; Richards, David; Toner-Clewes, Benjamin; McMillan, Dean

    2014-09-01

    Sudden gains have been linked to improved outcomes in cognitive behaviour therapy for depression. The relationship between sudden gains and outcome is less clear in other treatment modalities, including interpersonal psychotherapy and supportive expressive therapy, which may indicate different mechanisms of change between treatment modalities. The current study examined sudden gains in adults meeting diagnostic criteria for depression (N = 40) offered up to 12 sessions of behavioural activation treatment. Sudden gains were found in 42.5% of the sample. Sudden gains occurred early (median pre-gain session 2) and were related to outcome: those who experienced a sudden gain had significantly lower post-treatment scores on the PHQ-9. Furthermore, the proportion meeting the reliable and clinically significant change criteria at end of treatment was higher in the sudden gain group. These findings highlight the importance of understanding the mechanisms by which sudden gains relate to therapy outcome in behavioural activation.

  5. 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)

  6. [Therapeutic abortion: a difficult choice].

    PubMed

    Gratton-Jacob, F

    1981-01-01

    Because the primary responsibility for the care and raising of children still falls on women, they should be able to decide freely whether or not to have children. Although many women who do not initially desire their pregnancies turn out to be adequate mothers, studies have shown that unwanted children suffer disproportionately from a variety of emotional and behavioral disorders. Studies have also found that large numbers of women seeking abortions failed to use any contraception while others used less effective methods, sometimes because of lack of knowledge. Even the most reliable contraceptive methods are liable to occasional failures. According to some authors, undesired pregnancy many reflect a struggle of adolescents with authoritarian parents, the search of a lonely person for something to love or possess, a proof of femininity, an expression of conflict with the partner or an attempt to force a marriage, or ambivalence among middle-aged women at the prospect of becoming more independent when their children enter school. Women may obtain abortions at accredited hospitals in the Province of Quebec upon decision of a committee of 3 physicians that continuation of the pregnancy would result in danger to the life or health of the patient. In 1970 some 100-150,000 illegal abortions occurred, resulting in hospitalization of 20,000 women for complications. In 1972, 4 French-speaking hospitals performed 136 of the 2919 therapeutic abortions sought in the Province of Quebec. In recent years the number has increased. Reasons for obtaining an abortion are usually social or economic: poor relationship with the father, sufficient number of children already born, age of the preceding infant, economic difficulties, mother's age, or effect of pregnancy on work. Many adolescents refuse to tell their parents of their pregnancy for fear of their reaction, but others enjoy considerable parental support. A study of about 5000 French speaking adolescents conducted in 1977

  7. 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

  8. Sudden hearing loss in children.

    PubMed

    Ječmenica, Jovana; Bajec-Opančina, Aleksandra

    2014-08-01

    Sudden sensorineural hearing loss (SSHL) is defined as a 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 very rare in children. Sudden hearing loss is a symptom that suggests that there is a problem in the inner ear, surrounding structures, or the whole organism. The etiology and development of this disorder are still not fully understood. The literature contains numerous models of the pathogenesis of SSHL, with childhood SSHL having certain peculiarities. In practical terms, the multifactorial nature of SSHL is important in the choice of diagnostic methods and treatment methods. It is important to determine the cause and effect relationship between the underlying disease and hearing loss.

  9. 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

  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.

  12. 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

  13. 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.

  14. Benign cardiac tumors and tumorlike conditions.

    PubMed

    Jain, Deepali; Maleszewski, Joseph J; Halushka, Marc K

    2010-06-01

    Benign primary cardiac tumors and tumorlike conditions are rare, yet important surgical and autopsy pathology specimens. Although many of these entities are clinically silent, a few can cause significant morbidity or even sudden death. Some cardiac tumors arise in the setting of genetic disorders. Providing the correct diagnosis for a cardiac mass lesion will aid in patient care and genetic counseling. Therefore, a familiarity of these tumors is essential for both surgical and forensic pathologists. This comprehensive and up-to-date review describes the key clinical, gross, and histologic findings for 16 distinct entities. It also provides differential diagnoses and key facts to differentiate between similar appearing tumors. PMID:20471569

  15. Birth Control, Sterilization and Abortion

    PubMed Central

    Schneiderman, Lawrence J.; Prichard, Lorraine; Fuller, Scott; Atkinson, Leslie

    1974-01-01

    A questionnaire comprising case histories was administered to 27 Protestant and 27 Catholic clergymen in the San Diego area to test their attitudes toward the use of birth control, sterilization and abortion in families with specific genetic problems. The responses indicated: • Catholic and Protestant clergymen do not always follow the official positions of their churches in these matters, although the majority of them do. • Protestant clergymen were more likely to approve of birth control, sterilization, and abortion than Catholic clergymen. • The approval responses of Protestant and Catholic clergymen were not greatly influenced by whether the illness variables involved high Mendelian risk, high psychological cost, high social cost, or poor prognosis. • The approval responses of Protestant and Catholic clergymen were not significantly influenced by the socio-ethnic background of the families. PMID:4813802

  16. 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.

  17. 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.

  18. 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,…

  19. [Abortions and prevention of pregnancies in 1992].

    PubMed

    Helweg-Larsen, K; Wichmann, B

    1994-03-01

    In January 1994, the Health Service published its statistics about pregnancy prevention and abortion in 1991 and 1992. The number of legal abortions was 19,729 in 1991 and 18,833 in 1992, which was the lowest figure since the law was introduced about elective abortion in 1973. 2623 fewer abortions were carried out in 1992 than five years before. The general abortion rate decreased from 15.8 in 1990 to 14.9 in 1992 (it was the highest in 1975 with 23.7). The age-specific abortion rate fell mostly in the 18-29 age group, with fewer in the 15-19 and 30-34 age groups. The number of children who were born to women over 40 increased from 390 in 1982 to 864 in 1992, while the birth rate of women under 20 decreased to almost half. The abortion rate was the highest in large cities, it was about 2.5 times higher than in the county of Ringkobing, which had the lowest rate, especially in the age groups under 25 years. The combined abortion rate (per 1000 women of reproductive age) was 578 in 1982, 540 in 1990, and 505 in 1992. 97.5% of abortions were performed within 12 weeks of pregnancy in accordance with the abortion law. 2% of abortions were carried out because of the woman's health or for social indications. 80% of abortions were performed in the 10th week of pregnancy mostly with vacuum aspiration. Complications decreased compared to previous years, and made up 2.6% of all abortions in 1992, mainly bleeding and, for 1/5 of them, inflammatory conditions. Half of the women who underwent an abortion in 1992 had given birth to at least one living child, 8% to more than three. Half of the 20% of women who could given birth but chose abortion had given birth in the previous two years and 27% within less than a year before abortion. The number of spontaneous abortions was 10,717 in 1991 and 10,605 in 1992, about 1000 fewer than in 1990. The number of male sterilizations fell from 2784 in 1991 to 1722 in 1992, and female sterilizations from 4777 to 4429. About 13 million condoms

  20. [Abortion. Spain: the keys to the controversy].

    PubMed

    1983-01-01

    For many years, illegal abortion has been denounced in Spain. The estimate of 300,000 abortions annually is widely quoted but poorly founded in fact. Weekend "charters" to London and Amsterdam for women seeking abortions have been commented upon, denounced, and caricatured. The evidence indicates that abortions occur in Spain despite their illegality, just as they occur in every other country and have always occurred. Poor women abort in a poor way, with traditional healers, while rich women abort in a rich way, with physicians. "Charters" are the solution of the middle class. Proposed legislation in Spain would permit abortion on 3 grounds: rape, fetal malformation, and risk to the woman's life if the pregnancy continued. Excesses have been committed both by those opposing abortion and by those struggling for liberalization of laws. Defenders of abortion, such as radical feminists, appear to forget that abortion is a medical procedure with possible dangerous psychophysical consequences, and that preventive measures such as sex education and diffusion of contraception or social measures such as assistance for unwed mothers and their children would be preferrable to abortion. There is the question of whether medical personnel should be excused from assisting in abortions on grounds of conscience and whether those who do assist in abortions automatically become "progressive" by doing so. The staunchest defenders of fetal life are not moved to contribute anything beyond words to improvement of the plight of the many millions of already born who live in miserable conditions of hunger and want. Abortion is a violent act against the fetus and the pregnant woman. Its criminalization is a violent act against the woman and a social intrusion into matters better left to personal ethics. The government which proposes abortion on a few grounds fails to initiate a program to promote life through social protection of single mothers and their children or of families in general